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Unexplained Weight Loss — RACP Adult Medicine MCQ

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ModerateGeneral Internal MedicineUnexplained Weight LossRACP Adult Medicine

A 70-year-old man presents with unintentional weight loss of 12 kg over 6 months, anorexia, and fatigue. Physical examination, blood tests (including tumour markers), CT chest/abdomen/pelvis, upper and lower GI endoscopy, and PET-CT are all unremarkable. What is the next most important consideration?

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Correct answer: D — Consider psychiatric assessment for depression

When comprehensive investigation for unexplained weight loss (malignancy, infection, endocrine, GI, chronic disease) is negative, depression and other psychiatric/psychosocial causes should be strongly considered. Depression is one of the most common causes of unexplained weight loss in elderly patients (along with malignancy and GI disease – forming the top 3). A formal psychiatric assessment, geriatric depression scale, and functional assessment are appropriate. Social isolation, bereavement, dental problems, medication side effects, and early dementia should also be explored. If no cause is found after thorough evaluation, close follow-up with repeat assessment at 3–6 months is recommended.

Reference: eTG – 2025 – General Internal Medicine