View source for WBR1137

 {{WBRQuestion
|QuestionAuthor= {{PB}}
|ExamType=USMLE Step 2 CK
|MainCategory=Psychiatry
|SubCategory=Psychiatry, Ethics
|MainCategory=Psychiatry
|SubCategory=Psychiatry, Ethics
|MainCategory=Psychiatry
|SubCategory=Psychiatry, Ethics
|MainCategory=Psychiatry
|MainCategory=Psychiatry
|SubCategory=Psychiatry, Ethics
|MainCategory=Psychiatry
|SubCategory=Psychiatry, Ethics
|MainCategory=Psychiatry
|SubCategory=Psychiatry, Ethics
|MainCategory=Psychiatry
|SubCategory=Psychiatry, Ethics
|MainCategory=Psychiatry
|MainCategory=Psychiatry
|SubCategory=Psychiatry, Ethics
|Prompt=36 year old man comes to a primary care doctor, with complains of depressed mood and loss of interest from last 7 months when he lost his wife in a car accident.  On examinations, his vitals were stable and lab reports were,
*Hb 14
*AST 12 U/L
*ALT 14 U/L
*ALP 15 U/L
*Total bilirubin 0.6 mg/dl
*BUN 14 mg/dL
The dexamethasone suppression test did not reveal an adrenal axis pathology, also TSH was normal.  His mood brightened when he learns about positive events. He had a 20 pound weight gain in last 6 months and sleeping 10 hours a day.  Also, he described a heavy feeling in his arms and legs. What is the next step in the management?
|Explanation=This a case of atypical depression, it is treated by MAOIs.
|AnswerA=Prescribe Selegiline
|AnswerAExp=This a case of atypical depression, it is treated by MAOIs.
|AnswerB=Prescribe Doxepine
|AnswerBExp=MAOIs not Doxepine is first line treatment for atypical depression.
|AnswerC=Prescribe Lithium
|AnswerCExp=Lithium is a mood stabilizer, this patient does not have features of bipolar disorder.
|AnswerD=Prescribe Risperidone
|AnswerDExp=Risperidone is an antipsychotic, not used in the treatment of atypical depression.
|AnswerE=Prescribe Buspirone
|AnswerEExp=Buspirone is useful for treating depression with features of anxiety. 
|References=pg 510 MTB-CK
|RightAnswer=A
|Approved=No
}}