A 26-year-old woman with bipolar disorder explains to the PMHNP that she stopped taking her medication during a manic episode, but she now wants to start again. Prior to re-initiating lithium (Eskalith) for mood stabilization, which of the following labs are appropriate to obtain for this patient?
Thyroid function test, creatinine, liver function test
Thyroid function test, liver function test, pregnancy test
Thyroid function test, creatinine, complete blood count
Thyroid function test, creatinine, pregnancy test
The Correct Answer is D
Choice A reason: While liver function tests are sometimes monitored, lithium is primarily excreted renally, making creatinine more critical than liver function tests for baseline evaluation.
Choice B reason: Liver function tests alone are insufficient; kidney function must be assessed because lithium can cause nephrotoxicity.
Choice C reason: A complete blood count is not required prior to initiating lithium; the focus is on renal and thyroid function and pregnancy status.
Choice D reason: Baseline thyroid function is essential because lithium can affect thyroid activity. Creatinine assesses renal function since lithium is renally excreted. A pregnancy test is important due to potential teratogenic effects during pregnancy.
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Related Questions
Correct Answer is C
Explanation
Choice A reason: Fright syndromes typically involve transient anxiety and sadness but do not include the physical manifestations associated with Khayal.
Choice B reason: Weakness of the nervous system, such as neurasthenia, is associated with chronic fatigue and somatic complaints but does not reflect the acute episodic presentation of Khayal.
Choice C reason: Khayal is a Cambodian culture-bound syndrome characterized by a wind attack or sudden anxiety episode with physical symptoms, including tinnitus, palpitations, and neck soreness. It resembles a panic attack culturally contextualized.
Choice D reason: Excessive rumination or “thinking too much” is associated with some African or Caribbean syndromes but does not describe Khayal.
Correct Answer is C
Explanation
Choice A reason: Exercise therapy is a cornerstone of first-line treatment, improving strength, flexibility, and pain outcomes.
Choice B reason: Cognitive behavioral therapy addresses the psychosocial aspects of chronic pain and is recommended as first-line management.
Choice C reason: Spinal manipulation is not universally considered first-line treatment; it is adjunctive and varies in effectiveness depending on provider and patient.
Choice D reason: Encouraging patients to remain active is first-line advice, as immobility can worsen pain and disability.
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