Managing Acute Dystonic Reactions β A Critical UKMLA/PLAB Scenario
Master Emergency Clinical Scenarios for UKMLA and PLAB Success
This article explores a critical question from the August 2024 PLAB 1 exam, focusing on the recognition and immediate management of acute dystonic reactions. These potentially alarming side effects, often associated with dopamine receptor antagonists like metoclopramide, test your ability to provide rapid and effective treatment in high-pressure scenarios.
PLAB 1 Exam Case Scenario: A 45-year-old man develops acute-onset neck stiffness, difficulty swallowing, and a swollen tongue shortly after receiving intravenous metoclopramide for postoperative nausea. He is unable to move his neck normally and appears distressed.
Which is the most appropriate immediate management?
A) Administer intravenous diazepam
B) Commence intravenous hydrocortisone
C) Prescribe oral prochlorperazine
D) Stop metoclopramide and administer intramuscular procyclidine
E) Switch to ondansetron for nausea control
Answer with an explanation is provided below.
Our content is updated to align with the MLA content map
γ°οΈ
Our content is updated to align with the MLA content map γ°οΈ
The only guide you will ever need for your PLAB or UKMLA exam
Were MedRevisions.com materials enough to pass the First PLAB exam that was based of the MLA content map?: Visit here to see what this doctor had to say
Past PLAB 1 candidates reviews about MedRevisions verified with results
Follow us on telegram for more free questions
Exam preparation groups for the PLAB or MLA exam
Find the 10% discount referral links in the groups
More about the UKMLA or PLAB exam:
Important update to the PLAB exam: Is the PLAB exam based on the MLA content map from August 2024 onward? Find out more about the change and how to prepare for it here.
Evolving Nature of PLAB 1 Exam Questions: Is the exam getting tougher? A Closer Look with examples
What Past PLAB 1 candidates say about us (with exam results)
Explanation for the above PLAB / UKMLA exam question
Correct Answer: D) Stop Metoclopramide and Administer Intramuscular Procyclidine
Explanation and Clinical Reasoning
Key Features of Acute Dystonic Reactions
Rapid Onset:
Symptoms typically appear within hours of administering dopamine receptor antagonists such as metoclopramide.
Muscle Spasms:
Involuntary and often painful contractions, particularly in the neck (torticollis), jaw (trismus), or eyes (oculogyric crisis).
Dysphagia and Distress:
Difficulty swallowing due to pharyngeal muscle involvement, along with distress from the inability to control movements.
Reversible with Prompt Treatment:
Rapid administration of anticholinergic agents can reverse symptoms within minutes to an hour.
Why Procyclidine is the Optimal Treatment
Mechanism of Action:
Procyclidine, an anticholinergic, counters the dopamine blockade caused by metoclopramide. By restoring the balance between acetylcholine and dopamine in the basal ganglia, it alleviates dystonic symptoms.Fast Relief:
Intramuscular or intravenous procyclidine provides rapid symptom relief, making it the first-line treatment for acute dystonic reactions.Stopping Metoclopramide:
Discontinuing the offending agent prevents further exacerbation of symptoms.
Why Other Options Are Less Appropriate
A) Administer Intravenous Diazepam:
Diazepam may provide muscle relaxation but does not address the underlying dopamine-acetylcholine imbalance causing the dystonia.
B) Commence Intravenous Hydrocortisone:
Steroids are ineffective in treating acute dystonic reactions and do not address the pathophysiology.
C) Prescribe Oral Prochlorperazine:
Prochlorperazine, another dopamine receptor antagonist, could worsen the dystonia and is contraindicated.
E) Switch to Ondansetron for Nausea Control:
While ondansetron is a safer antiemetic alternative, it does not treat the acute dystonic reaction. The immediate priority is symptom reversal with procyclidine.
Management and Follow-Up
Immediate Steps:
Administer Procyclidine:
Administer intramuscular or intravenous procyclidine promptly. Alternative options, such as benztropine or diphenhydramine, can be used if procyclidine is unavailable.
Discontinue Metoclopramide:
Stop metoclopramide immediately to prevent symptom progression.
Monitor the Patient:
Observe for improvement in symptoms and any complications, such as respiratory distress.
Long-Term Considerations:
Switch to Safer Antiemetics:
Consider ondansetron for future nausea control to avoid dopamine antagonists.
Patient Education:
Inform the patient about their reaction and the need to avoid medications like metoclopramide in the future.
Prevention:
Document the adverse reaction in the patientβs medical records to prevent re-exposure.
π New Study Essential Mode For PLAB 1/UKMLA exam
For Focused, efficient, targeted learning for PLAB and UKMLA exam
This update gives you the freedom to prepare for your exam in a short time and cover the syllabus with around 1800+ questions and our updated notes. Then leverage the remaining 3000+ exam-style questions and solidify your concepts. Know how to use it from the link below and get access to the most updated and reliable exam-like materials. Learn more about the Study Essential Mode
Reference:
NICE Guidelines: Guidance on the management of drug-induced movement disorders, including acute dystonia.
Patient.info: Insights into recognising and managing dystonic reactions.
Remember: This blog post is for educational purposes only and should not be considered medical advice.
This is a high-yield exam PLAB 1/ UKMLA question-style question. At MedRevisions, We provide questions and not only explain the correct answer, we also explain the wrong answer so you will have a comprehensive understanding of the concepts that is commonly tested in the exam. On top of that, we also provide you PLAB 1 / UKMLA exam curated notes with no additional cost.
To discuss to more PLAB or UK-MLA exam questions, Join: PLAB 1 /UKMLA exam study group
At MedRevisions, we strive hard to provide the most up-to-date content available for PLAB Part 1. We constantly add exam-style questions derived from the most recent exam and also update the content to align with the latest NICE/CKS guidelines to ensure doctors pass PLAB Part 1 or UKMLA exam with ease in ONE attempt.
Past PLAB 1 candidates reviews about MedRevisions
How to use MedRevisions effectively for the PLAB 1 exam/ UKMLA exam preparation
Previous PLAB 1 or UKMLA exam guideline update
All MedRevisions recent updates
What we provide:
β 5000+ exam style questions
β Perfectly tailored exam style notes
β 30+ exam mocks
β
Spaced repetition learning tool
Haematology, Cardiology & Respiratory PLAB or UKMLA Exam Notes Also Got Better! Plus, Exciting Updates!