His behavior has changed in the past 6 months in that he has frequent episodes of depression, separated by episodes of bizarre behavior, including excessive alcohol drinking and shoplifting. He says his memory is now poor, and he has trouble focusing on tasks. He is a senior in high school and during the year, his grades have plummeted to the point that he is failing.
Which of the following is the best course of treatment for this patient? Morphine sulfate and metoprolol are administered. High flow supplemental oxygen and fluid resuscitation are initiated. Contrast CT reveals a small, unruptured AAA (diameter 4.1 cm). Abdominal ultrasound reveals the presence of an abdominal aortic aneurysm (AAA). Patient’s feet have the following appearance seen in the picture. A pulsatile abdominal mass is felt in the lower umbilical region. On physical examination, the patient is alert and cooperative. Vitals are temperature 37☌ (98.6☏), blood pressure 155/89 mm Hg, pulse 89/min, respirations 16/min, and oxygen saturation 98% on room air. Review of systems is significant for decreased appetite and feeling easily full. Patient reports a 30-pack-year smoking history and heavy alcohol use on the weekends. Current medications are sildenafil 100 mg orally as needed. Past medical history is significant for 2 transient ischemic attacks 6 months prior, characterized by a sudden right-sided weakness and trouble speaking but recovered fully within 30 minutes. He describes the abdominal pain as mild to moderate, dull, and deeply localized to the umbilical region. The patient states that his symptoms started about a week ago and have steadily worsened. Lorazepam and follow-up with psychiatryĪ 69-year-old male with a longstanding history of hypertension and high cholesterol presents with abdominal pain and ‘bruising on his feet’.Which of the following is the most appropriate further management of this patient? After an hour of supplemental oxygen, rest, and careful monitoring his dyspnea improves and chest pain resolves without medication. The patient’s weight is 63.5 kg (140 lb), height is 185 cm (6 ft 1 in), and he has a BMI of 18.5 kg/m 2. Temperature is 36.7☌ (98.0☏), blood pressure is 130/80 mm Hg, pulse is 82/min, and respiration rate is 14/min.
He smokes half a pack of cigarettes a day and drinks alcohol socially. His paternal uncle died of an aortic dissection at age 42. He says he has anxiety and takes alprazolam as needed. He reports that the pain is worse with inspiration and does not radiate. This event started when he was in class sitting for an exam. Which of the following additional clinical findings would you expect to be present?Ī 23-year-old man comes to the emergency department presenting with sudden-onset dyspnea and right-sided chest pain over the last hour. A computed tomography (CT) scan of his head is shown in the exhibit. The rest of the examination is within normal limits. An area of bluish discoloration is seen on his left eyelids and cheek.
His height and weight are at the 67th and 54th percentile for his age. Physical examination reveals normal vital signs. There is no history of fever or head trauma. His developmental milestones were slightly delayed. His birth history and family history are not available. Past medical history is significant for mild mental retardation and complex partial seizures sometimes leading to secondary generalized seizures.
The headaches are moderate-to-severe in intensity, unilateral, mostly affecting the left side, and pulsatile in nature.
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