Antipsychotics: hyperprolactinaemia: practice question

A Pharmacology 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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Pharmacology · Antipsychotics: hyperprolactinaemia

Sample item

A 26-year-old woman on risperidone for schizophrenia develops galactorrhoea and amenorrhoea. What is the mechanism?

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

The answer and the reasoning

C. Dopamine D2 blockade in the tuberoinfundibular pathway

Dopamine from the hypothalamus tonically inhibits prolactin secretion from the anterior pituitary. Blocking D2 receptors in the tuberoinfundibular pathway removes this inhibition, so prolactin rises, causing galactorrhoea, amenorrhoea and sexual dysfunction. Risperidone and amisulpride are strongly associated, whereas aripiprazole, a partial agonist, can lower prolactin.

Option by option

  • A. Serotonin 5-HT2A blockade in the cortex

    5-HT2A blockade is associated with reduced extrapyramidal effects.

  • B. Dopamine D2 blockade in the mesolimbic pathway

    Mesolimbic blockade produces the antipsychotic effect on positive symptoms.

  • C. Dopamine D2 blockade in the tuberoinfundibular pathway (correct)

    Tuberoinfundibular D2 blockade disinhibits prolactin release.

  • D. Histamine H1 blockade in the hypothalamus

    H1 blockade explains sedation and weight gain.

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.

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Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is C, Dopamine D2 blockade in the tuberoinfundibular pathway. Dopamine from the hypothalamus tonically inhibits prolactin secretion from the anterior pituitary.

Why is "Serotonin 5-HT2A blockade in the cortex" not the answer?

5-HT2A blockade is associated with reduced extrapyramidal effects.

Why is "Dopamine D2 blockade in the mesolimbic pathway" not the answer?

Mesolimbic blockade produces the antipsychotic effect on positive symptoms.

Why is "Histamine H1 blockade in the hypothalamus" not the answer?

H1 blockade explains sedation and weight gain.

What concept does this question test?

It tests Antipsychotics: hyperprolactinaemia in Pharmacology. Blocking D2 receptors in the tuberoinfundibular pathway removes this inhibition, so prolactin rises, causing galactorrhoea, amenorrhoea and sexual dysfunction. Risperidone and amisulpride are strongly associated, whereas aripiprazole, a partial agonist, can lower prolactin.

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 Antipsychotics: hyperprolactinaemia?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology 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.