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Neuroleptic malignant syndrome — SCE Acute Medicine MCQ

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ModerateToxicology and OverdoseNeuroleptic malignant syndromeSCE Acute Medicine

A 42-year-old man presents with collapse, confusion or vomiting after a possible exposure. Relevant history includes medication, recreational or environmental exposure. On assessment, toxidrome features and physiological instability are present. Investigations show haloperidol exposure with lead-pipe rigidity, fever and high CK. What is the most appropriate next step in management?

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Correct answer: B — Stop antipsychotic therapy and provide supportive care with critical care input

The key discriminator is that haloperidol exposure with lead-pipe rigidity, fever and high CK, which makes Stop antipsychotic therapy and provide supportive care with critical care input the single best answer. Give targeted antidote or reversal therapy is less appropriate because it does not address the dominant acute risk in the vignette; Give analgesia and antiemetic therapy would fit a different presentation or later stage of care. Start anticoagulation after assessing bleeding risk and Arrange routine outpatient follow-up are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: TOXBASE; BNF antipsychotics