skip to main content

HFrEF GDMT — USMLE Step 3 MCQ

Instant feedback + full explanation. One question, done properly.

HardInternal Medicine (Chronic Management)HFrEF GDMTUSMLE Step 3

A 64-year-old woman taking sertraline and tramadol is given linezolid for vancomycin-resistant Enterococcus bacteremia. Twelve hours later she develops agitation, diaphoresis, diarrhea, temperature 39.1 C, inducible ankle clonus, and hyperreflexia. The isolate is susceptible to daptomycin, which is immediately available. Which management is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Stop interacting drugs, change linezolid, and provide benzodiazepine-based supportive care

The best answer is “Stop interacting drugs, change linezolid, and provide benzodiazepine-based supportive care”. Clonus, hyperreflexia, autonomic activation, gastrointestinal symptoms, and rapid onset identify serotonin syndrome from linezolid combined with serotonergic drugs. Offending serotonergic agents are stopped, linezolid is changed when effective antimicrobial alternatives exist, and supportive care with benzodiazepines is first-line. Cyproheptadine can be considered for persistent moderate-to-severe toxicity; dantrolene and bromocriptine target different syndromes.

Reference: FDA Prescribing Information: Linezolid Injection: https://www.accessdata.fda.gov/drugsatfda_docs/label/2025/206473s011lbl.pdf