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A 78-year-old woman is brought in by her son. He is concerned about her agitation. On examination, you note she is agitated and appears confused about the date and time. She has a low grade fever and her urinalysis is suggestive of a urinary tract infection. She is now physically aggressive towards her son at the bedside and he is extremely distressed as she starts hitting the nurse tending to her.
Which of the following treatment is the most appropriate medication to manage her agitation?
A 35 year old patient is sent home with his first episode of severe gout of hit first MTP joint on the right foot. He filled his prescription at the local chemist. He returns 5 days later with his wife due to aggression, irritability and insomnia. His wife tells you he has bipolar disorder which has been well controlled for a long time. She has never seen him like this before.
You think it might be due to the medications he was sent home with for his gout.
Which of the following medication is likely to be the cause?
A 35 year-old-man with known polysubstance abuse presents with agitation and paranoid ideations. In the ED last night, it was noted that he appears to be responding to internal stimuli - auditory and visual hallucinations. He is reviewed this morning after a 14-hour admission to the 24 hour observation ED ward. He has complete resolution of his symptoms and is apologetic for his behaviour last night. He has no recollection of the events.
Which of the following is the most likely cause of his behaviour?
You are asked by the nurse to attend to an angry patient at Triage. The patient is sitting at Triage and you introduce yourself as the doctor. He appears to be extremely angry about the long wait. He is calm and not physically aggressive.
Which of the following is the most appropriate first step in your interaction with this patient?
An 86-year-old is brought in by her daughter due to a week history of confusion and inability to manage at home. She has been living independently for the last 12 months since being widowed, but in the last week there have been times where she has not remembered to take her medications or eat meals at the right time. She was seen by the GP but at that point seemed reasonably good and the GP didn't think there was anything to worry about. Her daughter has no confidence in the GP and hence brought her into the ED.
Which of the following in the history is suggestive of delirium and not dementia?
A 22 -year-old man is brought in by police. He is physically aggressive and has been restrained with handcuffs. In the ED, he continues to be combative. Verbal de-escalation has been unsuccessful.
Which of the following is the most appropriate management?
A mother of 2 presents to the ED with insomnia and restlessness. Her HR is 105/min, BP 124/80 RR 20/min Temp 37.8C. She tells you she is so restless that she cannot work and cannot look after her children.
Which of the following is the most appropriate next step in your management in the ED?
A 52-year-old man is brought in by ambulance to the ED. He has been agitated and abusive to his neighbours. On review in the ED, he is noted to be severely paranoid, claiming government is after him. Verbal de-escalation in the ED is unsuccessful. Patient has agreed to take oral medication
Which of the following is the most appropriate medication to use?
A 45-year-old man is brought in by his wife. He has been verbally aggressive towards her for the last 4 weeks after losing his job. He is not normally on medications. He does not drink alcohol. On examination, he is disorientated, but calm and cooperative.
Which of the following is essential to his initial evaluation in the Emergency Department?