What is the antidote for Warfarin (Coumadin)?

Choice A reason: Serotonin syndrome results from excessive serotonin, often from combining SSRIs and St. John’s Wort, which inhibits serotonin reuptake. Symptoms include dilated pupils (mydriasis) due to autonomic hyperactivity and loss of muscle coordination (ataxia) from neurological overstimulation, reflecting serotonin’s impact on motor control and sympathetic nervous system activation.

Choice B reason: Tinnitus and jerking movements are not primary features of serotonin syndrome. Tinnitus may occur in other conditions, like medication side effects, but is not typical here. Jerking movements could resemble myoclonus, but serotonin syndrome more consistently presents with autonomic symptoms (e.g., dilated pupils) and ataxia, making this choice less accurate.

Choice C reason: Pill-rolling movements and drooling are characteristic of Parkinson disease, not serotonin syndrome. These result from dopamine deficiency in the basal ganglia, unrelated to serotonin excess. Serotonin syndrome involves hyperactive neurological and autonomic symptoms, not parkinsonian features, making this choice incorrect for the condition described.

Choice D reason: Suicidal ideations are associated with depression or SSRI side effects but are not a hallmark of serotonin syndrome. This condition involves acute physiological symptoms like hyperthermia, tachycardia, and muscle rigidity due to serotonin toxicity, not primarily psychiatric manifestations, making this choice inappropriate.

Choice A reason: Frontotemporal lobar degeneration affects the frontal and temporal lobes, causing personality changes, language difficulties, and behavioral issues. It does not typically present with parkinsonian effects or fluctuating cognition, which are specific to Lewy body disease. The client’s stroke and parkinsonian symptoms make this diagnosis unlikely.

Choice B reason: Prion diseases, like Creutzfeldt-Jakob disease, cause rapid cognitive decline, myoclonus, and ataxia due to misfolded proteins. They do not typically feature parkinsonian effects or fluctuating cognition linked to stroke. The client’s symptoms align more with Lewy body disease, making prion disease an incorrect diagnosis.

Choice C reason: HIV-associated dementia results from HIV infection affecting the brain, causing cognitive impairment, motor dysfunction, and mood changes. While motor symptoms may occur, parkinsonian effects and fluctuating cognition are more characteristic of Lewy body disease, especially post-stroke, making HIV infection less likely in this context.

Choice D reason: Lewy body disease is characterized by parkinsonian symptoms (tremors, rigidity) due to alpha-synuclein deposits in the brain, often following stroke, and fluctuating cognition, including attention deficits and visual hallucinations. These match the client’s symptoms, as stroke can exacerbate Lewy body pathology, making this the most likely diagnosis.