+- USMLE Forum - Largest USMLE Community (https://www.usmleforum.com)
+-- Forum: USMLE Forum (https://www.usmleforum.com/forumdisplay.php?fid=1)
+--- Forum: Step 3 (https://www.usmleforum.com/forumdisplay.php?fid=6)
+--- Thread: 67 yr old man ---> Tt - harry206 (/showthread.php?tid=476037)
Pages:
1
2
67 yr old man ---> Tt - harry206 - ArchivalUser - 01-09-2010
A 67-year-old man is seen in the clinic for a scheduled
visit. He complains of walking difficulties
that have progressively worsened over many
months. He also has noticed œshaking of his
hands, resulting in his dropping objects occasionally.
He is greatly upset by these problems and
admits to frequent crying spells. His only chronic
medical illnesses are gastroesophageal reflux disease
and hyperlipidemia. He is currently prescribed a
proton pump inhibitor and cholesterol-lowering
agent. His MSE is notable for little expression or
range of affect. His vitals signs are within normal
limits. On physical examination, there is a noticeable
coarse tremor of his hands, left greater than
right. His gait is slow moving and broad-based.
Some time after initiation of treatment
with the proper medication, he becomes
agitated and is noted to be hallucinating.
Which of the following medications would
be the most appropriate to treat these new
symptoms?
(A) clozapine (Clozaril)
(B) haloperidol (Haldol)
© risperidone (Risperdal)
(D) quetiapine (Seroquel)
(E) thioridazine (Mellaril)
0 - ArchivalUser - 01-09-2010
i guess A .. levodopa induced pyshosis...
0 - ArchivalUser - 01-09-2010
Hi matchusa,
Clozapine is less practical as a first-line agent, because of risk of agranulocytosis and need for regular blood monitoring.
0 - ArchivalUser - 01-09-2010
for sure... quetiapine (Seroquel)
0 - ArchivalUser - 01-09-2010
Since this is an acute side effect start with Halodol,,,,,,,,,,then you can give clozapine as an out-pt.,,,,,,,,,this is my final answer
0 - ArchivalUser - 01-09-2010
Ans: (D) quetiapine (Seroquel)
0 - ArchivalUser - 01-09-2010
I will go with D, what is the final answer?
0 - ArchivalUser - 01-09-2010
Can you explain why> Is seroquel safer than Clozapine if used for long time?
0 - ArchivalUser - 01-09-2010
Explanation:
clozapine ----> agranulocystosis & frequent CBC
haloperidol ----> worsen the symp
risperidone ----> cause more problem
thioridazine ---> anticholinergic & increased QTc
quetiapine ----> with essentially no EPS
0 - ArchivalUser - 01-09-2010
Thanks a ton.