{"id":808,"date":"2023-10-26T14:00:00","date_gmt":"2023-10-26T14:00:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=808"},"modified":"2025-10-01T11:39:36","modified_gmt":"2025-10-01T19:39:36","slug":"usmle-step-1-question-of-the-day-neuroleptic-malignant-syndrome","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-neuroleptic-malignant-syndrome","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day: Neuroleptic Malignant Syndrome"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 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-neuroleptic-malignant-syndrome\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\" >The correct answer to today&#8217;s USMLE\u00ae Step 1 Question is&#8230;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-neuroleptic-malignant-syndrome\/#A_Myoclonus\" >A. Myoclonus<\/a><\/li><\/ul><\/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-neuroleptic-malignant-syndrome\/#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-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-neuroleptic-malignant-syndrome\/#B_Hyperthermia\" >B. Hyperthermia&nbsp;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-neuroleptic-malignant-syndrome\/#C_Tachycardia\" >C. Tachycardia<\/a><\/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-neuroleptic-malignant-syndrome\/#D_Increased_muscle_tone\" >D. Increased muscle tone<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-neuroleptic-malignant-syndrome\/#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-8\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-neuroleptic-malignant-syndrome\/#Major_Takeaway\" >Major Takeaway&nbsp;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-neuroleptic-malignant-syndrome\/#References\" >References&nbsp;<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics.&nbsp;<\/em><\/strong><strong><em>Today&#8217;s case focuses on a 23-year-old man who collapsed and started having tremors in the upper and lower extremities during a festival.&nbsp;<\/em><\/strong><strong><em>Can you figure it out?<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 23-year-old man is brought to the emergency department after collapsing at a music festival on a hot summer day. The patient was with friends at an electronic dance show. According to his friends, the patient consumed a powdered drug at the concert. Afterward, while dancing, he suddenly collapsed and started having tremors in the upper and lower extremities. He has a past medical history of depression, anxiety, and bipolar disorder, for which he takes fluoxetine, alprazolam as needed, and aripiprazole. Temperature is 39.0\u00b0C (102.2 \u00b0F), pulse is 132\/min, respirations are 24\/min, blood pressure is 172\/85 mmHg, and O2&nbsp;saturation is 97% on room air. On physical examination, the patient is diaphoretic, mumbling incoherent sounds, and will not lie still on the gurney. The patient has increased muscle tone. Brief, sudden jerks are present throughout the upper and lower extremities. Which of the following clinical features is most specific to this patient&#8217;s clinical presentation?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Myoclonus<br><br>B. Hyperthermia<br><br>C. Tachycardia<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Increased muscle tone<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Encephalopathy&nbsp;<\/strong><\/p>\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&#8217;s USMLE\u00ae Step 1 Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"A_Myoclonus\"><\/span>A. Myoclonus<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the Main Explanation, let&#8217;s look at the incorrect answer explanations. Skip to the bottom if you want to see the correct answer right away!<\/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\">The incorrect answers to today&#8217;s USMLE\u00ae Step 1 Question are&#8230;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B_Hyperthermia\"><\/span>B. Hyperthermia&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Hyperthermia is observed in both neuroleptic malignant syndrome and serotonin syndrome. However, the hyperthermia in neuroleptic malignant syndrome tends to be more exaggerated, and patients may have body temperatures exceeding 104\u00b0F (40\u00b0C).&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Tachycardia\"><\/span>C. Tachycardia<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Tachycardia is observed in both neuroleptic malignant syndrome and serotonin syndrome.. As a result, this finding is not specific to either condition.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Increased_muscle_tone\"><\/span>D. Increased muscle tone<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Muscle tone and rigidity are often observed in both neuroleptic malignant syndrome and serotonin syndrome. However, muscle rigidity is often much more severe in patients with neuroleptic malignant syndrome.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">E. Encephalopathy&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Incorrect: Encephalopathy is a feature of both neuroleptic malignant syndrome and serotonin syndrome. This clinical finding does not aid in the differentiation of these conditions.&nbsp;<\/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<p class=\"wp-block-paragraph\">This patient has multiple findings concerning serotonin syndrome, including autonomic instability, hyperthermia, altered mental status, and myoclonus. Among these findings, the one most specific for serotonin syndrome is&nbsp;<strong>myoclonus<\/strong>, which is absent in a similar condition, neuroleptic malignant syndrome.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Serotonin syndrome<\/strong>&nbsp;is a potentially life-threatening condition resulting from&nbsp;<strong>increased serotonergic activity<\/strong>&nbsp;of the central nervous system. The condition most commonly arises when multiple psychoactive compounds affecting serotonin are ingested simultaneously or in excess. The patient in this vignette likely consumed a stimulant drug (e.g.,&nbsp;<strong>ecstasy, cocaine, amphetamines<\/strong>) while at the music show. This drug, in combination with his prescribed fluoxetine, resulted in the onset of serotonin syndrome.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Clinically, the condition is characterized by&nbsp;<strong>increased neuromuscular activity<\/strong>&nbsp;(e.g., myoclonus, hyperreflexia, hypertonia) and&nbsp;<strong>autonomic instability<\/strong>&nbsp;(e.g., hyperthermia, diaphoresis). Additional findings include altered mental status, mydriasis, and ocular clonus.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Treatment is largely supportive and includes targeted temperature management, administration of intravenous fluids, correction of electrolyte disturbances, and benzodiazepines as needed. Historically, the medication&nbsp;<strong>cyproheptadine<\/strong>&nbsp;was recommended for treatment. However, this medication has largely fallen out of favor due to its limited efficacy in subsequent research trials.<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"600\" height=\"434\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2023\/10\/Myoclonus.jpg\" alt=\"\" class=\"wp-image-4677\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2023\/10\/Myoclonus.jpg 600w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2023\/10\/Myoclonus.jpg?resize=300,217 300w\" sizes=\"auto, (max-width: 600px) 100vw, 600px\" \/><\/figure>\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\"><strong>Serotonin syndrome<\/strong>&nbsp;is a potentially life-threatening condition resulting from&nbsp;<strong>increased serotonergic activity<\/strong>&nbsp;of the central nervous system. A distinguishing feature of this condition is the presence of&nbsp;<strong>myoclonus<\/strong>, which is absent in neuroleptic malignant syndrome.&nbsp;<\/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<p class=\"wp-block-paragraph\">Birmes, P., Coppin, D., Schmitt, L., Lauque, D. (2003)&nbsp;<em>Serotonin syndrome: A brief review<\/em>. CMAJ. 168, 1439-1442. PMID: 12771076.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/register\" target=\"_blank\" rel=\"noreferrer noopener\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/08\/1.png?w=700\" alt=\"Osmosis sign up ad\" class=\"wp-image-288\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/08\/1.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/08\/1.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong><em>Try Osmosis today! Access your\u00a0<a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a>\u00a0and find out why millions of current and future clinicians and caregivers love learning with us.<\/em><\/strong><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Explore a USMLE\u00ae Step 1 clinical case on serotonin syndrome and discover why myoclonus distinguishes it from similar conditions like neuroleptic malignant syndrome.<\/p>\n","protected":false},"author":202,"featured_media":809,"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":[733,440,187,84,954,955,219,650,956,185],"class_list":["post-808","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-case","tag-emergency-medicine","tag-exam-preparation","tag-medical-education","tag-myoclonus","tag-neuroleptic-malignant-syndrome","tag-neurology","tag-serotonin-syndrome","tag-toxicology","tag-usmle"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - 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