usmlebuzz
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A 18-year-old male comes to see his physician saying that he is going away to college next fall. He has had nightmares from which he wakes up screaming ever since he was a child. He never remembers the dream. He wonders if the doctor can prescribe anything to stop his nightmares, because he is planning to live in the dorm and it will be embarrassing if the problem continues. What is the proper response?
A. Prescribe a trial of ativan
B. Prescribe a trial of imiprimine
C. Prescribe a trial of phenobarbital
D. Psychiatric referral for forgotten trauma
E. Tell the patient that you are sorry but there is nothing that you can offer him
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| Ouli Maty
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Night terrors just like sleepwalking occur during the non-REM phase of the sleep in adult . They involve active use of muscles which aren't inhibited during that phase.
Long acting Benzodiazepines inhibiting phase 4 are used to treat those conditions.
C. Prescribe a trial of phenobarbital
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deep breathing...
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Phenobarbitol is a barbituate, not a benzo. Night terrors occur during stage 3/4 sleep which can be shortened (and therefore reduce frequency of attacks) by either a benzo or imipramine. The correct answer is therefore b) trial of imipramine.
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| dmnz
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Imipramine is second drug of choice after benzo-I agree with Mr Guest.
Deepak :wink:
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| drcounsel
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d- psychiatric ref. for trauma.... i think this is the answer
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Why not ativan?
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| Mann
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Answer is A-Ativan
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| oddissy4u
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whts Ativan and whts the mechanism of action????
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| Mann
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Lorazepam ( Alzapam, Ativan, Loraz, Lorazepam Intensol )
Lorazepam is an Antianxiety agent ( benzodiazepines, mild tranquilizer ) used for the relief of anxiety, agitation, irritability, to relieve insomnia, to calm people with mania / schizophrenia, and intravenously as a sedative and nervous tension or prior to surgery to relief the anxiety. It has less of an effect on the liver then other benzodiazepines, making it better suited if you are taking birth control pills, anti-abuse drugs, propranolol, ulcer medications, or any other drug that effects the liver. Ativan may also be used to help in the prevention of severe alcohol withdraw symptoms ( Delirium Tremens, DTs ), to treat serial seizures in children by placing it under the tongue, to promote amnesia, or in patients who are undergoing chemotherapy and have severe vomiting.
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| oddissy4u
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thnx mann.n what do u think is the answer to the ques?
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| usmlebuzz
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sorry for the delay in giving out corect answer :oops: :oops:
A is right :icon_thumb:
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| gpsbrar
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But actually it shoud be Ativan + Psychiatric consult. If the patient has anxiety and that too for such a long time, there is a requirement for psychiatrist consult. But if it what would you do NEXT?
is Ativan.
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B+
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| ssrpk
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| | 09/24/05 - 04:33 AM
1 of 1 forum leaders found this post helpful
| #13 |
remember, u don't refer ur pts on usmle exam. so give ur last priorities to referral!
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life is guud
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| sturge_weber
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| | 09/24/05 - 01:33 PM
1 of 1 forum leaders found this post helpful
| #14 |
wel gps that choice says psychiatric consult for forgotten trauma, its not trauma, its night terrors, which occur during nrem sleep, and they cant be remembered, person has tachycardia, and sweating etc, but pschi consult would not help
usmle buzz nice q, thanks
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| gpsbrar
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hey ssrpk. Thanks for the advice. I appreciate it my friend. You are right. Last pref. for the referals on the exam. I never thought that. Now I will keep that in mind. Thanks again.
And Sturge thanks to you to for simplifying the question and its options. i always make these silly mistakes. Thanks buddy. I should have focused more on the chief complaints.
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B+
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