A 32-Year-Old Woman Is Brought to the Emergency Department by Her

question 1431

Multiple Choice

A 32-year-old woman is brought to the emergency department by her husband due to slurred speech and difficulty walking.  The patient has also been uncharacteristically drowsy for the past several hours.  She has a history of bipolar disorder, insomnia, migraine headaches, seizures, and hypothyroidism.  Temperature is 37 C (98.6 F) , blood pressure is 110/70 mm Hg, pulse is 76/min, and respirations are 12/min.  The patient is lethargic and falls asleep during the interview and physical examination.  Pupils are 3 mm and reactive to light.  The neck is supple and the oropharynx is clear.  Chest auscultation is unremarkable.  The abdomen is soft and nontender; bowel sounds are normal.  Limited neurologic examination shows 2+ deep tendon reflexes in all 4 extremities; there is no Babinski sign and strength is 5 on a scale of 0-5 throughout.  No nystagmus or hand tremor is present.  Blood glucose is 130 mg/dL.  Which of the following is the most likely cause of this patient's symptoms?

• A)Benzodiazepine overdose
• B)Lithium toxicity
• C)Opioid intoxication
• D)Phenytoin toxicity
• E)Serotonin syndrome

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Definitions:

Selective Attention

The cognitive process of focusing on a particular object or task in the environment while ignoring others.

Schizophrenia

A serious mental illness marked by significant impairments in cognition, perception, feelings, speech, self-identity, and actions.

Paranoid Schizophrenia

A subtype of schizophrenia characterized by prominent delusions of persecution or grandeur, often accompanied by auditory hallucinations.

Dopamine

A neurotransmitter involved in regulating mood, reward, motivation, and movement, often associated with pleasure and addiction mechanisms in the brain.