Psychopharmacology: NMS treatment: practice question

A Psychiatry 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

Psychiatry · Psychopharmacology: NMS treatment

Sample item

A patient on haloperidol develops fever of 40 degrees C, lead-pipe rigidity, sweating, labile blood pressure and a creatine kinase of 12,000 units per litre. Apart from stopping the drug and cooling, which drugs are used?

ADantrolene and bromocriptineBCyproheptadine and chlorpromazineCHaloperidol at a lower doseDLithium and valproate

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

The answer and the reasoning

A. Dantrolene and bromocriptine

Neuroleptic malignant syndrome is managed by stopping the antipsychotic, supportive care with cooling and fluids, and benzodiazepines. Dantrolene, a muscle relaxant acting on ryanodine receptors, and bromocriptine, a dopamine agonist, are used in severe cases. ECT is an option in refractory cases.

Option by option

A. Dantrolene and bromocriptine (correct)
Correct. Dantrolene and bromocriptine are the usual specific agents.
B. Cyproheptadine and chlorpromazine
Cyproheptadine treats serotonin syndrome, and chlorpromazine is a dopamine blocker.
C. Haloperidol at a lower dose
Continuing any dopamine blocker worsens the syndrome.
D. Lithium and valproate
Lithium and valproate have no role in NMS.

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.

Questions about this Psychiatry question

What is the answer to this Psychiatry question?

The best answer is A, Dantrolene and bromocriptine. Neuroleptic malignant syndrome is managed by stopping the antipsychotic, supportive care with cooling and fluids, and benzodiazepines.

Why is "Cyproheptadine and chlorpromazine" not the answer?

Cyproheptadine treats serotonin syndrome, and chlorpromazine is a dopamine blocker.

Why is "Haloperidol at a lower dose" not the answer?

Continuing any dopamine blocker worsens the syndrome.

Why is "Lithium and valproate" not the answer?

Lithium and valproate have no role in NMS.

What concept does this question test?

It tests Psychopharmacology: NMS treatment in Psychiatry. Dantrolene, a muscle relaxant acting on ryanodine receptors, and bromocriptine, a dopamine agonist, are used in severe cases. ECT is an option in refractory cases.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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 Psychopharmacology: NMS treatment?

Learn each diagnosis by its core features and its first-line treatment. Then use the flashcards and the other Psychiatry 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.