American Board of Internal Medicine (ABIM) Certification Practice Exam

What initial management step is crucial for a patient presenting with neuroleptic malignant syndrome?

1. Increase hydration

2. Start antidepressants

3. Discontinue the causative agent

4. Administer antipsychotics

The correct answer is: Discontinue the causative agent

The initial management step that is crucial for a patient presenting with neuroleptic malignant syndrome (NMS) is to discontinue the causative agent. NMS is a life-threatening condition often triggered by antipsychotic medications. Stopping the offending medication is essential to halt the progression of the syndrome and prevent further complications. This step is critical as it allows the body to begin recovering from the effects of the neuroleptics and facilitates the resolution of symptoms. Other supportive measures and treatments may be implemented subsequently, but immediate discontinuation of the medication is the foremost priority in managing NMS. It sets the stage for further interventions such as hydration, temperature management, and pharmacological treatments as needed, but the foundational action is to remove the agent responsible for the syndrome.