Psychosocial Disorders 535491.A 42-year-old man with a history of schizophrenia is brought into
the ED by a friend who states that the patient has not taken his medication
for over 2 weeks and is now behaving bizarrely. His BP is 130/70 mm Hg,
HR 89 beats per minute, respiratory rate (RR) 15 breaths per minute, and
oxygen saturation 99% on room air. On examination he appears agitated
and is shouting, “the aliens are about to get me.” He is cooperative enough
that you decide to use pharmacologic sedation. Which of the following is the
most appropriate choice for sedating this patient?
a. Haloperidol and lorazepam
b. Etomidate and succinylcholine
c. Chlorpromazine and lorazepam
d. Ketamine and lorazepam
e. Clozapine
492.A 48-year-old man is brought to the ED by family members who
state that the patient has remained home-bound for weeks, sleeping for
many hours, and appears disheveled. The patient states that he is “fine” and
denies any medical symptoms. Initial vitals include HR of 77 beats per
minute, BP of 118/55 mm Hg, and RR of 12 breaths per minute with oxygen
saturation of 97% on room air. The patient is afebrile with an unremarkable
physical examination. He denies any chest discomfort, difficulty breathing,
constipation, cold intolerance, weakness, weight changes, or pain. The patient
reports that he has had difficulty concentrating, a decreased appetite, and
excessive sleeping patterns. The family reports that this has happened before,
but that his symptoms self-resolved and were not nearly as severe. Given this
patient’s presentation, which of the following is the most likely etiology of
this patient’s symptoms?
a. Hypothyroidism
b. Major depressive episode
c. Diabetes mellitus
d. Subdural hematoma
e. Cushing syndrome