A 24-year-old man presents to the emergency department after a motor vehicle collision. He was in the front seat and unrestrained driver in a head on collision. His temperature is 99.2°F (37.3°C), blood pressure is 90/65 mmHg, pulse is 152/min, respirations are 16/min, and oxygen saturation is 100% on room air. Physical exam is notable for a young man who opens his eyes spontaneously and is looking around. He answers questions with inappropriate responses but discernible words. He withdraws from pain but does not have purposeful movement. Which of the following is this patient's Glasgow coma scale?
A9
B15
C7
D11
E13
A 42-year-old man is brought to the emergency department by his wife because of a 1-day history of progressive confusion. He recently lost his job. He has a history of chronic alcoholism and has been drinking 14 beers daily for the past week. Before this time, he drank 6 beers daily. He appears lethargic. His vital signs are within normal limits. Serum studies show a sodium level of 111 mEq/L and a potassium level of 3.7 mEq/L. Urgent treatment for this patient's current condition increases his risk for which of the following adverse events?
AWernicke encephalopathy
BOsmotic myelinolysis
CCerebral edema
DCardiac arrhythmia
EHyperglycemia
An 82-year-old woman comes to the physician because of difficulty sleeping and increasing fatigue. Over the past 3 months she has been waking up early and having trouble falling asleep at night. During this period, she has had a decreased appetite and a 3.2-kg (7-lb) weight loss. Since the death of her husband one year ago, she has been living with her son and his wife. She is worried and feels guilty because she does not want to impose on them. She has stopped going to meetings at the senior center because she does not enjoy them anymore and also because she feels uncomfortable asking her son to give her a ride, especially since her son has had a great deal of stress lately. She is 155 cm (5 ft 1 in) tall and weighs 51 kg (110 lb); BMI is 21 kg/m2. Vital signs are within normal limits. Physical examination shows no abnormalities. On mental status examination, she is tired and has a flattened affect. Cognition is intact. Which of the following is the most appropriate initial step in management?
ABegin mirtazapine therapy
BBegin cognitive-behavioral therapy
CNotify adult protective services
DAssess for suicidal ideation
ERecommend relocation to a nursing home
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