488.Which of the following clinical presentations requires hospitalization?
a. A 37-year-old man with paranoid schizophrenia who has been off his medications
for a week and is hearing voices with no apparent violence in his thought content.
b. A 19-year-old woman who ingested 10 multivitamin pills after an argument with
her boyfriend.
c. A 39-year-old man with no previous psychiatric history presents with pressured
speech, no sleep for 4 days, and is feeling “great.”
d. A 22-year-old woman who is having visual hallucinations after ingesting D-lysergic
acid diethylamide (LSD).
e. A 43-year-old homeless man with a history of schizophrenia who was recently
discharged from the psychiatric ward being managed on antipsychotic medications.
489.A 35-year-old woman is eating dinner at a restaurant. Approximately
1 hour after finishing the main course of lamb, red wine, and a fine selection
of cheese, the patient experiences a severe occipital headache, diaphoresis,
mydriasis, neck stiffness, and palpitations. Which of the following medications
is this patient most likely taking?
a. Paroxetine
b. Alprazolam
c. Tranylcypromine
d. Citalopram
e. Amitriptyline
490.You walk into the examining room to interview a patient. He refused
giving vital signs at the triage station until he saw a doctor because he was
afraid that the nurse would inject poison into him. He appears agitated and
starts raising his voice as soon as you are in the room. You ask him in a calm
voice if you could help him and he replies by shouting obscenities and
throwing a box of gloves at you. You start to walk toward him but he says he will
kill you if you get any closer. Which of the following is the most appropriate
next step in management?
a. Tell the patient he is being uncooperative and is to leave the ED immediately.
b. Have the nurse go into the room alone to try to calm the patient.
c. Let the patient sit in the room for another hour and see if he calms down.
d. Ask the nurse to prepare an injection of lorazepam that you will give to sedate
the patient.
e. Alert hospital security that there is a violent patient and prepare to place the
patient in physical restraints.
534 Emergency Medicine