Behavioral Science & Ethics USMLE Step 1 Practice Question
A 32-year-old woman with a history of daily alcohol use is brought to the emergency department by her roommate who found her acutely confused and agitated this morning. The patient reports her last drink was approximately 24 hours ago. On examination, she is diaphoretic and tremulous, with a temperature of 38.1°C (100.6°F), heart rate of 118/min, blood pressure of 156/94 mmHg, and respiratory rate of 18/min. She is oriented to person only and has visual hallucinations. Physical examination reveals spider angiomas and a palpable liver edge 4 cm below the right costal margin. Neurological examination shows no focal deficits. Serum alcohol level is undetectable. CT head is unremarkable. Which of the following is the most appropriate initial management?
Answer choices
- AAdminister thiamine intravenously followed by lorazepamCorrect answer
- BAdminister haloperidol to control agitation while arranging neurology consultation
- CPerform emergent intubation and transfer to ICU for monitoring
- DInitiate acamprosate and schedule outpatient addiction medicine follow-up
- EAdminister high-dose fomepizole for suspected toxic ingestion
- FBegin chlordiazepoxide taper with phenytoin for seizure prophylaxis
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