Which combination is characteristic of neuroleptic malignant syndrome?

• A. Altered mental status, high fever, and muscle rigidity
• B. Hypotension, bradycardia
• C. Weight loss and diarrhea
• D. Cough and wheeze

Answer: (A)

Neuroleptic malignant syndrome is a dangerous reaction to dopamine blockade from antipsychotic drugs. It shows a distinct clinical picture centered on severe hyperthermia, generalized muscle rigidity (often described as lead-pipe rigidity), and changes in mental status, usually with autonomic instability such as tachycardia and fluctuating blood pressure. Because this triad of high fever, extreme muscle rigidity, and altered mental status is the hallmark of NMS, the option describing those exact features best captures what the syndrome looks like.

The other options don’t fit the characteristic pattern: hypotension with bradycardia is not typical—NMS more commonly involves tachycardia and unstable or elevated blood pressure. Weight loss with diarrhea and cough with wheeze are not features of NMS and point to other kinds of problems.