Quiz 1

Question 1

what is the legal driving limit of BAL?

Answer 1

0.08

Question 2

what level of BAL do you see changes in behavior and cognition?

Answer 2

0.02-0.03

Question 3

coma and possible death are expected at a BAL of what level?

Answer 3

0.4

Question 4

what term is described as abnormal need for a substance?

Answer 4

DEPENDENCE

• psychological: craving the behavior the drug gives
• physiological: having withdrawals if D/C drug

Question 5

What is the term used to describe the need to increase the dose to achieve the same effect OR a diminished effect with continued use?

Answer 5

Tolerance

Question 6

Abnormal physical and physiological symptoms that follow abrupt D/C of a substance

Answer 6

Withdrawals

Question 7

Of the criteria to diagnose a substance use disorder, >2 are needed over what period of time for diagnosis?

Answer 7

12 months

Question 8

patient presents with a positive urine drug screen. What is the next step?

Answer 8

do Gas Chromatography to confirm and rule out false positive.

Question 9

T or F: blood tests are more definitive than urine tests for drug screening

Answer 9

True!

Question 10

controlled substance use requires blood tests for screening how often?

Answer 10

every 3-6 months

Question 11

Which part of marijuana causes the “HIGH”

Answer 11

THC

Question 12

which part of marijuana is used for pain?

Answer 12

CBD

Question 13

why does THC stay in the system for a long period of time?

Answer 13

THC is stored in fat

urine testing positive for 4-6 days in short term users and 20-50 days in long-term users

Question 14

what is the most commonly used illegal stimulant in minnesota

Answer 14

methamphetamines

Question 15

patient presents to the clinic with delusions of parasitosis and aggression. On physical exam you notice dental decay. What is at the top of your diagnosis?

Answer 15

Methamphetamine abuse

dental decay is also known as “meth mouth”

Question 16

What 2 meds are used to treat ACUTE intoxication of stimulants?

Answer 16

benzodiazepines + antipsychotics (if needed)

Question 17

how long to keep a patient with an ACUTE stimulant intoxication?

Answer 17

72 hour hold with psych hospitalization (incase they are a threat to self or others)

Question 18

T or F: low to moderate doses of caffeine per day improve attention and task performance

Answer 18

True

30-200 mg per day are good!

Question 19

at what level of caffeine can you diagnose a patient with caffeinism?

Answer 19

> 500 mg per day

can mimic an anxiety disorder

Question 20

What are the 4 most commonly used substances?

Answer 20

alcohol, marijuana, opiates, meth

Question 21

how would you describe At-Risk drinking?

Answer 21

repetitive use of alcohol as coping for anxiety, depression, etc.

Question 22

what number of drinks for men and women are used to describe alcohol abuse?

Answer 22

MEN: >4 drinks per day or 14 per week

WOMEN: >3 drinks per day or 7 per week

Question 23

patient presents with Wernicke-Korsakoff syndrome. What does this mean and what is going on with the patient?

Answer 23

thiamine deficiency

he has alcoholism

Question 24

your patient has confusion, speech difficulty. On exam, he has asterixis. What are you thinking?

Answer 24

Hepatic encephalopathy (end stage alcoholism)

treat with lactulose to lower ammonia levels

Question 25

when a patient extends his wrist, you notice a flapping movement of the hands. What is this?

Answer 25

asterixis "liver flap" | hallmark of end-stage alcoholism/hepatic encephalopathy

Question 26

patient presents with confusion + ataxia (balance troubles) + ophthalmoplegia (6th nerve palsy). What is this?

Answer 26

Wernicke encephalopathy (classic triad)

Question 27

what is the classic triad of Wernicke encephalopathy?

Answer 27

confusion + ataxia + ophthalmoplegia

Question 28

in alcoholism, what will the AST/ALT ratio be like?

Answer 28

>2:1 ratio GGT elevated Ammonia elevated

Question 29

which lab values will be LOW in alcoholism?

