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multiple choice questions (MCQs)
In this quick video we are going to cover an 8-step cognitive active strategy that students can use to process thru multiple choice questions. An 8-Step Cognitively Active Strategy to Process MCQs Nikki Dyer Student Academic Support Services & Inclusion July 2016
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Practice question (pharmacology)
A 26-year-old woman has been on antidepressant therapy for several months. Today she complains of missing her period and having what is eventually determined to be galactorrhea. Your careful assessment reveals that she has developed some dyskinesias not unlike those you would typically associate with a phenothiazine or butyrophrenone (e.g. haloperidol) antipsychotic drug. Pregnancy tests are negative. What drug is most likely to have caused these findings? A. Amoxapine B. Citalopram C. Fluoxetine D. Sertraline E. Tranylcypromine For this video, I am going to use a pharmacology question from the PreTest Pharmacology book, 13th edition. You can see the footnote on the slide for bibliographic information. Reference: PreTest Pharmacology, 13th ed, M. Shlafer, pp. 142 & Nikki Dyer, Student Academic Support Services & Inclusion July 2016
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1. Cover the answer Choices
A 26-year-old woman has been on antidepressant therapy for several months. Today she complains of missing her period and having what is eventually determined to be galactorrhea. Your careful assessment reveals that she has developed some dyskinesias not unlike those you would typically associate with a phenothiazine or butyrophrenone (e.g. haloperidol) antipsychotic drug. Pregnancy tests are negative. What drug is most likely to have caused these findings? A. B. C. D. E. First: You want to cover the answer choices. Reference: PreTest Pharmacology, 13th ed, M. Shlafer, pp. 142 & Nikki Dyer, Student Academic Support Services & Inclusion July 2016
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2. Read the question stem first
A 26-year-old woman has been on antidepressant therapy for several months. Today she complains of missing her period and having what is eventually determined to be galactorrhea. Your careful assessment reveals that she has developed some dyskinesias not unlike those you would typically associate with a phenothiazine or butyrophrenone (e.g. haloperidol) antipsychotic drug. Pregnancy tests are negative. What drug is most likely to have caused these findings? Second: Read the question stem FIRST. This is usually the last sentence or two and indicates the problem you are being asked to solve. This is highlighted for you in red. Reference: PreTest Pharmacology, 13th ed, M. Shlafer, pp. 142 & Nikki Dyer, Student Academic Support Services & Inclusion July 2016
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3. Look for the “Doctor” words
A 26-year-old woman has been on antidepressant therapy for several months. Today she complains of missing her period and having what is eventually determined to be galactorrhea. Your careful assessment reveals that she has developed some dyskinesias not unlike those you would typically associate with a phenothiazine or butyrophrenone (e.g. haloperidol) antipsychotic drug. Pregnancy tests are negative. What drug is most likely to have caused these findings? Third: Look for and mark what Princeton Review refers to as "Doctor" words. These are words that if they were removed from the question, would change how you process and answer it. So examples could include someone's race, gender, age, duration of symptoms or words like least/most, except, best, and phrases that indicate priority like "what should you do first in this situation. Some words that I think may be doctor words for this questions are in bolded in red. Reference: PreTest Pharmacology, 13th ed, M. Shlafer, pp. 142 & Nikki Dyer, Student Academic Support Services & Inclusion July 2016
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4. Predict your answer Fourth: Predict your answer to the question as if it were a short-answer or open ended question rather than multiple choice. Keep this choice in mind as you move through the remaining steps. How does your answer compare to each answer choices given? Maybe for this particular question you have to first define a few terms galactorrhea or dyskinesias. Maybe based on the symptoms you expect to see a drug or drugs that act on the dopamine receptors.
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5. Eliminate answer choices
A 26-year-old woman has been on antidepressant therapy for several months. Today she complains of missing her period and having what is eventually determined to be galactorrhea. Your careful assessment reveals that she has developed some dyskinesias not unlike those you would typically associate with a phenothiazine or butyrophrenone (e.g. haloperidol) antipsychotic drug. Pregnancy tests are negative. What drug is most likely to have caused these findings? A. Amoxapine B. Citalopram C. Fluoxetine Fifth: Now only look at three of your answer choices and get rid of at least one that you believe is the most incorrect based on the information in the question and what you identified as Doctor words. We encourage you to eliminate at least one choice but in this instant maybe you believe you can delete two. Although you cannot remember a lot about it right now, you believe that Amoxapine works on the central nervous system and for this reason (remember Step 4) you decide to keep it. You remember Celexa is a brand name for citalopram and from what you can remember about Celexa the symptoms the patient is experiencing is not usual side effects so you decide to eliminate B. Prozac is a brand name for Fluoxetine and this one has you a little stomped. The patients symptoms do not seem typical of what you can remember about Prozac side effects, but you do remember that sometimes the drug is given to treat premenstrual dysphoric disorder. The patient is complaining of galactorrhea and a missed period. You decide, though, that based on the symptoms the patient is experiencing it does not seem likely that C is the answer so you decide to eliminate it as well. Reference: PreTest Pharmacology, 13th ed, M. Shlafer, pp. 142 & Nikki Dyer, Student Academic Support Services & Inclusion July 2016
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6. Continue Eliminating A 26-year-old woman has been on antidepressant therapy for several months. Today she complains of missing her period and having what is eventually determined to be galactorrhea. Your careful assessment reveals that she has developed some dyskinesias not unlike those you would typically associate with a phenothiazine or butyrophrenone (e.g. haloperidol) antipsychotic drug. Pregnancy tests are negative. What drug is most likely to have caused these findings? A. Amoxapine B. Citalopram C. Fluoxetine D. Sertraline E. Tranylcypromine Sixth: Continue the process of eliminating at least one answer choice until you are left with the two that you believe are most correct. Maybe the only thing that you know about tranylcypromine is that it is not a first line defense drug. It is usually given after a patient has been treated with other drugs with unsuccessful symptom reduction. This patient has been on antidepressant therapy for several months with no mention of previous unsuccessful treatment history. You assume several months is not a significant list of time in this case scenario. For this reason, you decide to eliminate it. Reference: PreTest Pharmacology, 13th ed, M. Shlafer, pp. 142 & Nikki Dyer, Student Academic Support Services & Inclusion July 2016
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7. Which answer is more correct?
