American Board of Family Medicine (ABFM) Practice Exam

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A patient who took an extra pill prescribed by a psychiatrist presents with diaphoretic symptoms and a resting symmetrical tremor. What is the likely diagnosis?

  1. Neuroleptic malignant syndrome

  2. Serotonin syndrome

  3. Dopamine agonist withdrawal syndrome

  4. Medication-induced tremor

The correct answer is: Serotonin syndrome

The scenario describes a patient exhibiting diaphoretic symptoms (sweating) and a resting symmetrical tremor, which are important clinical features. In the context of having taken an extra pill prescribed by a psychiatrist, the most likely diagnosis is serotonin syndrome. Serotonin syndrome occurs due to excessive serotonergic activity in the central nervous system, often triggered by an increase in serotonergic medications or interactions. Symptoms typically include altered mental status, autonomic instability (such as diaphoresis), and neuromuscular abnormalities, which can manifest as tremors, clonus, and hyperreflexia. The described resting symmetrical tremor, coupled with diaphoretic symptoms, aligns well with this syndrome, especially if the additional medication was a serotonergic agent. This condition is acute and can arise rapidly after changes in medication dosages or introductions of new serotonergic medications (like certain antidepressants, some migraine treatments, or stimulants). Recognizing these signs is crucial, as serotonin syndrome can progress rapidly and may require intervention. Other choices do not fit the presentation as well: neuroleptic malignant syndrome primarily involves severe muscle rigidity and dysautonomia, typically related to antipsychotic medication use; dopamine agonist withdrawal syndrome is associated with abrupt cessation