A 20-year-old woman is brought into the emergency department by ambulance after her friends noted that she was acting paranoid at a party. The patient was confused and could not give any history. She is repetitively grinding her teeth and biting her lower lip (movement known as bruxism). Her examination reveals a heart rate of 123 bpm and a blood pressure of 150/95 mm Hg. Her skin is moist, and her pupils are dilated. She is awake but delirious and highly agitated. Her friends that called 911 reported to the police that she had told them that she had taken one "hit" of ecstasy (designer amphetamine). The patient's friends report that she has a history of depression and is taking Selegiline for treatment. Answer the following questions in a thread: How can the symptoms listed above be caused by the patient taking ecstasy (make sure to talk about how each one of the symptoms/physiology is caused by a specific molecular/target interaction with the use of ecstasy)? Does Selegiline use by the patient have any importance in this case? Explain your answer why or why not. What would be the treatment that you may undertake in this case? There may be a number of correct treatments, so make sure to explain why you have picked the specific course of action that you did for her treatment.
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Madhur L.
A 25-year-old young woman is brought to the emergency department by the police after being found walking in traffic at a busy city intersection. The police place her on an involuntary commitment after she states that she was instructed to kill herself by accusatory, commanding voices. On examination, the patient appears disheveled, with an indifferent and flat affect, and disorganized thought processes. She answers most questions monosyllabically. When questioned about experiencing auditory hallucinations, she answers in the affirmative, but she is unable to articulate coherently the details of her experience. Throughout the examination, she appears intermittently distracted by internal stimuli; when asked what her experience is in the moment, she states: "They are talking to me." The patient's family reports that she became increasingly withdrawn after she moved away from home to attend graduate studies at a local university. The family reports that her academic performance in college was above average, but since starting university, she has struggled to complete her schoolwork. Since moving, she has also become more isolative: she made no new friends, stopped talking to her college friends, and maintained only sporadic contact with her family. The family was unaware of the patient experiencing any hallucinatory experiences. She had no past history of drug misuse, and her urine toxicology screen was negative, effectively ruling out a drug-induced psychosis. QUESTIONS: 1. What could have possibly triggered this young woman's episode? 2. a. What are two differential or possible diagnoses for her? b. Briefly explain each of these possible diagnoses. 3. What are the evidences which have informed each of the two possible diagnoses you listed in #2? 4. What is this young woman's actual diagnosis, and explain possible treatment options
Akash M.
You are an intensive care doctor and have a patient with a severe brain injury following an automobile accident resulting in a skull fracture with fragments of bone penetrating into the brain. The nursing staff is monitoring his vitals, and you have been asked to evaluate your patient due to a deteriorating condition. Some of the significant findings include: - Patient is unconscious and not responding to external stimulation such as a pinprick. - Testing of the pupillary light response shows that pupils are dilated and unresponsive to light bilaterally. - Increased extensor muscle tone. - Abnormal respiratory patterns. A. Explain why the above changes may have developed. Be specific and include information related to brain function and how the brain injury can affect the neurocircuitry involved in these functions. B. Post-traumatic epilepsy occurs following traumatic brain injuries at a rate of 2-50% depending on the severity of the injury. Explain and describe the mechanism by which epilepsy develops in these patients. C. Is this patient at risk of developing other complications? Why or why not. Please explain as thoroughly as possible so I can understand. Thank you.
Sri K.
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