536 Emergency Medicine
493.A 32-year-old woman presents to the ED after an aggressive outburst at
work where her behavior was deemed a threat to others. Her coworkers state
that she is normally very dependable, kind, and gracious but that over the
course of the week they noticed that she was especially reserved and at times
found her conversing with herself. Her initial vitals include HR of 89 beats per
minute, RR of 15 breaths per minute, and BP of 130/75 mm Hg with oxygen
saturation of 99% on room air. She tells you that she was recently started on a
new medication. Which of the following types of medications may be respon-
sible for this patient’s behavior?
a. β-Blockers
b. Oral contraceptives
c. Corticosteroids
d. Nonsteroidal anti-inflammatory drugs (NSAIDs)
e. Calcium-channel blockers
494.A 23-year-old woman is brought to the ED by police officials who state
that they found the patient in the middle of a busy intersection screaming.
Upon arrival, you see a disheveled woman who is yelling, “You can’t get away
with this! I’m the Queen of England!” She does not allow for the triage nurse
to obtain her vitals, but you can see a young woman who is of normal habitus
without any signs of trauma. Her speech is pressured, she is easily distracted
by the commotion of the ED and begins to answer your questions but then
continues to describe grandiose ideas about her social status. Given this
patient’s acute presentation, what is the most likely etiology of her symptoms?
a. Hypothyroid disorder
b. Manic episode
c. Benzodiazepine overdose
d. Anticonvulsant overdose
e. Barbiturate overdose