Psychiatry FORM 4 Highlighted Red = it is related to the question. Highlighted Green = Uptodate is the source. Highlighted Blue= Uworld is the source.
Highlighted Yellow = FA for Step 1 is the source
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. Patient did not complete the criteria for mania or hypomania (excluding choices A & B) Delusional disorder does not explain the hallucinations. Still in need for a toxicology screen to exclude choice E; but I would go with choice D as the right answer. Update: Right answer is D - Confirmed
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Patient did not complete the criteria (only 3 symptoms plus depressed mood) for a major depressive (excluding F); did not complete 2 years duration (excluding D & E); no symptoms of mania or past history of an episode (excluding C); no stressor
(excluding A & B). Patient most probably has Obstructive sleep apnea which may explain the symptoms.
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Right answer G: UpToDate: Ingestion of sympathomimetic agents (eg, tyramine-containing foods in patients who take chronic monoamine oxidase inhibitors [7], amphetamine-like compounds, cocaine, etc) can precipitate severe hypertension and end-organ damage. Such patients can be treated with intravenous phentolamine or nitroprusside. ===================================================================
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. The one who answered this form online; found out the Down syndrome is the wrong answer! Update: the right answer is C – Confirmed Online.
I can't make the distinction between fetal alcohol syndrome and Silver-Russel in this case! Here is what I could find:
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Right answer is Choice D. Here is a screenshot from Kaplan book:
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. Right answer is D
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. Right answer is D
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Right answer is F UpToDate: "Designer" opioids are synthetic derivatives of opioids created in makeshift laboratories and include 3-methylfentanyl, α-fentanyl , desomorphine, and other agents, such as MPTP (1, methyl, 4 phenyl 1,2,3,6 tetrahydropyridine). MPTP is a dopaminergic neuronal toxin that causes secondary parkinsonism. ==================================================================
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. Answer is C; Lithium The only drug that explains all the findings in the question stem (confusion, seizure, tremors, nystagmus, AV block) Adverse Reactions Significant Cardiovascular: Cardiac arrhythmia, hypotension, sinus node dysfunction, flattened or inverted T waves (reversible), edema, bradycardia, syncope Central nervous system: Blackout spells, coma, confusion, dizziness, dystonia, fatigue, headache, lethargy, pseudotumorcerebri, psychomotor retardation, restlessness, sedation, seizure, slowed intellectual functioning, slurred speech, stupor, tics, vertigo Neuromuscular & skeletal: Tremor, muscle hyperirritability, ataxia, choreoathetoid movements, hyperactive deep tendon reflexes, myasthenia gravis (rare) Ocular: Nystagmus, blurred vision, transient scotoma.
. A is wrong because: Bupropion is an antidepressant; not used in bipolar management. UW Screenshot
. B is wrong because: Haloperidol can be used only in acute mania management; it is not used as maintance. In addition, it cannot explain all the findings in the question stem. It does not cause AV block or nystugmus. UW Screenshot
Adverse Reactions Significant Cardiovascular: Abnormal T waves with prolonged ventricular repolarization, arrhythmia, hyper-/hypotension, QT prolongation, sudden death, tachycardia, torsade de pointes Central nervous system: Agitation, akathisia, altered central temperature regulation, anxiety, confusion, depression, drowsiness, dystonic reactions, euphoria, extrapyramidal reactions, headache, insomnia, lethargy, neuroleptic malignant syndrome (NMS), pseudoparkinsonian signs and symptoms, restlessness, seizure, tardive dyskinesia, tardive dystonia, vertigo . D is wrong because: Risperidone does not explain CNS or ocular findings in the question stem. Central nervous system: Sedation (children 12% to 63%; adults 5% to 11%), parkinsonian-like syndrome (children 6% to 62%; adults 8% to 25%), drowsiness
(adults 5% to 41%; children 4% to 11%), insomnia (≤32%), fatigue (children 18% to 31%; adults 1% to 9%), headache (12% to 21%), anxiety (≤8% to 16%), dizziness (3% to 16%), drooling (children 12%; adults <4%), akathisia (5% to 11%) Neuromuscular & skeletal: Tremor (adults ≤24%; children ≤11%) Cardiovascular: Bradycardia (<4%), bundle branch block (<4%), buttock pain (<4%), chest pain (<4%), ECG changes (<4%), facial edema (<4%), first degree atrioventricular block (<4%), hypotension (<4%), orthostatic hypotension (<4%), palpitations (<4%), paresthesia (<4%), prolonged Q-T interval on ECG (<4%), tachycardia (adults <4%; children <1%), hypertension (≤3%), peripheral edema (≤3%), syncope (1% to 2%) Ophthalmic: Blurred vision (2% to 7%), conjunctivitis (<4%), reduced visual acuity (<4%) . E is wrong answer because: Valproic acid does not explain the AV block Adverse Reactions Significant >10%: Central nervous system: Headache (≤31%), somnolence (≤30%), dizziness (12% to 25%), insomnia (>1% to 15%), nervousness (>1% to 11%), pain (1% to 11%) Neuromuscular & skeletal: Tremor (≤57%), weakness (6% to 27%) 1% to 10%: Cardiovascular: Peripheral edema (>1% to 8%), chest pain (>1% to <5%), edema (>1% to <5%), facial edema (>1% to <5%), hypertension (>1% to <5%), hypotension (>1% to <5%), orthostatic hypotension (>1% to <5%), palpitation (>1% to <5%), tachycardia (>1% to <5%), vasodilation (>1% to <5%), arrhythmia) Ocular: Nystagmus(1% to 8%), dry eyes (>1% to 5%), eye pain (>1% to 5%), abnormal vision (>1% to <5%), conjunctivitis (>1% to <5%)
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. Right answer is choice C
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. Despite the fact that answer C is verified to be the right answer by the one who took the form online, I could not confirm that Prochlorperazine can cause these symptoms mentioned @ the question stem. Here is a screenshot from Uptodate:
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. Right answer is C
Choice D may work if the patient did not have a plan.
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Right answer is C
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