WBR0596

Author	[[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pathology
Sub Category	SubCategory::Neurology
Prompt	[[Prompt::A 62 year old male patient, with a significant history of aortic valvulopathy, undergoes a planned prosthetic aortic valve replacement. Following the procedure in the coronary care units (CCU), the nurse notices the patient seizing continuously for 40 minutes without recovering from his state. The physician explains that the patient suffers from an ischemic stroke caused by calcific cerebral embolization during the surgery and prescribes a medication to acutely stop his seizures. In which of the following conditions is the prescribed class of medication not contraindicated?]]
Answer A	AnswerA::Acute liver toxicity
Answer A Explanation	AnswerAExp::Acute liver toxicity is a contraindication to the use of benzodiazepines.
Answer B	AnswerB::Acute angle glaucoma
Answer B Explanation	AnswerBExp::Benzodiazepines are contraindicated in acute angle glaucoma. They should be used with caution in patients with open-angle glaucoma.
Answer C	AnswerC::Pregnancy
Answer C Explanation	AnswerCExp::Benzodiazepines are considered class X, defined as containing teratogenic properties. As such, they are contraindicated in pregnancy.
Answer D	AnswerD::Myasthenia gravis
Answer D Explanation	AnswerDExp::Because myasthenia gravis (MG) potentially causes respiratory depression due to involvement of the diaphragm, benzodiazepines are contraindicated in MG because of their possible potentiation of respiratory depression.
Answer E	AnswerE::Restless leg syndrome
Answer E Explanation	AnswerEExp::Benzodiazepines are indicated for improving symptoms of restless leg syndrome.
Right Answer	RightAnswer::E
Explanation	[[Explanation::Benzodiazepines, especially lorazepam and diazepam, are indicated in the acute management of status epilepticus, defined as continuous seizure lasting more than 30 minutes or recurrent seizures without regaining consciousness for more than 30 minutes. However, benzodiazepines are not to be used alone following status epilepticus. Frequently, phenytoin is combined for the maintenance phase in patients with seizure disorder. Benzodiazepines are generally indicated in anxiety and sleep disorders, mood disorders, restless leg syndrome, and symptomatic improvement of substance withdrawal. They are considered teratogenic, hence contraindicated in pregnancy. They are also contraindicated in acute liver toxicity, and acute angle glaucoma. Use of benzodiazepines is also contraindicated in myasthenia gravis because of the drug's potentiation of respiratory depression in myasthenic patients with diaphragmatic involvement. Educational Objective: Benzodiazepines are indicated in the acute management of status-epilepticus and may also be used in restless leg syndrome. Educational Objective: References: ]]
Approved	Approved::No
Keyword	WBRKeyword::benzodiazepine, WBRKeyword::restless, WBRKeyword::leg, WBRKeyword::syndrome, WBRKeyword::restless leg syndrome, WBRKeyword::seizure, WBRKeyword::status, WBRKeyword::epilepticus, WBRKeyword::status epilepticus, WBRKeyword::embolization, WBRKeyword::stroke, WBRKeyword::valvulopathy, WBRKeyword::valve, WBRKeyword::disease, WBRKeyword::aortic, WBRKeyword::replacement, WBRKeyword::prosthetic, WBRKeyword::myasthenia, WBRKeyword::gravis, WBRKeyword::myasthenia gravis, WBRKeyword::prosthetic valve replacement, WBRKeyword::acute, WBRKeyword::liver, WBRKeyword::toxicity, WBRKeyword::acute liver toxicity, WBRKeyword::psychosis, WBRKeyword::acute psychosis, WBRKeyword::pregnancy, WBRKeyword::class X, WBRKeyword::class, WBRKeyword::X, WBRKeyword::contraindicated, WBRKeyword::contraindication, WBRKeyword::indicated, WBRKeyword::indication, WBRKeyword::cerebral, WBRKeyword::calcific, WBRKeyword::ischemic
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