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A 57-year-old man who manages his own accounting firm has a 5-year history of malignant melanoma | 一位经营自己会计师事务所的 57 岁男性，有 5 年的恶性黑色素瘤病史，
that has been treated with local excision and immunotherapy. | 曾接受过局部切除和免疫治疗。
He now is admitted to the hospital for evaluation of constant pain in his back and left hip | 他现在住院以评估背部和左髋部的持续疼痛，
and an 11-kilogram or 24-pound weight loss. | 以及 11 公斤（24 磅）的体重减轻。
He and his wife of 35 years are worried that the cancer may be back. | 他和结婚 35 年的妻子担心癌症可能复发了。
Pelvic and abdominal CT scans show multiple bony metastases. | 盆腔和腹部 CT 扫描显示多处骨转移。
He tells you, I just want to die. I can't bear this. | 他告诉你，“我只想死。我受不了了。”
Which of the following is the most appropriate initial intervention? | 以下哪项是最合适的初始干预措施？
A. Adjust his analgesic regimen. | A. 调整他的止痛方案。
B. Arrange for him to be transferred to a psychiatric service. | B. 安排将他转至精神科。
C. Begin antidepressant medication. | C. 开始服用抗抑郁药物。
D. Initiate hyperalimentation. | D. 开始高营养治疗（全静脉营养）。
E. Refer him to a cancer patient support group. | E. 推荐他参加癌症患者支持小组。
So for this personally, we see this guy, the melanoma seems to spread | 就我个人而言，我们看到这个人，黑色素瘤似乎已经扩散了，
and he just has constant pain and he says, I can't bear this, right? | 他一直处于持续的疼痛中，并说 “我受不了了”，对吧？
So let's maybe fix his pain. | 所以，我们也许应该先解决他的疼痛。
So I'm going to go with option A here. Adjust his analgesic regimen. | 所以我选 A。调整他的止痛方案。
This guy does not seem to have any psychiatric problems, right? | 这家伙似乎没有任何精神问题，对吧？
Fix the pain first. | 先解决疼痛。
If he's still having this, I just want to die. | 如果他在疼痛得到控制后，
If he's still having this type attitude, you know, after the pain has been taken care of, | 仍然有这种 “我只想死” 的态度，
then maybe you want to, you know, refer him for like some psych thing, right? | 那么你可能想把他转诊到精神科，对吧？
But I think option A is the best answer here. | 但我认为选项 A 是这里的最佳答案。
Again, antidepressant medication, it does not meet the 5 out of 9 CIGICAPS criteria for depression. | 再说抗抑郁药，他并不符合抑郁症 SIGECAPS 标准中 9 项中的 5 项。
Hyperalimentation is for weight loss, but this guy can probably eat just fine. | 高营养治疗是针对体重减轻的，但这个人可能吃得还行。
And then cancer patient support group. No, fix the pain, right? | 至于癌症患者支持小组。不，先解决疼痛，对吧？
That's the problem that is propounded in the question. | 那是题目中提出的核心问题。
All right, question 48 says, | 好了，第 48 题说，
So for this, anorexia, can it be linked to the cancer? | 那么对于这个，食欲不振，它是否与癌症有关？
Yeah, cancer makes people cachectic, makes people not want to eat, right? | 是的，癌症会让患者出现恶病质，让人不想吃东西，对吧？
So I don't think I would chalk that up to a major depressive syndrome in the patient, right? | 所以我不认为我会把它归咎于患者的重度抑郁综合征，对吧？
Expressions of discouragement. | 气馁的表现。
Right. Could it be linked to the cancer? | 对。它可能与癌症有关吗？
Yeah, it could. It could. But I guess let's keep that. | 是的，有可能。有可能。但我想我们先保留这个选项。
Although, yeah, it could. Although expressions of discouragement, right? | 虽然，是的，它有可能。尽管气馁的表现，对吧？
It could be linked to the cancer, but it could also be a sign of major depressive syndrome. | 它可能与癌症有关，但也可能是重度抑郁综合征的征兆。
C says insomnia. | C 选项是失眠。
Well, the person has cancer. The person is in a lot of pain. | 嗯，这个人患有癌症。这个人非常痛苦。
Could that be attributed to the cancer? | 这能归因于癌症吗？
Yes, it could, right? | 是的，可以，对吧？
So I don't know if I would say that that's most suggestive of a major depressive syndrome. | 所以我不知道我是否会说那是重度抑郁综合征最典型的表现。
D, low energy. | D，缺乏活力。
Low energy can definitely be from the cancer, right? | 缺乏活力绝对可以源于癌症，对吧？
So again, it could be from depression, but it could be from the cancer. | 所以，它可能源于抑郁，但也可能源于癌症。
So it's probably not most suggestive, right? | 所以它可能不是最具有暗示性的，对吧？
It's just not as specific. | 它只是不够特异。
And then option E says withdrawal from family. | 然后选项 E 是疏远家人。
I think I'll take that one, right? | 我想我会选这一个，对吧？
Withdrawal from family, right? | 疏远家人，对吧？
Withdrawing from your family is not as a result of the cancer, right? | 疏远你的家人通常不是癌症直接导致的结果，对吧？
It can be a result. Basically, that's anhedonia, right? | 它可能是一个结果。基本上，那就是兴趣缺失（anhedonia），对吧？
So like, you know, you want to hang with your family, right? | 就像，你知道，你原本是想和家人待在一起的。
