QuestionSBA
QuestionChoice
Neither opioid intoxication, which presents with reduced GCS, pinpoint pupils and slow breathing nor withdrawal, which presents with insomnia, yawning, diarrhoea, piloerection and lacrimation, would explain the presentation.
10034945
d
Heroin
QuestionChoice
In overdose, hallucinogenic mushrooms tend to cause psychosis, renal failure, seizures and coma.
10034944
c
Hallucinogenic mushrooms
QuestionChoice
In high doses and with extensive use, marijuana can induce temporary psychotic symptoms such as paranoia, delusions, anxiety and hallucination.
10034946
e
Marijuana
QuestionChoice
This is correct. This scenario describes serotonin syndrome due to time of onset, fever, sweating and hyperreflexia. Concomitant use of SSRIs and  ecstasy can precipitate serotonin syndrome with the increasing incidence of ecstasy usage amongst adolescents with depressive disorders making this important knowledge for healthcare professionals.
10034942
a
Ecstasy
QuestionChoice
Neither alcohol intoxication, which presents with slurred speech, vomiting, possible loss of consciousness and mental confusion, nor alcohol withdrawal, which presents with tremors, hallucination and possible seizures, explains this presentation.
10034943
b
Alcohol
QuestionComment
I chose MDMA because she was partying but marijuana and magic mushrooms are also highly serotonergic and could well cause serotonin syndrome especially if she is also on antidepressants  
49337
User
subscriber
Axillary Serotonin
Concept
Chapter
2693
6107
Serotonin Syndrome
Topic
199
Emergency Medicine
19392
Serotonin syndrome can occur with the use of ecstasy, especially in patients on SSRIs, presenting with hyperreflexia, muscle rigidity, and autonomic instability.
A 23-year-old woman comes to the emergency department complaining of fever and sweating. Examination reveals hyperreflexia, hypertension and muscle rigidity. She has a background of depression and describes partying last night, admitting to recreational drug use but is unsure of the name of the drug.

What is the most likely agent causing this presentation?
a