Emergency medicine: malignant hyperthermia and NMS: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

General Medicine · Emergency medicine: malignant hyperthermia and NMS

Sample item

Within an hour of induction with sevoflurane and succinylcholine, a patient develops rigidity, rising end-tidal CO2 and temperature of 40 C. What is the specific treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Intravenous dantrolene

Malignant hyperthermia is triggered by volatile anaesthetics and succinylcholine in susceptible patients with RYR1 mutations, causing uncontrolled calcium release. Dantrolene blocks the ryanodine receptor and is the specific therapy, along with stopping triggers and cooling. Neuroleptic malignant syndrome is treated by stopping the neuroleptic, supportive care and dantrolene or bromocriptine in severe cases.

Option by option

  • A. Neostigmine

    Neostigmine does not treat this condition.

  • B. Intravenous bromocriptine only

    Bromocriptine alone is not the treatment of malignant hyperthermia.

  • C. Intravenous haloperidol

    Haloperidol can trigger NMS and worsen the picture.

  • D. Intravenous dantrolene (correct)

    Correct. Dantrolene is specific for malignant hyperthermia.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, Intravenous dantrolene. Malignant hyperthermia is triggered by volatile anaesthetics and succinylcholine in susceptible patients with RYR1 mutations, causing uncontrolled calcium release.

Why is "Neostigmine" not the answer?

Neostigmine does not treat this condition.

Why is "Intravenous bromocriptine only" not the answer?

Bromocriptine alone is not the treatment of malignant hyperthermia.

Why is "Intravenous haloperidol" not the answer?

Haloperidol can trigger NMS and worsen the picture.

What concept does this question test?

It tests Emergency medicine: malignant hyperthermia and NMS in General Medicine. Dantrolene blocks the ryanodine receptor and is the specific therapy, along with stopping triggers and cooling. Neuroleptic malignant syndrome is treated by stopping the neuroleptic, supportive care and dantrolene or bromocriptine in severe cases.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Emergency medicine: malignant hyperthermia and NMS?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.