{"id":2228,"date":"2022-11-30T20:24:00","date_gmt":"2022-11-30T20:24:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=2228"},"modified":"2025-10-01T11:40:33","modified_gmt":"2025-10-01T19:40:33","slug":"usmle-step-1-question-of-the-day-activating-n-methyl-d-aspartate-nmda-receptors","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-activating-n-methyl-d-aspartate-nmda-receptors","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day: Activating N-Methyl-D-Aspartate (NMDA) Receptors"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-activating-n-methyl-d-aspartate-nmda-receptors\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\" >The correct answer to today&#8217;s USMLE\u00ae Step 1 Question is&#8230;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-activating-n-methyl-d-aspartate-nmda-receptors\/#A_Nystagmus\" >A. Nystagmus<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-activating-n-methyl-d-aspartate-nmda-receptors\/#Incorrect_answer_explanations\" >Incorrect answer explanations<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-activating-n-methyl-d-aspartate-nmda-receptors\/#B_Conjunctival_injection\" >B. Conjunctival injection<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-activating-n-methyl-d-aspartate-nmda-receptors\/#C_Mydriasis\" >C. Mydriasis<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-activating-n-methyl-d-aspartate-nmda-receptors\/#D_Respiratory_depression\" >D. Respiratory depression<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-activating-n-methyl-d-aspartate-nmda-receptors\/#E_Prinzmetal_angina\" >E. Prinzmetal angina<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-activating-n-methyl-d-aspartate-nmda-receptors\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-activating-n-methyl-d-aspartate-nmda-receptors\/#Major_Takeaway\" >Major Takeaway<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-activating-n-methyl-d-aspartate-nmda-receptors\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics.&nbsp;<\/em><\/strong><strong><em>Today&#8217;s case focuses on a 24-year-old-man showing aggression. Urine toxicology confirms the use of a drug that exerts its effects by binding to and activating<strong><em>&nbsp;N-methyl-D-aspartate (NMDA) receptor<\/em><\/strong>s. Can you figure it out?<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 24-year old man is brought to the emergency department by the police after being found wandering the streets screaming at bystanders. He resisted arrest and became physically aggressive. While a nurse attempts to place an IV, the patient screams and attempts to hit him. His temperature is 37.1\u00b0C (98.6\u00b0F), respirations are 20\/minute, heart rate is 120\/minute, and blood pressure is 155\/95 mmHg. The patient is subsequently provided with intramuscular haloperidol. Urine toxicology confirms the use of a drug that exerts its effects by binding to and activating N-methyl-D-aspartate (NMDA) receptors. Which of the following physical exam findings is highly associated with this drug?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Nystagmus<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Conjunctival injection<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Mydriasis&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Respiratory depression<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Prinzmetal angina<\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s USMLE\u00ae Step 1 Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"A_Nystagmus\"><\/span>A. Nystagmus<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the Main Explanation, let&#8217;s look at the incorrect answer explanations. Skip to the bottom if you want to see the correct answer right away!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_answer_explanations\"><\/span>Incorrect answer explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The incorrect answers to today&#8217;s USMLE\u00ae Step 1 Question are&#8230;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B_Conjunctival_injection\"><\/span>B. Conjunctival injection<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Conjunctival injection is common to cannabis intoxication. Cannabis exerts its effects by binding to the cannabinoid binding receptors 1 and 2 (CB1 and CB2).&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Mydriasis\"><\/span>C. Mydriasis<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Miosis is more commonly observed with PCP intoxication, not mydriasis.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Respiratory_depression\"><\/span>D. Respiratory depression<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Respiratory depression is a well-known complication of overdoses on opioids like heroin, which exerts their effects by binding to the opioid receptors, not NMDA receptors.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Prinzmetal_angina\"><\/span>E. Prinzmetal angina<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Prinzmetal angina is associated with overdoses of vasoconstrictive agents like cocaine. Cocaine does not exert its effects on NMDA receptors.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This patient presents with characteristic features of phencyclidine (PCP) intoxication \u2013 an analgesic and anesthetic drug that exerts its effects by antagonizing the N-methyl-D-aspartate (NMDA) receptors found in the hypothalamus, basal ganglia, and neocortex.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Mechanistically, PCP is classified as a dissociative anesthetic. It is most commonly inhaled, with a rapid onset of effects including dysphoria, agitation, and diminished pain perception. Aggressive combative behavior is usually seen in patients taking PCP and may lead to serious injuries to self or others. When consumed in excess, patients may suffer from seizures as well.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">On physical examination, patients with PCP intoxication have evidence of hypertension, tachycardia, hyperventilation, and hyperthermia. Nystagmus is almost always observed on physical examination, often with associated miosis.&nbsp;<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"961\" height=\"610\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T142540.264.png\" alt=\"Phencyclidine (PCP) symptoms\" class=\"wp-image-2230\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T142540.264.png 961w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T142540.264.png?resize=300,190 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-11T142540.264.png?resize=768,487 768w\" sizes=\"auto, (max-width: 961px) 100vw, 961px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">PCP is a dissociative anesthetic that works via binding to NMDA receptors. Intoxication is associated with agitation, combative behavior, dysphoria, diminished perception of pain, and nystagmus.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Bey, T., &amp; Patel, A. (2007).&nbsp;<em>Phencyclidine intoxication and adverse effects: a clinical and pharmacological review of an illicit drug. The California journal of emergency medicine, 8(1), 9\u201314.&nbsp;<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Journey JD, Bentley TP.\u00a0<em>Phencyclidine (PCP) Toxicity<\/em>. [Updated 2020 Jun 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from:\u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK507865\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK507865\/<\/a>\u00a0\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0_____________________<br><em>Try Osmosis today! Access your\u00a0<a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a>\u00a0and find out why millions of current and future clinicians and caregivers love learning with us.<\/em><\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><a href=\"https:\/\/www.osmosis.org\/\"><img loading=\"lazy\" decoding=\"async\" width=\"994\" height=\"356\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_d8ddfb.png\" alt=\"Osmosis sign up ad\" class=\"wp-image-2231\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_d8ddfb.png 994w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_d8ddfb.png?resize=300,107 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_d8ddfb.png?resize=768,275 768w\" sizes=\"auto, (max-width: 994px) 100vw, 994px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em><a href=\"https:\/\/www.osmosis.org\/\"><\/a><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics.&nbsp;Today&#8217;s case focuses on a 24-year-old-man showing aggression. Urine toxicology confirms the use of a drug that exerts its effects by binding to and activating&nbsp;N-methyl-D-aspartate (NMDA) receptors. Can you figure it out? A 24-year old man is brought [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":2229,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,1369,44],"tags":[],"class_list":["post-2228","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-step-1-questions","category-step-1"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 1 Question of the Day: Activating N-Methyl-D-Aspartate (NMDA) Receptors - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-activating-n-methyl-d-aspartate-nmda-receptors\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 1 Question of the Day: Activating N-Methyl-D-Aspartate (NMDA) Receptors - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics.&nbsp;Today&#8217;s case focuses on a 24-year-old-man showing aggression. Urine toxicology confirms the use of a drug that exerts its effects by binding to and activating&nbsp;N-methyl-D-aspartate (NMDA) receptors. Can you figure it out? 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