A 26-year-old woman has been on antidepressant therapy for several months. Today she complains of missing her period and having what is eventually determined to be galactorrhea. Your careful assessment reveals that she has developed some dyskinesias not unlike those you would typically associate with a phenothiazine or butyrophrenone (e.g. haloperidol) antipsychotic drug. Pregnancy tests are negative. What drug is most likely to have caused these findings? A. Amoxapine (Acts on dopamine receptors) B. Citalopram C. Fluoxetine D. Sertraline (CNS agent) E. Tranylcypromine Seventh: Look at these two answer choices that are left and think about how they are different. Is one more correct because of a doctor word in the question? In this case you have to decide between Amoxapine and Sertraline. Sertraline, you are unsure about. It is a CNS agent but you do not know anything about the side effects of the drug. Reference: PreTest Pharmacology, 13th ed, M. Shlafer, pp. 142 & Nikki Dyer, Student Academic Support Services & Inclusion July 2016
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8. Select the best answer A 26-year-old woman has been on antidepressant therapy for several months. Today she complains of missing her period and having what is eventually determined to be galactorrhea. Your careful assessment reveals that she has developed some dyskinesias not unlike those you would typically associate with a phenothiazine or butyrophrenone (e.g. haloperidol) antipsychotic drug. Pregnancy tests are negative. What drug is most likely to have caused these findings? A. Amoxapine (Acts on dopamine receptors) B. Citalopram C. Fluoxetine D. Sertraline (CNS agent) E. Tranylcypromine Eighth: Select the BEST answer based on your Active analysis of the question. Based on the doctor words and the patient symptoms you believe that what is most significant is that amoxapine acts on dopamine receptors so you go with Choice A and eliminate D. Reference: PreTest Pharmacology, 13th ed, M. Shlafer, pp. 142 & Nikki Dyer, Student Academic Support Services & Inclusion July 2016
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Explanation The mention of menstrual irregularities, galactorrhea, and what appears to be extrapyramidal side effects, should be a tip-off that we are dealing with a drug that interacts with dopamine receptors- specifically D2, by blocking them. Amoxapine, the correct answer, is a tricyclic antidepressant (secondary amine). It is rather unique among all the tricyclics (other secondary amines, and tertiary amines such as the more familiar amitriptyline and imipramine) in several respects. For one thing it inhibits neuronal dopamine and NE reuptake (the others affect mainly NE and serotonin). That however, does not readily explain the amenorrhea-galactorrhea and extrapyramidal side effects. What provides the explanation or mechanism relates to another rather unique property of amoxapine: one of its metabolites is a strong dopamine receptor antagonist, an action not shared by any of the other tricyclics; by the SSRIs( eg, citalopram, fluoxentine, sertraline; answers b, c, and d); or by the monoamine oxidase inhibitors (eg, tranylcypromine, e; or phenelzine). You should recall that such antipsychotic drugs such as the phenothiazines and haloperidol may also cause amenorrhea-galactorrhea and extrapyramidal side effects, by the same dopaminergic receptor-blocking mechanism. Conversely, drugs that activate dopamine receptors in one way or another (eg bromocriptine) can be used to manage these endocrine dysfunctions. Amoxapine’s dopamine receptor blockade also seems to account for why the drug exerts some antipsychotic properties, theoretically making it useful for patients with both psychosis and depression. Congratulations, you have just completed the 8 step approach to answering multiple choice questions. This strategy is particularly helpful when you are unsure of an answer or when several answer choices are probable but have to select the better choice. For your review, you can read the explanation to the practice question that we just completed. If you have any additional questions about processing through multiple choice questions, resources for practice questions, or other concerns please feel free to make an appointment with an educational specialists. You can make an appointment online, via or phone, or you can stop by the office to schedule one. Thank you. Reference: PreTest Pharmacology, 13th ed, M. Shlafer, pp. 142 & Nikki Dyer, Student Academic Support Services & Inclusion July 2016
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