American College of Physicians: Internal Medicine — Doctors for Adults ®


The MKSAP Challenge

From the March ACP Observer, copyright 2004 by the American College of Physicians.

Clinical scenario

A 36-year-old man with long history of heavy alcohol use presents within 24 hours of his last drink. He states that he "needs help with the withdrawal." He denies any other drug use.

On examination, his pulse rate is 120/min and blood pressure is 172/96 mm Hg. He is moderately tremulous and is having visual hallucinations.

What is the most appropriate management?

A. Admit the patient and give clonidine, 1 mg
B. Admit the patient and give diazepam, 20 mg
C. Prescribe outpatient chlordiazepoxide, 50 mg
D. Prescribe outpatient lorazepam, 2 mg
E. Prescribe outpatient atenolol, 50 mg



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