Chemical Dependency / Abuse

Question 1

23 yo in ER after a party. Has dehydration, dilated pupils, HTN, elevated CPK. Which drug did he take?

Answer 1

MDMA

Question 2

35 yo in ER presents with hypoventilation, blue lips, pinpoint pupils, crackles on lung auscultation, and mild arrhythmia on EKG. Most likely drug of abuse?

Answer 2

codeine

Question 3

A state of general fatigue, hypersomnolence, and depression may be seen during a patient’s withdrawal from what drug?

Answer 3

cocaine

Question 4

While intoxicated with a psychomimetic drug, a young man reports “seeing sounds” and “patterns of color like fireworks or colored flames” associated with real auditory stimuli. What best describes this type of sensory experience?

Answer 4

synesthesia

Question 5

After cannabis ingestion (in chronic use), it can be detected in urine for how long?

Answer 5

one month

Question 6

Which drug causes euphoria, a feeling like “flying above the dance floor”, social withdrawal, and nystagmus?

Answer 6

ketamine

Question 7

18 yo pt in ER with a clouded sensorium, agitation and hyperactivity, mild paranoia, pressured speech, and euphoric, labile mood. On exam, had hypertension, tachycardia, and vertical nystagmus. What drug was most likely used?

Answer 7

phencyclidine (PCP)

Question 8

Best describes the intervention goal associated with contemplation stage of substance abuse treatment using motivational enhancement therapy:

Answer 8

acknowledge ambivalence and evoke reasons to change

Question 9

The large number of CB1 cannabinoid receptors found in the hippocampus best explains cannabis’s negative effects on:

Answer 9

short term memory

Question 10

One acute caffeine withdrawal symptom:

Answer 10

headache

Question 11

What is NOT likely to be an effective intervention for a physician with a substance abuse problem?

Answer 11

observing the patient until he/she becomes motivated to seek treatment

Question 12

What does the pentobarbital challenge test do?

Answer 12

estimates the starting dose of pentobarbital used for barbiturate detoxification

Question 13

Person who smokes a pack of cigs/day stops smoking and has a need for a cigarette after every meal. This is..

Answer 13

an environmental trigger

Question 14

Motivational interviewing of patients with addictive disorders addresses what?

Answer 14

ambivalence about becoming drug free

Question 15

Maximum duration of PCP in the urine:

Answer 15

8 days

Question 16

40 yo dentist is referred for evaluation by staff members who are concerned about his erratic behavior, staying excessively late at the office and having problems with dexterity in treating patients. He complains of numbness and weakness of limbs, loss of dexterity, and loss of balance. Which drugs is the dentist most likely abusing?

Answer 16

nitrous oxide

Question 17

Neurotoxicity associated with MDMA is associated with deficits in neurons that produce which of the following neurotransmitters?

Answer 17

serotonin

Question 18

Teen with sleepiness, nausea, red eyes, sores around mouth. Which substance was used?

Answer 18

aerosol inhalants

Question 19

17 yo patient is brought to the ED by friends who report that he ingested a drug 2 hours earlier. Patient’s behavior after the drug ingestion is relaxed and tranquil but talkative. Soon after, the patient complains of drowsiness, dizziness, and nausea. On exam, patient has labile level of consciousness. The drug screen is negative for benzodiazepines, barbiturates, and opioids. Psych MD alerts ED to the possibility of imminent respiratory difficulty. What drug most likely caused this condition?

Answer 19

gamma-hydroxybutyrate (GHB)

Question 20

Substance found in several over the counter cold remedies and is abused to produce a dissociative feeling:

Answer 20

dextromethorphan

Question 21

Psychotherapy for addiction utilizes a disease-model approach and emphasizes acceptance of the disease and surrender to help beyond oneself:

Answer 21

12 step facilitation

Question 22

Drug of abuse associated with symptoms of bruxism, anorexia, diaphoresis, decreased ability to orgasm, and hot flashes:

Answer 22

MDMA/ecstacy

Question 23

A muscular male patient presents to an outpatient psychiatric clinic complaining of discomfort in public places and excessive irritability. Though warm outside, the patient is dressed in heavy, baggy clothes, making him appear bigger than he is. The patient’s belief that he is shrinking greatly distresses him. Which of the following is the most likely diagnosis for the patient?

Answer 23

anabolic-androgenic steroid abuse

Question 24

17 yo patient brought to the ED after reporting recent cocaine use to teacher. In ED, patient is agitated, hyperaroused, and unable to concentrate on interview. Patient denies hallucinations, however appears very distractible and frightened. Physical exam shows HR 100, normal rhythm. What is the most appropriate intervention?

Answer 24

lorazepam 2 mg

Question 25

What class of medications has the greatest prevalence for prescription drug abuse?

Answer 25

pain relievers

Question 26

Which dx criteria helps to establish dx of substance dependence vs abuse?

Answer 26

recurrent unsuccessful efforts to control use