ChoiceHub
Sign in
A 34-year-old man is brought to the emergency department six hours after his general practitioner increased his sertraline and added tramadol for back pain. He was started on quetiapine for insomnia four days ago and last used methamphetamine three days ago. He is restless and shivering. Temperature 38.9 °C, heart rate 124/min in sinus rhythm, blood pressure 155/90 mmHg; no goitre is palpable. His shirt is soaked with sweat and bowel sounds are active. Passive dorsiflexion of both ankles produces several rhythmic beats, the knee jerks are brisker than the biceps jerks, and there is no rigidity. Which one of the following best explains his fever, agitation and reflex findings?
Shared by Mornienmiddle twist

Keep going — a set of ten like this one, one at a time.

Practise more

More from Acute Care

See all

A 7-year-old boy is ready to leave a Perth emergency department six hours after a moderate asthma flare-up. He has had salbutamol by spacer and a first dose of…

Clinical rotations · middle twist

A 78-year-old woman is being discharged after an admission with melaena. She takes apixaban for atrial fibrillation. Gastroscopy showed a bleeding duodenal ulce…

Clinical rotations · middle twist

You are the intern on a Perth surgical ward. Overnight a 74-year-old woman received ten times the intended dose of insulin because of a prescribing error you ma…

Pre-internship · middle twist

An 81-year-old man had a large left middle cerebral artery infarct ten days ago. He cannot swallow safely and can neither understand nor communicate a decision.…

Pre-internship · middle twist

A 62-year-old Aboriginal woman from a remote Kimberley community is admitted to a Broome hospital with small bowel obstruction and listed for laparotomy on tomo…

Pre-internship · middle twist