Psychopharmacology: antidepressants and angle-closure glaucoma: 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 · Psychopharmacology: antidepressants and angle-closure glaucoma

Sample item

A 62-year-old woman with a shallow anterior chamber starts amitriptyline and soon develops a painful red eye with haloes around lights and blurred vision. What is the mechanism?

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

The answer and the reasoning

B. Anticholinergic pupillary dilatation narrows the angle

Tricyclic antidepressants block muscarinic receptors, causing mydriasis that can precipitate acute angle-closure glaucoma in those with narrow angles. SSRIs and other drugs causing mydriasis can also do so rarely. It is an ophthalmic emergency.

Option by option

  • A. Direct toxic effect on the retina

    This is not a retinal toxicity, since the syndrome is acute angle closure.

  • B. Anticholinergic pupillary dilatation narrows the angle (correct)

    Correct. Mydriasis from anticholinergic action closes a narrow angle.

  • C. Histamine blockade raising aqueous production

    Histamine blockade does not raise aqueous production.

  • D. Alpha-1 blockade causing miosis

    Alpha-1 blockade causes miosis and does not precipitate angle closure.

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 B, Anticholinergic pupillary dilatation narrows the angle. Tricyclic antidepressants block muscarinic receptors, causing mydriasis that can precipitate acute angle-closure glaucoma in those with narrow angles.

Why is "Direct toxic effect on the retina" not the answer?

This is not a retinal toxicity, since the syndrome is acute angle closure.

Why is "Histamine blockade raising aqueous production" not the answer?

Histamine blockade does not raise aqueous production.

Why is "Alpha-1 blockade causing miosis" not the answer?

Alpha-1 blockade causes miosis and does not precipitate angle closure.

What concept does this question test?

It tests Psychopharmacology: antidepressants and angle-closure glaucoma in Psychiatry. SSRIs and other drugs causing mydriasis can also do so rarely. It is an ophthalmic emergency.

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 Psychopharmacology: antidepressants and angle-closure glaucoma?

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.