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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.

  • Must address important content
  • Must be well structured


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?

A Bromocriptine
B Cyproheptadine
C Dantrolene
D Physostigmine

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.


Written with a purpose

Understanding why an answer choice is incorrect is just as important as knowing why one is correct. That’s why every Rosh Review question includes detailed explanations for the correct and incorrect answer choices. These comprehensive summaries link the most important components of a topic—from risk factors to diagnostics and treatment—giving you the context to build relationships between them.

  • Created for optimal learning and recall
  • Help reinforce your knowledge
  • Focus on the essential information


Created to enhance learning

Custom illustrations and tables help further clarify the core concepts. When information is presented visually, you can focus on meaning, easily reorganize and group similar ideas, and make better use of your memory.

serotonin syndrome

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After each explanation is a straightforward question with a simple, memorizable answer that reinforces the corresponding topic.

  • Strengthens your knowledge
  • Stands alone from the main explanation so you’re not rereading content

Q: What other class of medications is helpful in managing serotonin syndrome?

Reveal Answer

A: Benzodiazepines.

Serotonin Syndrome

  • Patient with a history of taking multiple medications that increase the amount of serotonin
  • PE will show mental status changes, autonomic instability, and neuromuscular abnormalities
  • Treatment is benzodiazepines, cyproheptadine, removing the offending agent(s)

Rapid Review

Keeping things simple

These bulleted reviews focus on condensed, high-yield concepts about the main topic, from patient presentation to preferred management.

  • Cover the fundamentals in one list
  • Allow you to quickly scan the must-know information
I focused on the Rosh Review Qbank before my shelf exam, and I scored the highest in my clerkship. All I have to say is...your content is amazing.


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You can access free practice questions with a free trial for a Shelf Exam Qbank—no billing information required. The free trial includes practice questions that align with topics found on the shelf exam and include comprehensive answer explanations and beautiful teaching images.

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