WBR261

Author	[[PageAuthor::Sapan Patel M.B.B.S]]
Exam Type	ExamType::USMLE Step 3
Main Category	MainCategory::Community Medical Health Center, MainCategory::Primary Care Office
Sub Category	SubCategory::Neurology, SubCategory::Psychiatry
Prompt	[[Prompt::The patient is a 72-year-old man brought to the primary care clinic by his family over concerns that he has Alzheimer's disease. They have noticed a worsening of his memory over the past 6 months. He does not seem to want to get out of bed, and he appears to have difficulty providing for his basic needs such as cleaning, dressing, and cooking for himself. He is hesitant when talking, but it is unclear whether he is unable or unmotivated to speak. His family has also noticed that he appears depressed and is often seen crying. A MSE of the patient is performed to help determine whether he is suffering from a dementing illness or a depressive illness (pseudodementia). Further history, cognitive examinations, physical examination, and laboratory/radiographic studies are obtained. The results are consistent with Alzheimer's dementia. While the family had been able to take care of him initially, they have since returned to the clinic stating that they can no longer keep him at home. They feel that he is becoming much more agitated. He is staying up at night. Lately he has been rearranging the furniture, claiming to look for "the little people who are teasing me." They have noticed that he has difficulty walking, often moving slowly and dropping items. The family has pursued nursing home placement, but they wish to have something prescribed in order to help him sleep and keep him calm. Which of the following medications should be avoided in this patient?]]
Answer A	AnswerA::Buspirone
Answer A Explanation	AnswerAExp::Incorrect- This drug should not be avoided as it does not have extrapyramidal side effects.
Answer B	AnswerB::Donepezil
Answer B Explanation	[[AnswerBExp::Incorrect- This drug should not be avoided as he has Alzheimer's disease. It is treatment of choice.]]
Answer C	AnswerC::Lorazepam
Answer C Explanation	AnswerCExp::Incorrect- This drug should not be avoided as it does not have extrapyramidal side effects.
Answer D	AnswerD::Trazodone
Answer D Explanation	AnswerDExp::Incorrect- This drug should not be avoided as it does not have extrapyramidal side effects.
Answer E	AnswerE::Risperidone
Answer E Explanation	AnswerEExp::Correct- See expanation
Right Answer	RightAnswer::E
Explanation	[[Explanation::This patient displays characteristics of Lewy body disease, a dementia that may be related to Alzheimer dementia. The classic triad of Lewy body dementia is a fluctuating course, peduncular hallucinations (visual hallucinations of small people, animals, or objects), and parkinsonian features. These patients tend to be very sensitive to extrapyramidal side effects and, therefore, antipsychotics such as risperidone should be avoided or sparingly used. Educational objective:In patients with Lewy body dementia, antipsychotics such as risperidone should be avoided or sparingly used as they tend to be very sensitive to extrapyramidal side effects. Educational Objective: References: ]]
Approved	Approved::Yes
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