Approach to stimulant use, intoxication, and overdose Quiz: Ace Your Exams

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A 27-year-old woman is brought to the emergency department for a 2-hour history of paranoia and agitation. The patient was found pacing and shouting outside a nightclub and was brought to the hospital by emergency medical services (EMS). The patient used a drug earlier in the evening purchased from a stranger. There is no past medical or surgical history. Temperature is 37.4°C (99.3°F), pulse is 132/min, respirations are 20/min, and blood pressure is 168/100 mmHg. Cardiopulmonary examination reveals no murmurs and clear lungs on auscultation. Mental status exam shows hypervigilance, pressured speech, and restlessness. Complete blood count (CBC) and comprehensive metabolic panel (CMP) are normal. Urinary drug screen is pending. Which of the following additional features would help support the likely diagnosis?

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Severe headache and visual hallucinations

Diaphoresis and mydriasis

Conjunctival injection and hyperphagia

Diffuse muscle rigidity and hyperreflexia

Disorganized speech and thought blocking