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Old 03-22-2013
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Neuro Patient with memory problem?

A 29-year-old woman with an 11-year history of bipolar disorder comes to the physician because she is concerned about memory loss over the past 2 weeks. She has had difficulty remembering appointments that she has made, and on one occasion, she got lost going to the health club where she has been a member for years. She has taken lithium carbonate for 8 years, and she has been taking a friend's diuretic for perimenstrual weight gain over the past 3 months. Physical examination shows a resting tremor of both hands and mild ataxia. On mental status examination, she is oriented to person, place, and time, but recalls only one of three objects at 5 minutes.

For each patient with a memory problem, select the most likely diagnosis.

(A) Alcohol-induced amnestic episode (blackout)
(B) Alcohol withdrawal
(C) Apathetic hyperthyroidism
(D) Bipolar disorder, depressed
(E) Delirium due to a medical condition
(F) Dementia, alcohol-related
(G) Dementia, Alzheimer's type
(H) Generalized anxiety disorder
(I) Masked depression
(J) Medication toxicity
(K) Normal age-associated memory decline
(L) Normal pressure hydrocephalus
(M) Parkinson's disease
(N) Pick's disease
(O) Pseudodementia
(P) Residual schizophrenia
(Q) Multi-infarct (vascular) dementia


Please explain.
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Old 03-22-2013
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(J) medication toxicity

thats the first thing that came to my mind.

Lithium + diuretics = ^ lithium toxicity.

Renal injury, toxins and drugs such as Diuretics, NSAIDS and ACE-I can increase the proximal tubular absorption of sodium and will increase lithium levels which will elevate the risk of lithium toxicity.

Lithium causes Tremors and high Sodium causes delirium.
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Old 03-22-2013
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Correct Answer Correct answer is (J) medication toxicity

Thanks for the explanations!
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Behavioral-Sciences-, Nervous-System-, Pathology-, Step-1-Questions, Toxicology-

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