NBME form2, q10. Thanks

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NBME form2, q10. Thanks

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14 Posts

Perhaps
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08/15/06 - 01:30 PM

A 47-year-old woman is brought to the emergency department by her husband because of hallucinations and agitation for 6 hours. She has a 10-year history of alcoholism. Her last alcoholic drink was 48 hours ago. She is agitated and inattentive. Her temperature is 38.3 C (101 F), blood pressure is 190/120 mm Hg, and pulse is 110/min. She is oriented to person but not to place or time. During the examination, she shrieks, "Make the lizards go away." Which of the following is the most appropriate initial step in management?

A) Electroencephalography
B) CT scan of the head
C) Intravenous ampicillin therapy
D) Intravenous haloperidol therapy
E) Intravenous lorazepam therapy

HighHopes
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08/15/06 - 03:21 PM

E, but what about her High blood pressure?

GDS2008
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08/15/06 - 03:23 PM

I will go with E as well

frank100
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08/15/06 - 03:23 PM

(d) is a fastest approach.

shumaila
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08/15/06 - 03:28 PM

alcohal withdrawl.... so answer is E

frank100
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08/15/06 - 03:30 PM

yup, you´re right. it´s E. sorry

shumaila
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08/15/06 - 03:38 PM

when r u giving ur exam frank 100?

humbty
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08/16/06 - 10:13 AM

I m kind of torn. As far as I know Benzodiazepines are the main treatment in Delirium tremens, but Haloperidol is also recommended to treat hallucination and agitation.

HighHopes
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08/16/06 - 10:48 AM

in DT you also have hallucination and agitation

humbty
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08/16/06 - 12:46 PM

#10

HighHopes wrote:
in DT you also have hallucination and agitation

yes thats the reason why i think d and e are appropriate

AAAAA
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08/16/06 - 03:16 PM

#11

E

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AAAAA
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08/16/06 - 03:18 PM

#12

D is incorect (I think) because the ativan or valium can stable the patient and the halluncination may eventually goes away !

(I have a friend who quitted by himself without any med. So if there are no major symptoms, ativan or valium is the drug of choice !

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study_ing
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08/16/06 - 05:59 PM

#13

i agree the patient is in distress but she isnt getting overtly violent and duz not pose a threat tot he staff's security ...hence the need for haloperidol wud be less.

id go for bdz

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juanma0
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08/17/06 - 08:46 PM

#14

First diagnosis : Delerium tremens, given symptoms and history make this the most likely. Acute onset of hallucinations and agitation describe a acute pshychotic disorder, would be a good second dx.
Second, treatment :
DT : BDZ
APD : haloperidol

So my answer is E.

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