pharmacology q

Discussion in 'Step I' started by ddw2013, 05.13.14.

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  1. ddw2013

    ddw2013

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    A 66-year-old man is brought to the emergency
    department by neighbors 1 hour after the sudden
    onset of progressive confusion and sleepiness.
    He had just seen the physician 1 week before,
    and he appeared cheerful and his usual sharp self
    until he was found wandering in his neighbor's
    yard the day of admission. He appears sleepy,
    but he is arousable. He is oriented to person, but
    not to place or time. He recalls two of three
    objects after 5 minutes. He says, "There are so
    many little people here. What sort of place is
    this?" He then falls back asleep. Which of the
    following is the most likely cause of this patient's
    condition?
    (A) Acute paranoid schizophrenia
    (B) Arsenic poisoning
    (C) Dementia, Alzheimer type
    (D) New medication regimen
    (E) Tertiary syphilis

    D is the right answer. Can someone explain?
     
    Last edited: 05.13.14
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  3. Ismet

    Ismet PGY-fun SDN Administrator 5+ Year Member

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    Answer of elimination.

    He has zero signs of paranoia, so it's not A.
    If he had arsenic poisoning, he would have vomiting/diarrhea, alopecia, convulsions, etc. So it's not B.
    He was perfectly fine a week ago, and Alzheimer's doesn't progress that fast, so it's not C.
    Tertiary syphilis would demonstrate things like tabes dorsalis, parasthesias, loss of coordination, etc. It's not E.

    Only thing left that makes sense is D. He visited the doctor a week ago, apparently changed his meds, and now he's experiencing the side effects.
     
    dyspareunia and BlueArc like this.
  4. J ROD

    J ROD Watch my TAN walk!! Lifetime Donor 10+ Year Member

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    Yeah, process of elimination. Sounds like anti-musk
     
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  5. Enzymes

    Enzymes 2+ Year Member

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    Seems like delirium secondary to the scores of of "anti" drugs that can cause it. Anyone agree?
     
  6. Dharma

    Dharma 5+ Year Member

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    i.e. tripping balls. Jamestown, VA 1705.
     
  7. Apoplexy__

    Apoplexy__ Blood-and-thunder appearance Bronze Donor 2+ Year Member

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    Yeah.

    Also, you can eliminate C and E because this is delirium, and those would cause dementia.
     
  8. NeuroLAX

    NeuroLAX Discere faciendo 2+ Year Member

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    Remember, delirium presents with acute and fluctuating changes in consciousness with altered perception, disorientation, and poor attention. This patient has all of these symptoms. Given his age and the fact that he recently visited his physician, drugs seem to be the culprit. It's not uncommon for those >65 years to be taking 10 or more prescription medications (polypharmacy).
     
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  9. dyspareunia

    dyspareunia

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    All this, plus the thread title "pharmacology q".









    ;)
     
    CherryRedDracul likes this.
  10. Ismet

    Ismet PGY-fun SDN Administrator 5+ Year Member

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    :laugh: i totes missed that
     

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