Mehl. bullet: extrapyramidal

Question 1

M. Medication that can cause tardive dyskinesia that is not an antipsychotic?

Answer 1

metoclopramide (D2 antagonist); can also prolong QT interval and cause hyperprolactinemia.

Question 2

M. Antipsychotic medication started + muscle rigidity + no fever; Dx + Tx?

Answer 2

acute dystonia, not neuroleptic malignant syndrome (because no fever);

Tx with benztropine (muscarinic receptor antagonist) or diphenhydramine (1st gen H1 blocker, which has strong anti-muscarinic side-effects).

Question 3

M. Antipsychotic medication started + abnormal eye movements + stiff neck; Dx?

Answer 3

acute dystonia (oculogyric crisis + torticollis).

Question 4

M. Antipsychotic medication started + muscle rigidity + fever; Dx + Tx?

Answer 4

neuroleptic malignant syndrome; give dantrolene (inhibits ryanodine channel).

Question 5

M. Antipsychotic med + restlessness; Dx + Tx?

Answer 5

Akathisia;

Tx with propranolol.

Psych shelf has Q where patient says: “I feel as though I am going to jump out of my skin!”answer = “adverse effect of prochlorperazine.”

Question 6

M. Antipsychotic med + bradykinesia; Dx + Tx?

Answer 6

drug-induced Parkinsonism; Tx with amantadine or propranolol.

Question 7

M. Antipsychotic med + abnormal tongue movements; Dx + Tx?

Answer 7

tardive dyskinesia; s

top antipsychotic + switch to atypical -> answer on Psych shelf for one Q is “discontinue haloperidol and switch to risperidone.”

Question 8

M. Mechanism for tardive dyskinesia?

Answer 8

answer on Psych NBME = “increased sensitivity of dopamine receptors.”