Antidepressants: tricyclic overdose: practice question

A Psychiatry question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Psychiatry · Antidepressants: tricyclic overdose

Sample item

A patient who took many amitriptyline tablets has a wide QRS complex on ECG and ventricular arrhythmias. Which treatment is indicated?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Intravenous sodium bicarbonate

TCA cardiotoxicity results from sodium channel blockade, causing QRS widening and arrhythmias, and sodium bicarbonate (alkalinisation and sodium load) is the treatment. Flumazenil can precipitate seizures in TCA overdose.

Option by option

  • A. Intravenous sodium bicarbonate (correct)

    Correct. Bicarbonate reverses sodium channel blockade effects.

  • B. Physostigmine

    Physostigmine is generally avoided in TCA poisoning because of risk of seizures and asystole.

  • C. Intravenous digoxin

    Digoxin can worsen the arrhythmia and conduction.

  • D. Flumazenil

    Flumazenil is for benzodiazepine overdose and may provoke seizures here.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Psychiatry question

What is the answer to this Psychiatry question?

The best answer is A, Intravenous sodium bicarbonate. TCA cardiotoxicity results from sodium channel blockade, causing QRS widening and arrhythmias, and sodium bicarbonate (alkalinisation and sodium load) is the treatment.

Why is "Physostigmine" not the answer?

Physostigmine is generally avoided in TCA poisoning because of risk of seizures and asystole.

Why is "Intravenous digoxin" not the answer?

Digoxin can worsen the arrhythmia and conduction.

Why is "Flumazenil" not the answer?

Flumazenil is for benzodiazepine overdose and may provoke seizures here.

What concept does this question test?

It tests Antidepressants: tricyclic overdose in Psychiatry. Flumazenil can precipitate seizures in TCA overdose.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Antidepressants: tricyclic overdose?

Learn each diagnosis by its core features and its first-line treatment. Then use the flashcards and the other Psychiatry questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.