54-year-old man with weight gain and muscle weakness

Review of Systems

  • General: 10-kg weight gain despite no change in appetite. Complains of increased thirst and urination; no fever.

  • Skin: Recent onset acne on the upper back, new stretch marks on the lower abdomen, mild chronic pruritus.

  • HEENT: Noncontributory

  • Pulmonary: Mild exertional shortness of breath, no cough.

  • Cardiovascular: Occasional left-sided chest pain on exertion that resolves at rest; no palpitations.

  • Gastrointestinal: No nausea or vomiting, bowel movement once daily with normal stool.

  • Genitourinary: Noncontributory

  • Musculoskeletal: Bilateral painless leg swelling

  • Neurologic: Patient complains of worsening short-term memory for the past month or two; he forgot his doctor appointment twice recently. Also notes bilateral leg weakness especially noted when standing up from sitting or climbing stairs. No headaches, visual symptoms or sensory changes.

  • Psychiatric: Low mood for the past 2 months with no significant change since starting citalopram. He is asking you to authorize 2-weeks of sick leave as he struggles at work due to poor concentration.