Step 2

Psychiatry 4

Patient is a 51-year-old woman who presents to the emergency department for altered mental status. She was found to be agitated and speaking nonsensical words. Her husband is at bedside and reports a history of depression for which she was treated with fluoxetine. The patient also uses diphenhydramine for her insomnia and seasonal allergies. Recently she had severe low back pain refractory to over-the-counter Tylenol and ibuprofen that she took her sister’s tramadol (Ultram) as per the husband. Her temperature is 39°c (103.2°F), blood pressure of 150/89, and pulse of 114.Hyperreflexia and muscular rigidity are noted on physical exam.

What is the most appropriate treatment for this patient condition?

  • A) Dantrolene
  • B) Cyproheptadine
  • C) Phenelzine
  • D) Physostigmine salicylate
  • E) Bromocriptine


Marina Tawadrous


Dr. Raj Dasgupta