Toxicology: MDMA: practice question

A Forensic 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.

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Forensic Medicine · Toxicology: MDMA

Sample item

An 18-year-old at an all-night dance party is brought with agitation, jaw clenching, temperature of 41 degrees Celsius and a serum sodium of 124 mEq/L after drinking a lot of water. What is the best initial management?

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

The answer and the reasoning

A. Rapid external cooling and intravenous benzodiazepines

MDMA releases serotonin and causes hyperthermia, agitation and, with excess water intake and ADH release, hyponatraemia. Priorities are active cooling and benzodiazepines for agitation and seizures. Antipyretics do not work because the cause is not a raised hypothalamic set point.

Option by option

  • A. Rapid external cooling and intravenous benzodiazepines (correct)

    Correct. Cooling and benzodiazepines treat hyperthermia and agitation.

  • B. Intravenous haloperidol for agitation

    Antipsychotics lower the seizure threshold and impair heat loss.

  • C. Oral paracetamol and observation

    Paracetamol is ineffective because the temperature is not driven by a raised set point.

  • D. Large volumes of hypotonic fluid to flush the drug

    Hypotonic fluid would worsen the hyponatraemia.

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 Forensic Medicine questions

Questions about this Forensic Medicine question

What is the answer to this Forensic Medicine question?

The best answer is A, Rapid external cooling and intravenous benzodiazepines. MDMA releases serotonin and causes hyperthermia, agitation and, with excess water intake and ADH release, hyponatraemia.

Why is "Intravenous haloperidol for agitation" not the answer?

Antipsychotics lower the seizure threshold and impair heat loss.

Why is "Oral paracetamol and observation" not the answer?

Paracetamol is ineffective because the temperature is not driven by a raised set point.

Why is "Large volumes of hypotonic fluid to flush the drug" not the answer?

Hypotonic fluid would worsen the hyponatraemia.

What concept does this question test?

It tests Toxicology: MDMA in Forensic Medicine. Priorities are active cooling and benzodiazepines for agitation and seizures. Antipyretics do not work because the cause is not a raised hypothalamic set point.

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 Toxicology: MDMA?

Learn postmortem changes with their timelines, and toxicology as poison, sign, test and antidote. Then use the flashcards and the other Forensic 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.