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Serotonin syndrome — SCE Acute Medicine MCQ

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ModerateToxicology and OverdoseSerotonin syndromeSCE Acute Medicine

A 34-year-old woman is assessed on the acute medical unit. She started linezolid while taking sertraline and now has agitation, sweating, diarrhoea, inducible clonus and hyperreflexia. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most likely diagnosis?

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Correct answer: A — Serotonin syndrome

Serotonin syndrome is the best answer because clonus and hyperreflexia after serotonergic drug exposure are key features of serotonin syndrome. Acute liver failure is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Neuroleptic malignant syndrome is usually slower and associated with lead-pipe rigidity.

Reference: https://bnf.nice.org.uk/#acute-medicine-order-68-1