{"id":5880,"date":"2025-04-23T12:01:48","date_gmt":"2025-04-23T20:01:48","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=5880"},"modified":"2026-07-29T13:07:15","modified_gmt":"2026-07-29T21:07:15","slug":"usmle-step-1-question-of-the-day-tramadol","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-tramadol","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day:\u00a0Tramadol"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_86 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-tramadol\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\" >The correct answer to today\u2019s USMLE\u00ae Step 1 Question is\u2026<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-tramadol\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-tramadol\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-tramadol\/#Major_Takeaway\" >Major Takeaway&nbsp;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-tramadol\/#Want_to_learn_more_about_this_topic\" >Want to learn more about this topic?<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-tramadol\/#References\" >References&nbsp;<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><em><strong>Determine the most likely diagnosis for a 50-year-old woman presenting with a variety of concerning symptoms after being prescribed tramadol<\/strong><\/em><strong><em>. Do you know the answer? Let&#8217;s find out!<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 50-year-old woman is brought to the emergency department by her son after being found lying on the bedroom floor. She appears disoriented, tremulous, diaphoretic, and complains of abdominal cramps and diarrhea. She visited the emergency department yesterday for evaluation of severe back pain and was prescribed tramadol by the ED physician. Past medical history is significant for major depressive disorder and type II diabetes mellitus. Current medications include metformin, atorvastatin, and escitalopram. She occasionally drinks alcohol on weekends; her last drink was two weeks ago. Her temperature is 38.9 C (102 F\u00b0), pulse is 118\/min, respirations are 18\/min, and blood pressure is 150\/92 mm Hg. Physical examination shows dilated pupils bilaterally, flushed skin, dry mucous membranes, and a positive Babinski sign. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Which of the following is the <em>most likely<\/em> diagnosis?\u00a0<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Neuroleptic malignant syndrome<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Hypertensive crisis<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Serotonin syndrome<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Delirium tremens<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Acute dystonia<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em>Scroll down for the correct answer!<\/em><\/p>\n\n\n\n<figure class=\"wp-block-embed aligncenter is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Learn with Osmosis\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/iDxHtjjCMbU?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\"><\/span>The correct answer to today\u2019s USMLE\u00ae Step 1 Question is\u2026<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Serotonin syndrome<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Correct:<\/strong> See Main Explanation.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_Answer_Explanations\"><\/span>Incorrect Answer Explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Neuroleptic malignant syndrome<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect: <\/strong>Neuroleptic malignant syndrome is a rare but serious complication of antipsychotic medications and classically presents with mental status changes, muscular rigidity, and autonomic instability, including fever (hyperthermia &gt;38\u00b0C). Serum creatine kinase &gt;1000 IU\/L suggests the diagnosis.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Hypertensive crisis<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Hypertensive crisis refers to a blood pressure of \u2265180\/120 mm Hg and can occur in patients on monoamine oxidase inhibitors (MAOI) following ingestion of tyramine-containing foods. Neither tramadol nor escitalopram is an MAOI.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Delirium tremens<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Delirium tremens can present with altered mental status and autonomic and neuromuscular hyperactivity; however, it occurs in heavy alcohol users 2-4 days after their last drink.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Acute dystonia<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Acute dystonia refers to involuntary contractions of muscles characterized by sudden onset muscle spasm, stiffness, and oculogyric crisis occurring hours to days after the use of typical antipsychotics, anticonvulsants, or metoclopramide. Altered mental status and autonomic hyperactivity are atypical.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<figure class=\"wp-block-image alignleft size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"970\" height=\"496\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/04\/image-6.png\" alt=\"Serotonin Syndrome\n* Serotonin Accumulation (Overstimulation of the nervous system)\n* Flushing\n* Hyperthermia\n* Agitation\n* Muscle rigidity\n* Seizure\n* Coma\" class=\"wp-image-5883\" style=\"aspect-ratio:1.9556492003730441;width:428px;height:auto\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/04\/image-6.png 970w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/04\/image-6.png?resize=300,153 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/04\/image-6.png?resize=768,393 768w\" sizes=\"auto, (max-width: 970px) 100vw, 970px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">This patient presents with increased neuromuscular activity (e.g., tremors, positive Babinski sign), autonomic instability, and altered mental status in the setting of tramadol ingestion with escitalopram consistent with <strong>serotonin syndrome.