OVERVIEW
This page is dedicated to organizing various examples of standardized exam questions whose answer is serotonin syndrome. While this may seem a odd practice, it is useful to see multiple examples of how serotonin syndrome will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a tradition question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.
QUESTION EXAMPLES
Question # 1
A 55 year old woman comes to the emergency department due to a right lower extremity swelling pain, and erythema. her medical history is notable for type 2 diabetes, hypertension, and depression. Her mediations include metformin, lisinopril, paroxetine, and a multivitamin. The patient is clinically diagnosed with cellulitis, admitted to the inpatient unit, and started on the antibiotic linezolid. She continues her at home medications when she is in the hospital. There days later, the patient becomes very agitated, and is delirious. She complains of abdominal pain cramps and also begins to experience diarrhea. Her temperature is 103.°F, blood pressure is 180/105 mm Hg, and heart rate is 115/min. Upon physical examination she is noted to be diaphoretic, tremulous, and her pupils are dilated. Neurological examination reveals hyperreflexia and ankle clonus bilaterally. That patient begins to have seizures. What is the likely explanation for this patient’s clinical picture?
Explanation: paroxetine + linezolid = serotonin syndrome
Question # 2
A 33 year old man is brought to the clinic by his wife because he has been experiencing increasing and confusion and agitation since arriving from work 3 hours ago. he first experienced a headache, and the began to pace around the house nonstop, voicing how anxious he was. One week ago, he strained his back and then began to take tramadol. he has a 5 year history of major depressive disorder that is successfully being treated with fluoxetine. He is anxious in the clinic, and diaphoretic. he is oriented to who he is, but does not know the the time or where he is. His temperature is 103.9°F, pulse is 110/min, respiration’s are 19/min, and blood pressure is 160/100 mm Hg. His physical exam shows dilated pupils, hyperreflexia, and muscle rigidity. What explains this patient’s presentation?
Explanation: tramadol + fluoxetine = serotonin syndrome
Question # 3
A 24 year old man is brought to the emergency department about 45 minutes after his brother found him agitated, tremulous and complaining of a “wicked headache”. The patient had eaten a PB&J sandwich about 10 hours before the onset of his symptoms. He has a 10 year history of major depressive disorder that has been controlled in the past with both selective sere toning reuptake inhibitors and tricyclic antidepressants. Eight days ago he went to an new physician because he felt his current medication regiment was not working well anymore. The clinician immediately discontinued his fluoxetine and substituted tranylcpromine to start 1 week later. He instructed toes patient to modify his diet to one approved to be compatible with a monoamine oxidase inhibitor. Other current medications in crude diphenhydramine (as needed) for seasonal allergies. He does not have any other remarkable past medical history. Upon arriving to the emergency room he is agitated. His temperature is 104.8°C, pulse is 125/min, respirations are 25/min, and blood pressure is 180/120 mm Hg. His physical exam reveals diaphoresis and a tremor in his arms. Deep tendon reflexes are 3+ bilaterally in all the extremities. On mental status exam he complains of a headache. He knows his name, but is not oriented to the time or place. What is the likely diagnosis for this patient?
Explanation: fluoxetine + tranylcypromine = serotonin syndrome (need at least 2 weeks between stopping an SSRI and starting an MAOI to avoid this from happening).
Page Updated: 09.14.2016