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IM haloperidol
2%
1/50
Haloperidol depot
8%
4/50
Clozapine
6%
3/50
Urine toxicology
40%
20/50
ANA and anti-dsDNA levels
42%
21/50
Select Answer to see Preferred Response
This patient is presenting with 5 of 11 criteria for systemic lupus erythematosus (SLE). The best next step in management for this patient's underlying condition is an ANA and anti-dsDNA level to support the diagnosis. The diagnosis of SLE can be made when 4 of 11 SLE criteria are met (serositis (pleuritis/pericarditis), oral ulcers, arthritis, photosensitivity, blood disorder (anemia, leukopenia), renal problems, ANA (+), immunological (anti-dsDNA or anti-Smith), neurological symptoms (psychosis, seizures), malar rash, discoid rash). This patient is presenting with serositis (pericardial friction rub), oral ulcers, hemolytic anemia, new-onset psychosis, and renal failure. To further confirm the diagnosis, a sensitive test (ANA titer) and specific test (anti-dsDNA titer or anti-Smith titer) should be obtained prior to the onset of therapy. Incorrect Answers: Answer 1: IM haloperidol would offer quick-onset relief of this patient's new-onset psychosis, in particular if the patient refuses to take any medications by mouth. However, this patient is no longer experiencing any psychotic symptoms (she is resting in bed peacefully) and it would be more appropriate to further confirm the diagnosis first. Answer 2: Haloperidol depot is the treatment of choice for schizophrenic patients who do not reliably take their medications as it offers a long-acting therapy to control their symptoms. Since this patient no longer seems to be experiencing symptoms of psychosis, further workup is a more appropriate next step. Answer 3: Clozapine is the most effective anti-psychotic that is typically used as a final line in treatment of schizophrenia due to its side-effects such as agranulocytosis. This would not be used first-line to manage psychosis, and further workup should be explored to confirm the diagnosis. Answer 4: Urine toxicology would be an appropriate initial step in workup in a patient presenting with new-onset psychosis. This question asked which of the following is the best next step in management for this patient's underlying condition. Since this patient's underlying condition is SLE, further confirming the diagnosis is a better answer. Bullet Summary: The best initial step in management is to confirm the diagnosis with an ANA level (sensitive test) and anti-dsDNA or anti-Smith level (specific test).
3.9
(13)
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