<\/strong>&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Serotonin syndrome is a life-threatening condition caused by<strong> the overstimulation of central and peripheral serotonin receptors<\/strong>. It presents with a <strong>triad of mental status changes, autonomic hyperactivity <\/strong>(e.g., hyperthermia, diaphoresis, and diarrhea), and <strong>neuromuscular abnormalities<\/strong> (clonus, hyperreflexia, hypertonia, tremor, and seizure).\u00a0<\/p>\n\n\n\n<figure class=\"wp-block-image alignright size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"961\" height=\"650\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/04\/image-7.png\" alt=\"Medications Associated with Serotonin Syndrome\nPsychiatric Drugs:\nMAOIs\nSSRIs\nSerotonin-norepinephrine reuptake\nTricyclic antidepressants (TCAs)\nVilazodone\nVortioxetine\nBuspirone\n\nNonpsychiatric Drugs\nTramadol\nOndansetron\nTriptans\nLinezolid\nMDMA\nDetromethorphan\nMeperidine\nSt. John's Wort\" class=\"wp-image-5884\" style=\"aspect-ratio:1.4784697741219481;width:583px;height:auto\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/04\/image-7.png 961w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/04\/image-7.png?resize=300,203 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/04\/image-7.png?resize=768,519 768w\" sizes=\"auto, (max-width: 961px) 100vw, 961px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">It results from an interaction<strong> <\/strong>between multiple medications that increase serotonergic neurotransmission. Treatment consists of<strong> immediate discontinuation of all serotonergic medications<\/strong>, supportive care (oxygen, intravenous fluids), benzodiazepines, and administration of <strong>cyproheptadine (serotonin antagonist that blocks 5HT2 receptors).<\/strong>\u00a0<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Before prescribing an SSRI or a serotonergic medication, potential <strong>medication interactions<\/strong> should be considered to avoid serotonin syndrome. When switching between serotonergic medications, adequate washout periods should be allowed to prevent the accumulation of excessive serotonin.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Serotonin syndrome is caused by overstimulation of central and peripheral serotonin receptors and presents a triad of mental status changes, autonomic hyperactivity, and neuromuscular abnormalities. It results from an interaction between multiple medications that increase serotonergic neurotransmission, most commonly SSRIs.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Want_to_learn_more_about_this_topic\"><\/span>Want to learn more about this topic?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Read this Osmosis Answer page:&nbsp;<a href=\"https:\/\/www.osmosis.org\/answers\/serotonin-syndrome\">Serotonin Syndrome<\/a><\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Lommel K.M., &amp; Meadows A.L., &amp; Chopra N, &amp; Thompson S (2017). Psychiatric emergencies. Stone C, &amp; Humphries R.L.(Eds.), CURRENT Diagnosis &amp; Treatment: Emergency Medicine, 8e. McGraw-Hill.&nbsp;<\/li>\n\n\n\n<li>Mason, P. J., Morris, V. A., &amp; Balcezak, T. J. (2000). Serotonin syndrome. Presentation of 2 cases and review of the literature. Medicine, 79(4), 201-209.&nbsp;<\/li>\n\n\n\n<li>Ganetsky, M., &amp; Brush, D. E. (2005). Serotonin syndrome\u2014what have we learned?. Clinical Pediatric Emergency Medicine, 6(2), 103-108.&nbsp;<\/li>\n\n\n\n<li>Mossop E, &amp; DiBlasio F (). Overdose, poisoning, and withdrawal. Oropello J.M., &amp; Pastores S.M., &amp; Kvetan V(Eds.), Critical Care. McGraw-Hill.&nbsp;<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><a href=\"https:\/\/www.osmosis.org\/mobile-app\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2021\/02\/Blog_Display_Ads_MOBILE1_2023.png?w=700\" alt=\"\" class=\"wp-image-4531\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2021\/02\/Blog_Display_Ads_MOBILE1_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2021\/02\/Blog_Display_Ads_MOBILE1_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><strong><em>Get<\/em><\/strong><em><strong> your\u00a0<em><strong><a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a><\/strong><\/em>\u00a0now to discover why millions of current and future clinicians and caregivers love learning by Osmosis.<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Enhance your USMLE\u00ae Step 2 CK exam preparation with today\u2019s case study of a 50-year-old woman experiencing symptoms of serotonin syndrome after tramadol use. Learn to recognize the clinical signs and understand the critical role of medication interactions in diagnosing this potentially life-threatening condition.<\/p>\n","protected":false},"author":202,"featured_media":5882,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,16,1366,1369,44],"tags":[649,651,440,84,245,149,652,650,451,648,185],"class_list":["post-5880","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-do","category-questions","category-step-1-questions","category-step-1","tag-clinical-diagnosis","tag-drug-interactions","tag-emergency-medicine","tag-medical-education","tag-nursing-education","tag-patient-care","tag-psychiatric-emergencies","tag-serotonin-syndrome","tag-step-1","tag-tramadol","tag-usmle"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 1 Question of the Day:\u00a0Tramadol - Osmosis Blog<\/title>\n<meta name=\"description\" content=\"Prepare for your USMLE\u00ae Step 1 exam by testing your knowledge on serotonin syndrome. 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