Cases

Agitation and tremor in a 41-year-old woman

Dana Whitfield · Emergency Department

History

0/10 key findings

Ask the questions your differential demands — not just the ones the case volunteers. Every diagnosis you intend to list owes you one discriminating question.

Opening

You are the psychiatry consult resident called to the Emergency Department. Dana Whitfield, 41, was brought in by her husband about an hour ago for agitation, shaking, and confusion that began earlier today. She is alert but restless, answering some questions and losing the thread of others. Her husband is at the bedside and can fill in the history.

From the husband

She was completely herself yesterday evening. This morning she seemed jittery and "off," and by early afternoon she was sweating through her shirt, shaking, and saying things that did not make sense. He has never seen her like this.

Triage note

Ambulatory on arrival. No trauma. No witnessed seizure. Blood glucose at triage 112 mg/dL.