USMLE PRACTICE QUESTION #84
TOPIC: Neurology/pharmacology
Today’s question will test your understanding of a commonly tested neurological condition and its treatment.
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A 65-year-old male presents to his primary care physician with progressive difficulty in concentrating, memory loss, and difficulty in performing daily tasks over the past six months. His wife also reports that he has become more irritable and socially withdrawn. The patient has a history of hypertension and is currently taking amlodipine. His vital signs are as follows: Blood pressure 140/90 mmHg, heart rate 78/minute, respiratory rate 14/minute, temperature 98.4°F (36.9°C), and oxygen saturation 97% on room air. A neurological examination reveals a decline in cognitive function, but no motor or sensory deficits. Which of the following medications would be most appropriate for this patient to enhance synaptic transmission in the context of his condition?
A) Memantine
B) Levodopa
C) Tetrabenazine
D) Sumatriptan
E) Baclofen
F) Donepezil
G) Propranolol
Detailed Breakdown of Answers + Correct Answer Below ⏬
ANSWER + QUESTION BREAKDOWN
The MENTAL MODEL used to answer this question comes from our detailed test-taking skills masterclass (check it out… it’s like putting your test-taking skills on steroids!) Here’s how to think through this question:
Step 1. Read the last line to get to the heart of the question: “Which of the following medications would be most appropriate for this patient to enhance synaptic transmission in the context of his condition?”
Step 2: Is this a first-, second-, or third-order question?
Answer: 2nd order. 1st: Diagnose the condition, and 2nd: Identify the most appropriate medication.
Step 3: Read the vignette carefully and ask yourself: “Which medication would help this patient based on enhancing synaptic transmission?”
Step 4. Look at the answer choices and select the option most closely resembling your final thought from “Step 3” above.
GENERAL ANALYSIS
The patient's symptoms and clinical findings suggest a decline in cognitive function, likely due to Alzheimer's disease or a similar form of dementia.
ANSWER CHOICES:
CHOICE A: Memantine
Explanation: An NMDA receptor antagonist may be used for moderate to severe Alzheimer's disease to regulate glutamate activity. While useful, it is typically added later or combined with cholinesterase inhibitors.
CHOICE B: Levodopa
Explanation: This drug is used primarily for Parkinson’s disease.
CHOICE C: Tetrabenazine
Explanation: This is used to treat hyperkinetic movement disorders by depleting monoamines. It is not relevant for cognitive enhancement.
CHOICE D: Sumatriptan
Explanation: This is a serotonin agonist used for treating migraines. It is not related to cognitive function improvement.
CHOICE E: Baclofen
Explanation: This is a muscle relaxant used for spasticity. It does not address cognitive decline.
CHOICE F: Donepezil
Explanation: This is a cholinesterase inhibitor used to treat symptoms of Alzheimer's disease by preventing the breakdown of acetylcholine, thereby enhancing cholinergic transmission in the brain. It is commonly prescribed to improve memory and cognitive function in patients with Alzheimer's disease.
CHOICE G: Propranolol
Explanation: This is a beta-blocker used for hypertension and anxiety. It is not indicated for cognitive enhancement.
FINAL VERDICT…
Donepezil is the most appropriate choice for enhancing synaptic transmission and improving cognitive symptoms in this patient.
CORRECT ANSWER: F) Donepezil
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That’s it for question 84!
See ya tomorrow 👋