271.A 46-year-old woman is brought to the ED by her husband for 1 day
of worsening confusion. The patient has a history of systemic lupus ery-
thematosus (SLE) and takes chronic oral steroids. She has not been feeling
well for the last few days. Her BP is 167/92 mm Hg, HR is 95 beats per
minute, temperature is 100.3°F, and RR is 16 breaths per minute. On exam-
ination the patient is oriented to name and has diffuse petechiae on her
torso and extremities. Laboratory results reveal hematocrit 23%, platelets
17,000/μL, BUN 38 mg/dL, creatinine 1.9 mg/dL. Which of the following is
the most likely diagnosis?
a. Henoch-Schönlein purpura
b. Disseminated intravascular coagulopathy
c. Von Willebrand disease
d. Idiopathic thrombocytopenic purpura
e. Thrombotic thrombocytopenic purpura (TTP)
272.A 63-year-old man presents to the ED complaining of headache,
vomiting, and “not being able to think straight” for 1 day. The patient states
that he has hypertension and diabetes but ran out of his medications in the
last week. His BP is 245/138 mm Hg, HR is 90 beats per minute, tempera-
ture is 98.7°F, and his RR is 14 breaths per minute. Fingerstick glucose is
178 mg/dL. On examination the patient appears slightly confused and ori-
ented to name and place only. The neurologic examination is significant for
papilledema. Which of the following is the most appropriate next step in
management?
a. Nitroprusside IV
b. Magnesium sulfate IV
c. Metoprolol by mouth
d. Hydrochlorothiazide by mouth
e. Obtain head CT
273.A 26-year-old man with a long history of epilepsy is brought to the
ED for a recent seizure. While in the ED, he is rhythmically moving his
right leg and is unresponsive. Which of the following best describes this
seizure pattern?
a. Petit mal seizure
b. Generalized tonic-clonic seizure
c. Partial seizure with secondary generalization
d. Simple partial seizure
e. Complex partial seizure
278 Emergency Medicine