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|AnswerEExp='''Correct:''' Lithium is a mood-stabilizer used to treat bipolar disorder.  Its mechanism of action is poorly understood.  One of the side effects of lithium is hypothyroidism, which is responsible for the menstrual irregularities, constipation and fatigue in this patient.  Further questioning might reveal other manifestations of hypothyroidism such as cold intolerance.
|AnswerEExp='''Correct:''' Lithium is a mood-stabilizer used to treat bipolar disorder.  Its mechanism of action is poorly understood.  One of the side effects of lithium is hypothyroidism, which is responsible for the menstrual irregularities, constipation and fatigue in this patient.  Further questioning might reveal other manifestations of hypothyroidism such as cold intolerance.
|RightAnswer=E
|RightAnswer=E
|WBRKeyword=Bipolar, Bipolar disorder, Lithium, Hypothyroidism,
|WBRKeyword=Bipolar, Bipolar disorder, Lithium, Hypothyroidism, Side effect
|Approved=No
|Approved=No
}}
}}

Revision as of 03:49, 27 September 2013

 
Author PageAuthor::Anonymous (Edited by Will Gibson)
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Behavioral Science/Psychiatry, MainCategory::Pharmacology
Sub Category SubCategory::Neurology
Prompt [[Prompt::A 23-year-old woman comes to your office with symptoms of depressive episodes, insomnia, and decreased appetite. She also reports episodes of excited mood and euphoria. You recognize her disorder as likely bipolar in nature and refer her to a psychiatrist in the area. After 2 months, she returns to your office and states her symptoms of mood swings as well as very high and low periods of excitation have improved after her psychiatrist placed her on medication, although she can't remember the name. However, she does complain of recent menstrual irregularities, constipation, and fatigue. What medication was likely used to control her bipolar type symptoms?]]
Answer A AnswerA::Carbamazepine (Tegretol).
Answer A Explanation [[AnswerAExp::Incorrect: Carbamazepine is an anticonvulsant and mood-stabilizing drug used primarily in the treatment of epilepsy and bipolar disorder. It is also the first line treatment for trigeminal neuralgia. Carbamazepine stabilizes the inactivated state of voltage-gated sodium channels, thereby reducing the excitability of neurons. Carbamazepine is an inducer of the Cytochrome P-450 system and adverse reactions to Carbamazepine include rash, SIADH, agranulocytosis and teratogenicity.]]
Answer B AnswerB::Gabapentin (Neurontin).
Answer B Explanation AnswerBExp::'''Incorrect:''' Gabapentin is a GABA analogue that inhibits voltage-gated calcium channels. It is used to treat epilepsy, peripheral neuropathy and bipolar disorder. Adverse effects include sedation and ataxia.
Answer C AnswerC::Venlafaxine (Effexor).
Answer C Explanation AnswerCExp::'''Incorrect:''' Venlafaxine is an SNRI (inhibits serotonin and norepinephrine reuptake) that is used for depression and generalized anxiety disorder.
Answer D AnswerD::Amitriptyline.
Answer D Explanation AnswerDExp::'''Incorrect:''' Amitryptyline is a tricyclic antidepressant.
Answer E AnswerE::Lithium (Lithobid).
Answer E Explanation [[AnswerEExp::Correct: Lithium is a mood-stabilizer used to treat bipolar disorder. Its mechanism of action is poorly understood. One of the side effects of lithium is hypothyroidism, which is responsible for the menstrual irregularities, constipation and fatigue in this patient. Further questioning might reveal other manifestations of hypothyroidism such as cold intolerance.]]
Right Answer RightAnswer::E
Explanation [[Explanation::This patient has likely been placed on lithium (Lithobid) for mood stabilization, one side effect of which is hypothyroidism.

Educational Objective: Lithium is a mood-stabilizer used to treat bipolar disorder; one side effect of Lithium therapy is hypothyroidism.

References: First Aid 2012 page 499
Educational Objective:
References: ]]

Approved Approved::No
Keyword WBRKeyword::Bipolar, WBRKeyword::Bipolar disorder, WBRKeyword::Lithium, WBRKeyword::Hypothyroidism, WBRKeyword::Side effect
Linked Question Linked::
Order in Linked Questions LinkedOrder::