QBDOTW: 28-year-old Female Complaining of Fear & Apprehension
Welcome to our USMLE Question of the Week. Here’s the break down of a high-yield USMLE style Pharmacology question for those preparing for your Step 1 Exam. As always you want to begin with reading the last sentence of the vignette first to get an understanding of what the question is asking for.
Question Break Down of the Week:
A 28-year-old female presents to her primary care physician complaining of overwhelming fear and apprehension. The patient states that she has been feeling anxious for the past 9 months and worried about many things on almost a daily basis. She states that she sometimes feels like her heart is racing, but her pulse is never above 100. She has difficulty concentrating and difficulty sleeping because she “can’t shut her brain off.” She also says she often feels tense and restless. She denies past substance abuse. Which of the following drugs would be considered first-line treatment for her illness?
A) Amitriptyline
B) Buspirone
C) Sertraline
D) Flumazenil
E) Midazolam
The correct answer choice is C. This patient suffers from generalized anxiety disorder (GAD), which is marked by symptoms of excessive worry and anxiety about every aspect of one’s life. Excessive anxiety and worry about different aspects of daily life (e.g., work, school, children) for most days of ≥ 6 months. Associated with ≥ 3 of the following for adults (≥ 1 for kids): restlessness, irritability, sleep disturbance, fatigue, muscle tension, difficulty concentrating. Treatment: CBT, SSRIs, SNRIs are the first line. Buspirone, TCAs, benzodiazepines are second line. Benzodiazepines are second-line agents in the treatment of GAD due to their sedative properties. However, patients with polydrug or alcohol use, chronic pain disorders, and severe personality disorders probably should not be prescribed benzodiazepines in light of the high potential in such patients for benzodiazepine dependence.
Did you think the answer was different?
Did you think that the correct answer choice was other than C? You can view this video for a deeper discussion of why A, B, D, and E were not the correct answer choices.
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