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A 17-year-old boy is brought to the emergency department by his parents because of bizarre behavior for 6 hours. Last night he was out with friends, and since returning, he has been confused and has "trashed" his room. His blood pressure is 165/95 mm Hg. He is hypervigilant, has little spontaneous speech, and is disoriented to place and time. He appears catatonic but abruptly becomes assaultive two times and needs to be restrained. Which of the following is the most likely substance taken?
A
) Cocaine
B
) Ecstasy
C
) LSD
D
) Methaqualone
E
) PCP
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A ,these nbme qs are very tough
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yea really it is anyone please?
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i think it is PCP bcos pt is more assaultive....may be i am wrong ....simonsez could u shed some light on this ?
Thanks.
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hi kti,
When I am looking out for cocaine intoxication I usually look for the 2 "-ia" +2 -"ty" +hypervigilance and pupillary dilation
the 2 "-ia" are tachycardia and euphoria
the 2 "-ty" are anxiety and grandiosity
This q stem has the buzzword "hypervigilance" for cocaine intoxication, it aslo has high BP a common feature of cocaine intoxication.
But catatonic states, psychosis lasting greater than 1 hour and disorentation to time and space are more towards PCP. The buzzwords for PCP like "vertical nystagmus", "hypersalivation" are not mentioned
If I remember right I chose PCP only because of the catatonia and the impulsive, assaultive behavior+the long lasting effect...cocaine is usually fast acting and effects last max 1 hour.
For those who chose cocaine, why not ecstasy???it is a hallucinogen and a stimulatnt(amphetamine)???cocaine is a stimulant too!!
these are just personal opinions and are not to be considered absolute answers or statements. Anyone with a better explanation and more reliable analysis is welcome.
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thanks simonsez it was a nice explaination
and yea PCP seems to be the correct choice....even cocaine, ecstacy, PCP and LSD havehypertension, tachycardia but i f pt more assaultive , aggressive, catatonic i think it is PCP and if more psychotic features then ecstacy pls correct me if i am wrong.
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I think it is cocaine, due to hypertension, hypervigilent. aggresivness can be in any of those options. there is no nystagmus, hallucinations whic is favor for PCP.
