Mehl. bullet: medications (depresion) + tic disorders

Question 1

M. Doxepin is asked on 2CK Psych form, where the Q rides on you knowing it’s a TCA to get it right (i.e., the only drug listed that causes anti-cholinergic effects). I mention this because students get the Q wrong and then are like wtf is doxepin.

Answer 1

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Question 1

M. USMLE will give you kid who had sore throat two weeks ago + now has a new-onset tic, ADHD, or OCD, and they will ask what will most likely diagnose etiology for the disorder??

Answer 1

anti-streptolysin O titers.”

Dx - PANDAS

Question 2

M. 2M + sore throat + new-onset tic; Dx?

Answer 2

ANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus); Group A Strep infection can lead to tic, ADHD, OCD; question on
student’s USMLE asked for “anti-streptolysin O titer” as the answer to help assess etiology in kid with
a tic starting after a sore throat.

Question 3

M. 2M + sore throat + new-onset tic; how to make etiology?

Answer 3

USMLE asked for “anti-streptolysin O titer” as the answer to help assess etiology in kid with
a tic starting after a sore throat.

Question 4

M. 7F + facial grimaces past 5 months + no other motor findings or abnormal sounds + mental status normal; Dx?

Answer 4

provisional tic disorder

1/5 children experience some form of tic disorder; most common ages 7- 12; usually lasts less than a year; “watch and wait” approach recommended. Provisional tic disorder used to be called transient tic disorder; the name was changed because a small % go on to develop chronic tics.

Question 5

M. 7F + facial grimaces past 5 months + no other motor findings or abnormal sounds + mental status normal; Mx?

Answer 5

schedule a follow-up examination in 3 months;

Dx provisional tic disorder