Aligned with the National Board of Medical Examiners format. Authored & peer-reviewed by faculty, clinicians, and clerkship directors.
Each question is written to resemble the format and topics on the exam, meaning you won’t see any negatively phrased questions, no “all of the following except,” no “A and B”…you know what we mean. Most importantly, all questions include selective distractors (incorrect answer choices), which will help you think critically.
A 62-year-old woman presents to the emergency room with acute onset of disorientation, akathisias, flushing, low-grade fever, hypertension, diaphoresis, tachycardia, and myoclonus. Her medications include citalopram, hydrochlorothiazide, metformin, and transdermal selegiline. What pharmacological intervention would be most effective in addition to admitting this woman to the hospital?
This woman is suffering from serotonin syndrome due to a drug-drug interaction between selegiline and citalopram. Serotonin syndrome is a potentially life-threatening condition characterized by altered level of consciousness, autonomic instability, and neuromuscular abnormalities such as myoclonus, hyperreflexia, nystagmus, akathisia, and muscle rigidity. The differential diagnoses could include neuroleptic malignant syndrome, malignant hyperthermia, anticholinergic toxicity, sympathomimetic intoxication, and sedative-hypnotic withdrawal. Treatment of serotonin syndrome includes discontinuation of the offending agents, supportive therapy, and use of the nonspecific serotonin antagonist cyproheptadine.
Use of bromocriptine (A) and dantrolene (C) is indicated in neuroleptic malignant syndrome. However, bromocriptine can worsen serotonin syndrome. Though typically thought of as a dopamine agonist, it also has serotonin agonist properties. Though anticholinergic toxicity can be reversed with physostigmine (D), it has no role in treating serotonin syndrome.
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After each explanation is a straightforward question with a simple, memorizable answer that reinforces the corresponding topic.
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