Answer 29

Potassium and Magnesium

Question 30

a person has small eyes, thin upper lip, and flat philtrum. His mother reports learning and attention problems. What do you think he has?

Answer 30

fetal alcohol spectrum disorder

Question 31

overdose is defined as a BAL of what?

Answer 31

>0.35 for most people characterized by respiratory depression, seizure, shock, coma

Question 32

T or F: acute alcohol intoxication will yield hyperglycemia

Answer 32

FALSE: hypoglycemia in kids and diabetics

Question 33

What is the treatment for acute intoxication?

Answer 33

supportive (let them sleep it off in safe environment) -antiemetics, fluids, resp support if needed

Question 34

which symptoms is NOT part of alcohol withdrawal: | tachycardia, drop in BP, fever, tremor, headache, anxiety

Answer 34

drop in BP - you will see elevated BP

Question 35

what is the time frame for onset of symptoms of alcohol withdrawal?

Answer 35

6-36 hours after last drink

Question 36

peak intensity of alcohol withdrawal?

Answer 36

48-72 hours after last drink

Question 37

alcohol withdrawal seizures typically occur how long after stopping alcohol?

Answer 37

6-48 hours

Question 38

describe what the alcohol withdrawal seizures are like

Answer 38

brief nonfocal occur 1-2 times self-limited

Question 39

T or F: a seizure is often the first sign of alcohol withdrawal

Answer 39

True

Question 40

what can alcohol withdrawal seizures progress to?

Answer 40

Delirium Tremens

Question 41

what is Delirium tremens and how is it managed?

Answer 41

most severe form of alcohol withdrawal: confusion, hallucinations, fever, tachy, htn -give LARGE DOSE of Benzodiazepines

Question 42

what is the mainstay of alcohol withdrawal treatment?

Answer 42

benzodiazepines

Question 43

although benzos are the mainstay of alcohol withdrawal treatment, what is given FIRST??

Answer 43

IV thiamine (to prevent development of Wernicke encephalopathy)

Question 44

do you screen your 19 year old patient for alcohol misuse?

Answer 44

YES - everyone over 18

Question 45

which 2 drugs are used to treat alcoholism?

Answer 45

Disulfiram (Antabuse) - causes vomiting with alcohol use | Naltrexone - reduces cravings

Question 46

it is difficult to see opiate intoxication on physical exam. What one finding might you see?

Answer 46

miosis - pinpoint pupils patient might also feel euphoria, drowsiness, nausea

Question 47

this opiate medication can cause QT prolongation and torsades

Answer 47

methadone

Question 48

what is used for treatment of opiate intoxication?

Answer 48

Naloxone (Narcan) given IM or IV; may need to be repeated due to short duration

Question 49

what might your patient experience with mild opiate withdrawal?

Answer 49

cravings, yawning, rhinorrhea, restlessness moderate-severe: above plus piloerection, mydriasis, tachycardia

Question 50

which 3 drugs are used in long term treatment of opiate withdrawal

Answer 50

methadone suboxone + buprenorphine naltrexone

Question 51

When diagnosing a patient with depression, they need 5/9 symptoms for what duration?

Answer 51

almost all day every day for 2 weeks must include anhedonia and/or depressed mood

Question 52

how long is an adequate trial of antidepressants?

Answer 52

4-12 months

Question 53

what psych disorder is characterized by alternating shifts in emotions from periods of depression to periods of mania (highs)

Answer 53

bipolar disorder

Question 54

what should never be used alone in treating depression?

Answer 54

antidepressants - always combine w/ antipsychotics or benzos

Question 55

T or F: bipolar disorder is genetic

Answer 55

TRUE: 10x more likely to get it if family member has it.

Question 56

what is bereavement?

Answer 56

grief after loss through death

Question 57

diagnosing bereavement and deciding to treat it requires a grief period of over how long?

Answer 57

> 6 months + 1 of the symptoms: | intense yearning for person and feelings of emptiness, recurrent thoughts that life is meaningless and urge to join them

Question 58

which demographics are most common for suicide?

Answer 58

native americans native Alaskans children