12/21/17 Inspira Conference Quiz

A 52-year-old male presents with depression over two weeks. Which of the following is a finding most concerning for risk of suicide?

A 21 year old woman presents to your ER demanding medications for her anxiety. She has been to 3 other doctors and she reports that they are ‘the worst.’ She states that for the last 4 years she has had intermittent anxiety and depression, even a few suicidal gestures. She looks at you and says she can tell you are a much better doctor than anyone she has seen before. On social history you discover that she has a pattern of impulsive and self-defeating behaviors as well as sexual promiscuity. Which of the following is the most likely diagnosis?

A mother brings her 5-week old daughter to the emergency department for "trouble sleeping." The infants vitals and exam are unremarkable, but the mother breaks down into tears and confesses she has not been able to sleep for over two weeks, despite feeling incredibly tired. She does not even enjoy caring for her new baby or showing him to family. She feels she is too tired to enjoy anything any more. She is suffering from what disorder?

An 18-year-old male is brought to the ED for evaluation. His mother reports a year of alternating episodes of depression and mania. Currently, he has not slept for a week because he stays-up all night editing a screenplay for Steven Spielberg. His mother reports that her son has never been employed by Mr. Spielberg. On examination the patient is noted to have pressured speech, flight of ideas, and psychomotor agitation. Based on these symptoms, what is the best treatment for this patient?

A 30 year old male is brought to the emergency department by EMS and police with disruptive behavior. EMS reports that he was evicted from his apartment today because he was shouting loudly and behaving violently. He has medical history of schizophrenia. He has no known drug allergies. On examination his vital signs are within the normal limits and he is agitated, unable to focus on commands, is muffling his ears while yelling at "the voices," and is pacing. What is the most appropriate initial management plan of this patient?

A 32 yo male presents to your ED with his long-time girlfriend. She is concerned about changes in his behavior over the past several months, in particular, at times she feels that he is reacting to voices that she cannot hear. They use marijuana recreationally and he drinks alcohol 1-2 times per week. His vital signs are HR 84bpm, BP 124/78, RR 12, Sat 99% on RA and afebrile. On exam, he appears to be responding to internal stimuli, is difficult to engage in conversation but is otherwise unremarkable. Which of the following factors support a functional psychosis in this patient?

A 70-year-old female is brought in to the Emergency Department by her family for altered mental status. She has a history of dementia, however the family is endorsing a significant change over the past several days. Vital signs are grossly normal. On exam, the patient is agitated and appears to be responding to visual hallucinations. Which of the following is the most likely diagnosis?

A 29 year old man is brought to the emergency room by the police for a blood alcohol level check. The patient was arrested under the suspicion of drunk driving after having run a red light and striking another vehicle. He refused a breathalyzer and is verbally abusive with staff. He appears to have no remorse regarding injuring the driver of the other vehicle. Upon further questioning he states that alcohol is not really a problem for him and he can quit at any time. He denies feeling anxious or jittery whenever he has chosen to reduce his level of intake. He has had 1 other DUI in the past and feels like he is being targeted by the police. The patient endorses drinking tonight after being fired from his second job in six months. He believes he was really fired because his boss was a ‘jerk.’ He reports drinking only a few beers every other day during the week, but will drink up to 20 drinks over the weekend and has done this for 8 years. The patient has also been arrested twice for assault and spent a portion of his youth in juvenile hall for violent behavior. What is the most likely diagnosis?

An 18-year-old, previously healthy male, is brought in the Emergency Department by his parents who state that for the past 4 days their son has been acting bizarrely, sitting in his bed and staring off into space. The parents state that during this time the patient has stopped eating, has not used the restroom and has been verbally unresponsive. His vitals are BP 115/68, P 80, RR 15 O2Sat 98%, T98.6F (37C). On physical exam the patient is awake, well appearing, sitting comfortably in the gurney with a fixed gaze and with hypokinetic behavior not influenced by external stimuli. There is waxy flexibility in his arms and legs and when the nurse starts an IV the patient barely flinches. What is the next best step in management?

A 23-year-old male presents to the ED by ambulance after being found yelling at cars on a nearby highway. On interview, the patient is disheveled and endorsing beliefs that the staff is trying to poison his water. After threatening the staff, the patient is chemically sedated with haloperidol and lorazepam. Two hours later, the patient appears to be in distress stating that he cannot move his eyes. On exam, both eyes are deviated upwards bilaterally. What is the next most appropriate action?

A 55 year old woman presents to the ED with restlessness. She reports an "inner tension" that she can't control. She denies any hallucinations, suicidality. Her medical history includes schizophrenia for which she takes olanzapine. She is dressed appropriately and is pacing the room and fidgety but is able to sit for the interview. Her vital signs and a focused neurological examination are normal. What is the most appropriate initial management?

A 33-year old female presents to the Emergency Department after a seizure. Initial blood glucose level is 33 mg/dl. She is given one amp of D50 and rapidly improves. Upon further history, the patient endorses a history of a recently diagnosed pancreatic tumor. A review of the medical records reveals she has also recently been hospitalized for polymicrobial bacteremia and sepsis. C-peptide levels drawn in the emergency department are within normal limits. What is the most likely diagnosis in this patient?

A 40-year-old male presents with recurrent nosebleeds. He has had 6 visits to the Emergency Department in the last month. He has been admitted multiple times with a full hematologic work-up that is negative. He is now requesting a repeat CT face and nasal biopsy, but the nosebleed resolves spontaneously. Further testing is not done, and immediately prior to discharge, the patient is caught digitally manipulating his nose. A factitious disorder is suspected. What is the type of manipulation and secondary gain typically seen in munchausen’s syndrome?

Agranulocytosis

Akathisia

Fever, Muscle Rigidity, Autonomic Instability, Elevated CK

Hallicunations are defined as a sensory experience that exists only in the mind of the person experienceing it?

Patients with functional psychosis are oriented?

Delusions are defined as erroneous beliefs that usually involve a misinterpretation of perceptions or experiences?