Toxicology: drug-induced acute dystonia: practice question

A Forensic Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Forensic Medicine · Toxicology: drug-induced acute dystonia

Sample item

Hours after an overdose of a phenothiazine, a young woman has torticollis, oculogyric crisis and a protruding tongue. What is the treatment of choice?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Intravenous or intramuscular benzatropine or promethazine

Acute dystonia from dopamine blockade responds to anticholinergics such as benzatropine, procyclidine or diphenhydramine. Haloperidol would worsen it, levodopa is not used acutely and naloxone has no role.

Option by option

  • A. Intravenous or intramuscular benzatropine or promethazine (correct)

    Correct. An anticholinergic reverses acute dystonic reactions to dopamine blockers.

  • B. Intravenous haloperidol

    Haloperidol is itself a dopamine blocker and would worsen the dystonia.

  • C. Intravenous naloxone

    Naloxone reverses opioids and not dopamine blocker effects.

  • D. Oral levodopa

    Levodopa is not the acute remedy for a drug-induced dystonic reaction.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Forensic Medicine question

What is the answer to this Forensic Medicine question?

The best answer is A, Intravenous or intramuscular benzatropine or promethazine. Acute dystonia from dopamine blockade responds to anticholinergics such as benzatropine, procyclidine or diphenhydramine.

Why is "Intravenous haloperidol" not the answer?

Haloperidol is itself a dopamine blocker and would worsen the dystonia.

Why is "Intravenous naloxone" not the answer?

Naloxone reverses opioids and not dopamine blocker effects.

Why is "Oral levodopa" not the answer?

Levodopa is not the acute remedy for a drug-induced dystonic reaction.

What concept does this question test?

It tests Toxicology: drug-induced acute dystonia in Forensic Medicine. Haloperidol would worsen it, levodopa is not used acutely and naloxone has no role.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Toxicology: drug-induced acute dystonia?

Learn postmortem changes with their timelines, and toxicology as poison, sign, test and antidote. Then use the flashcards and the other Forensic Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.