A 67-year-old man presents with insomnia, irritability, and palpitations for 3 months. He is known to have hypertension, depression, and atrial fibrillation. He is on amiodarone, f... A 67-year-old man presents with insomnia, irritability, and palpitations for 3 months. He is known to have hypertension, depression, and atrial fibrillation. He is on amiodarone, fluoxetine, and enalapril. Clinically, he is unremarkable: Blood pressure 130/70 mmHg, Heart rate 76/min, Oxygen saturation 95%. Which of the following is the most appropriate next step? A. Add propranolol B. Measure thyroxine level and TSH C. Substitution of antidepressant drug D. Refer him for psychiatric assessment
Understand the Problem
The question is asking which medical step should be taken next for a patient with a history of hypertension, depression, and atrial fibrillation who is experiencing insomnia, irritability, and palpitations. The context implies it is a clinical decision-making scenario.
Answer
Measure thyroxine level and TSH.
The most appropriate next step is to measure thyroxine level and TSH.
Answer for screen readers
The most appropriate next step is to measure thyroxine level and TSH.
More Information
Amiodarone can cause both hyperthyroidism and hypothyroidism due to its high iodine content, making thyroid function tests crucial in this context.
Tips
A common mistake is to overlook medication side effects as the cause of symptoms, so always consider drug interactions and side effects.
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