WBR0128

Author	Mahmoud Sakr M.D.
Exam Type	USMLE Step 3
Main Category	Primary Care Office
Sub Category	Psychiatry
Prompt	38 y/o female patient of yours has been complaining of vigorous mood swings, with some days she’s having irritability, restlessness, increased energy, racing thoughts, high sex drive, and a tendency to make grand and unattainable plans. Other days, she’s too tired to get out of bed and feels hopless. You decide to start her on lithium for bipolar disorder. Which of the following blood test should you order first:
Answer A	TSH, BUN, creatinine, Pregnancy test
Answer A Explanation	TSH, BUN, creatinine, Pregnancy test are necessary tests to perform prior to starting patients on lithium due to associated teratogenicity, renal injury and thyroid disorders with lithium therapy.
Answer B	TSH, BUN, creatinine and LFTs
Answer B Explanation	Liver injury is not known to occur with lithium.
Answer C	TSH, LFTS, pregnancy test
Answer C Explanation	Liver injury is not known to occur with lithium.
Answer D	TSH, BUN, creatinine, cortisol and pregnancy test
Answer D Explanation	Adrenal injury is not known to occur with lithium.
Answer E	LFTs, BUN, creatinine and pregnancy test.
Answer E Explanation	Liver injury is not known to occur with lithium.
Right Answer	A
Explanation	TSH, BUN, creatinine, Pregnancy test are necessary tests to perform prior to starting patients on lithium due to associated teratogenicity, renal injury and thyroid disorders with lithium therapy. Liver or adrenal injury is not known to occur with lithium as indicated in the distractors. Educational Objective: References:
Approved	No
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