497.An 18-year-old man presents to the ED after telling a school counselor
that he wanted to harm himself. His physical examination is unremarkable
without any signs of trauma. He reports occasional excessive alcohol use.
He states that his parents recently separated and that he has been living
with either parent on a rotating schedule. Overall, he feels supported by family
and friends but continues to feel hopeless despite this. Which of the following
factors in this patient is most likely to increase his risk of an actual suicidal
attempt?
a. Sex
b. Age
c. Hopelessness
d. Alcohol use
e. Parent separation
498.A thin 16-year-old girl is brought in the ED after collapsing at home. Her
initial vitals include an HR of 110 beats per minute, BP of 80/55 mm Hg, and an
RR of 18 breaths per minute with an oxygen saturation of 98% on room air.
Upon physical examination, you note a cachectic female in mild distress. Her
chest is clear to auscultation; her sunken-in abdomen is soft and nontender.
Upon inspecting her extremities, you notice small areas of erythema over the
dorsum of her right hand distally. Given this patient’s presentation and physical
examination, which of the following etiologies must be further explored in this
patient?
a. Bulimia
b. Gastroenteritis
c. Malingering
d. Factitious disorder
e. Suicidality
538 Emergency Medicine