15th February 2025

You are working in the Emergency department when a 62-year-old man in the waiting room becomes agitated, verbally abusing other members of the public for “invading my home”.

You are working in the Emergency department when a 62-year-old man in the waiting room becomes agitated, verbally abusing other members of the public for “invading my home”. The patient’s notes state a past medical history of rheumatoid arthritis, paranoid schizophrenia and irritable bowel syndrome.

A set of observations are done and show:

HR 114, BP 152/95, RR 26, Sats 92% (room air), temperature 38.5℃ 

Examination is difficult, but you note limb rigidity when assisting him to the examination room.

What is the most likely diagnosis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.