American Board of Internal Medicine (ABIM) Certification Practice Exam

Which syndrome resembles neuroleptic malignant syndrome and is caused by the sudden withdrawal of dopaminergic medications?

1. Serotonin syndrome

2. Malignant hyperthermia

3. Parkinsonian-hyperpyrexia syndrome

4. Reye syndrome

The correct answer is: Parkinsonian-hyperpyrexia syndrome

The condition that closely resembles neuroleptic malignant syndrome and occurs as a result of the sudden withdrawal of dopaminergic medications is known as Parkinsonian-hyperpyrexia syndrome. This syndrome is characterized by severe rigidity, high fever, autonomic instability, and altered mental status, mirroring the symptoms seen in neuroleptic malignant syndrome. When a patient who has been on dopaminergic medications for Parkinson's disease abruptly stops these medications, there can be a dramatic rebound effect, leading to increased muscle rigidity and other autonomic dysfunctions. This parallels the presentation of neuroleptic malignant syndrome, where there is a similar symptomatology following the administration of antipsychotic drugs. The other options do not specifically relate to the sudden withdrawal of dopaminergic medications. Serotonin syndrome is typically associated with the excess of serotonin, particularly after the use of serotonergic drugs. Malignant hyperthermia is a hypermetabolic reaction caused by certain anesthetic agents, not by the withdrawal of dopaminergic treatments. Reye syndrome is a rare but serious condition that causes swelling in the liver and brain, often triggered by viral infections and salicylate use in children, rather than related to dopamine withdrawal. Parkinsonian-hyper