Step 2

Psychiatry 3

A 22-year-old man Is brought in by ambulance to the emergency department with profound rigidity and extreme agitation for the past 1 hour. His mother relays that the patient was previously well but woke up this morning feeling very hot with no symptomatic relief with acetaminophen. She recalls the patient visiting a psychiatrist 7 days ago following concerns that he could hear voices telling him to kill himself that no one else around him was able to hear. She is unsure of the outcome of this appointment. Vital signs are temperature 39.5° C (103.1° F), pulse 115 beats/min, and respirations 22/min. Systolic blood pressure is noted to fluctuate between 133mmHg and 160mmHg. On physical examination, the patient appears diaphoretic and displays mutism. Neurological examination reveals generalized muscle rigidity and bradyreflexia.

Pertinent laboratory studies include the following:

  • Leukocyte count - 21,000/mm3
  • Creatine kinase - 2,000 U/L

Intravenous access is obtained, and the patient is transferred to intensive care unit (ICU).

Which of the following medications would not be useful in managing this patient?

  • A) Amantadine
  • B) Bromocriptine
  • C) Cyproheptadine
  • D) Dantrolene
  • E) Diazepam

Authors

Geraldine Le

Editor

Ted O'Connell

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