Quiz: Ace Your Exams
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A 40-year-old woman comes to the office because of fatigue and muscle aches for the past three days. The patient says, “I rarely have to use a sick day at work, but today I had to excuse myself. My nose won't stop running, and I'm having the worst headache of my life. I don't feel like talking to anyone and have to use the restroom every hour.” The patient reports difficulty sleeping and felt warm last night. Past medical history is significant for major depressive disorder and hyperlipidemia. Current medications include atorvastatin and paroxetine. She did not pick up the refill for her scheduled medications five days ago because she lacked transportation. Family history is noncontributory. She drinks alcohol occasionally on weekends; her last drink was two weeks ago. Her temperature is 37.6 C (99.8 F), pulse is 88/min, respirations are 17/min, and blood pressure is 130/75 mm Hg. Physical examination shows a restless woman with clear nasal discharge and normal nasopharyngeal mucosa. Her cardiopulmonary examination is within normal limits. Neurological examination shows mild bilateral tremors of both hands without focal neurological deficits. Which of the following is the most likely cause of this patient’s symptoms?
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