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|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|SubCategory=Cardiology, Dermatology, Gastrointestinal
|SubCategory=Cardiology, General Principles
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|SubCategory=Cardiology, Dermatology, Gastrointestinal
|SubCategory=Cardiology, General Principles
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|SubCategory=Cardiology, Dermatology, Gastrointestinal
|SubCategory=Cardiology, General Principles
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|SubCategory=Cardiology, Dermatology, Gastrointestinal
|SubCategory=Cardiology, General Principles
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|SubCategory=Cardiology, Dermatology, Gastrointestinal
|SubCategory=Cardiology, General Principles
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|SubCategory=Cardiology, Dermatology, Gastrointestinal
|SubCategory=Cardiology, General Principles
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|SubCategory=Cardiology, Dermatology, Gastrointestinal
|SubCategory=Cardiology, General Principles
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|SubCategory=Cardiology, Dermatology, Gastrointestinal
|SubCategory=Cardiology, General Principles
|Prompt=A 25-year-old man presents to the clinic with complaints of fatigue for the past 4 weeks. The patient is a college student in his senior year. The student states that this began after a teacher assigned a project to each class member a group project to be discussed and presented at a conference in 6 months. He feels frightened about standing in front of a big crowd.  Upon examination his vitals are: 124/80mmHg, HR: 120, RR: 21, Temp: 37C. The patient looks fidgety and has a rapid speech.  The patient is prescribed the drug of choice for this disorder. After 2 he months he decides to increase the dose and starts developing diarrhea, wheezing and  flushing. Which of the following could be used to treat this patient’s new symptoms?
|Prompt=A 25-year-old man presents to the emergency department for altered mental status. He was brought in by his mother who found him lying on his bedroom floor. She reports that her son is a very healthy person with no significant past medical history. He was only recently diagnosed with performance anxiety that was interfering with his daily functioning at his new job as a financial advisor. The mother also noted that her son has been very anxious for the past week because of an upcoming project presentation. On admission, the patient's blood pressure is 80/55 mm Hg, heart rate is 37/min, and temperature is 36.7 ᵒC (98 ᵒF).  The patient is not responsive, but opens his eyes to painful stimuli. An ECG tracing is obtained and shown below. Which of the following medications is the most appropriate choice for the acute treatment of this patient?<br>
|Explanation=This patient is presenting with Social phobia, also known as Social Anxiety Disorder.  The treatment of choice of phobias short term include Beta blockers, such as Propranol and cognitive therapy.  SSRIs which increase the  are prescribed long term to treat to underlying anxiety. After a course of 2 months with treatment this patient is presenting with cutaneous flushing, diarrhea, and wheezing; typical characteristics of serotonin syndrome. This syndrome is due to an excess of serotonin. The treatment of choice for serotonin syndrome Cyproheptadine, a first generation antihistamine with anticholinergic, antiserotoninergic and local anesthetic properties. 
[[Image:WBR0366.jpg]]
<br>
<font color="MediumBlue"><font size="4">'''Educational Objective:''' </font></font> serotonin syndrome characterized by wheezing, flushing and diarrhea, can be treated with cyproheptadine, a first generation antihistamine which has anti-serotoninergic and anticholinergic properties.
|AnswerA=Cyproheptadine
|AnswerA=Cyproheptadine
|AnswerAExp=<font color="Green">'''Correct.'''</font> [[Cyproheptadine]] is used to treat the management of moderate to severe cases of serotonin syndrome. This excess of serotonin can be caused by SSRIs excess,  MAO Inhibitors intoxication and carcinoid tumor.
|AnswerAExp=[[Cyproheptadine]] is used to treat the management of moderate to severe cases of serotonin syndrome. This excess of serotonin can be caused by SSRIs excess,  MAO Inhibitors intoxication and carcinoid tumor.
|AnswerB=Glucagon
|AnswerB=Glucagon
|AnswerBExp=<font color="red">'''Incorrect.'''</font> [[Glucagon]] is used to reverse the intoxication of Betablockers.
|AnswerBExp=[[Glucagon]] is used to reverse the intoxication of Betablockers.
|AnswerC=Flumazenile
|AnswerC=Flumazenil
|AnswerCExp=<font color="red">'''Incorrect.'''</font> [[Flumazenile]] reverses the effects of [[benzodiazepines]].
|AnswerCExp=[[Flumazenil]] reverses the effects of [[benzodiazepines]].
|AnswerD=Naloxone
|AnswerD=Naloxone
|AnswerDExp=<font color="red">'''Incorrect.'''</font> [[Naloxone]] is used to reverse acute intoxications with [[Opioids]].
|AnswerDExp=[[Naloxone]] is used to reverse acute intoxications with [[Opioids]].
|AnswerE=Sodium bicarbonate
|AnswerE=Sodium bicarbonate
|AnswerEExp=<font color="red">'''Incorrect.'''</font> [[Sodium bicarbonate]] alkalinizes the urine allowing the elimination of acidic substances in the urine by inhibiting the reabsorption. It can be used in cases of Salicylates and TCAs intoxication.
|AnswerEExp=[[Sodium bicarbonate]] alkalinizes the urine allowing the elimination of acidic substances in the urine by inhibiting the reabsorption. It can be used in cases of Salicylates and TCAs intoxication.
|RightAnswer=A
|RightAnswer=B
|Approved=Yes
|Approved=Yes
}}
}}

Revision as of 22:37, 1 August 2014
Author [[PageAuthor::[User:Gonzalo Romero]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pharmacology
Sub Category SubCategory::Cardiology, SubCategory::General Principles
Prompt [[Prompt::A 25-year-old man presents to the emergency department for altered mental status. He was brought in by his mother who found him lying on his bedroom floor. She reports that her son is a very healthy person with no significant past medical history. He was only recently diagnosed with performance anxiety that was interfering with his daily functioning at his new job as a financial advisor. The mother also noted that her son has been very anxious for the past week because of an upcoming project presentation. On admission, the patient's blood pressure is 80/55 mm Hg, heart rate is 37/min, and temperature is 36.7 ᵒC (98 ᵒF). The patient is not responsive, but opens his eyes to painful stimuli. An ECG tracing is obtained and shown below. Which of the following medications is the most appropriate choice for the acute treatment of this patient?

File:WBR0366.jpg]]

Answer A AnswerA::Cyproheptadine
Answer A Explanation [[AnswerAExp::Cyproheptadine is used to treat the management of moderate to severe cases of serotonin syndrome. This excess of serotonin can be caused by SSRIs excess, MAO Inhibitors intoxication and carcinoid tumor.]]
Answer B AnswerB::Glucagon
Answer B Explanation [[AnswerBExp::Glucagon is used to reverse the intoxication of Betablockers.]]
Answer C AnswerC::Flumazenil
Answer C Explanation [[AnswerCExp::Flumazenil reverses the effects of benzodiazepines.]]
Answer D AnswerD::Naloxone
Answer D Explanation [[AnswerDExp::Naloxone is used to reverse acute intoxications with Opioids.]]
Answer E AnswerE::Sodium bicarbonate
Answer E Explanation [[AnswerEExp::Sodium bicarbonate alkalinizes the urine allowing the elimination of acidic substances in the urine by inhibiting the reabsorption. It can be used in cases of Salicylates and TCAs intoxication.]]
Right Answer RightAnswer::B
Explanation [[Explanation::

Educational Objective:
References: ]]

Approved Approved::Yes
Keyword
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