skip to main content

Panic disorder — USMLE Step 3 MCQ

Instant feedback + full explanation. One question, done properly.

HardPsychiatry (Outpatient Management)Panic disorderUSMLE Step 3

A 34-year-old with bipolar disorder becomes mute and immobile after a manic episode. She maintains fixed postures, resists passive movement, and intermittently imitates the examiner. Temperature, CK, and autonomic findings are normal. Which next step is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Administer a lorazepam challenge and monitor for clinical improvement

The best answer is “Administer a lorazepam challenge and monitor for clinical improvement”. The syndrome is catatonia, and a lorazepam challenge is both diagnostic and therapeutic. Antipsychotics can worsen catatonia. Normal temperature and CK argue against malignant syndromes. ECT is highly effective when benzodiazepines fail or malignant catatonia is present. The alternatives are less suitable because they mistime the intervention, omit a necessary component, or apply treatment for a different physiologic problem; the stem's decisive findings determine the sequence.

Reference: American Psychiatric Association, Resource Document on Catatonia: https://www.psychiatry.org/getattachment/bd1b5149-2c2e-472c-8fa9-1e5e79aeb4d5/Resource-Document-on-Catatonia.pdf