Approach to unintentional weight loss Quiz: Ace Your Exams
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An 85-year-old man presents to the primary care clinic to discuss concerns about his weight. Over the past year, the patient has unintentionally lost 15 lb. (6.8 kg). He has not started any new medication. He has no fevers, chills, night sweats, insomnia, or anhedonia. The patient has a bowel movement daily and frequently has two loose bowel movements per week. His past medical history is significant for chronic kidney disease stage 1 and well-controlled major depressive disorder. Current medication includes citalopram and multivitamins. The patient lives in an apartment attached to the home of his daughter and her family, whom he sees often. Vital signs are within normal limits. His current weight is 142 lb. (64.4 kg). On physical examination, the patient has temporal wasting and poor extremity muscle mass. He has dentures in place which fall out of his mouth several times during the exam. Thyroid-stimulating hormone (TSH) is 0.35 µU/mL and free T4 is 1.4 ng/dL. Which of the following elements is the most probable cause of this patient’s unintentional weight loss?
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