Trastorno por Consumo de sustancias y adicciones

Question 1

4.1.
A patient experiencing liver failure from alcohol, cravings to
use again in spite of losing their job and marriage, and getting
arrested for driving under the influence, would be classified as
having which of the following alcohol disorders in the DSM-5?

A. Abuse

B. Addiction

C. Dependence

D. Intoxication

E. Use

Answer 1

4.1. E. Use
In the past, various DSM terms have been used to refer to those with
substance abuse. Alcohol/substance dependence and abuse were
terms used in previous DSM editions. The word addiction or addict
is not an official medical term. Substance use disorder is a DSM-5
term referring to prolonged use and abuse of a substance and the
specific substance should be specified. Criteria include two or more
physiologic symptoms, symptoms of addition, and/or psychological
sequelae of use for a period of 12 months, leading to psychosocial
impairment. Some symptoms include tolerance, withdrawal,
cravings, using more than intended, difficulty stopping, etc. along
with those mentioned above such as using in spite of health
problems or adverse social or occupational consequences. Substance
intoxication is the diagnosis used to describe specific signs or
symptoms from recent exposure to the substance.

Question 2

4.2.
The frequency of suicide in those with substance abuse is
second only to which of the following psychiatric disorders?

A. Bipolar

B. Eating

C. Generalized anxiety

D. Major depressive

E. Panic

Answer 2

4.2. D. Major depressive
Approximately ⅓ to ½ of those with opioid abuse or dependence and
about 40% of those with alcohol abuse or dependence meet criteria
for a major depressive disorder. Those with substance use alone are
20 times more likely to die by suicide than the general population,
with a total of around 15% of those with alcohol abuse or dependence
committing suicide. The frequency of suicide in substance use is only
secondary to that in major depressive disorder

Question 3

4.3.
Which of the following pharmacologic agents is designed at
helping tobacco dependence?

A. Acamprosate

B. Disulfiram

C. Levomethadyl acetate

D. Naltrexone

E. Varenicline

Answer 3

4.3. E. Varenicline
Along with nicotine delivery devices and bupropion, varenicline can
help with tobacco dependence. Acamprosate, disulfiram, and
naltrexone can help with alcoholism. Levomethadyl acetate can help
with heroin addiction

Question 4

4.4.
In the United States, which ethnic or racial group has the
highest lifetime rate of substance use?

A. African Americans

B. American Indians

C. Asians

D. Caucasians

E. Hispanics

Answer 4

4.4. B. American Indians
In the United States, the highest lifetime rate of substance use is
among American Indians or Alaska Natives. Caucasians have higher
rates compared to African Americans.

Question 5

4.5.
The locus coeruleus likely mediates the effects of which of the
following drugs?

A. Amphetamines

B. Benzodiazepines

C. Cannabis

D. Nicotine

E. Opioids

Answer 5

4.5. E. Opioids
The locus ceruleus, the largest group of adrenergic neurons, is
thought to mediate the effects of the opiates and opioids. The
dopaminergic neurons in the ventral tegmental area (VTA) are
involved with the sensation of reward and may represent a mediation
of the effects of amphetamines and cocaine

Question 6

4.6.
Which range of blood alcohol concentration is considered to be
the legal definition of intoxication in most states in the United
States, as levels in this range have been shown to increase
incoordination and cause errors in judgment.

A. 20 to 40 mg/dL

B. 40 to 60 mg/dL

C. 80 to 100 mg/dL

D. 200 to 250 mg/dL

E. >300 mg/dL

Answer 6

4.6. C. 80 to 100 mg/dL
The legal definition of intoxication in most states in the United States
is a blood alcohol concentration of 80 to 100 mg ethanol per
deciliter, or 0.08 to 0.10 g/dL. At levels between 80 and 200 mg/dL,
typically incoordination is increased and judgment errors are more
likely to occur, along with mood instability and a deterioration in
cognitive status. Levels of 20 to 30 mg/dL can lead to slowed motor
performance and decreased ability to think. Levels of 30 to 80
mg/dL can lead to increased motor and cognitive problems.
Nystagmus, slurred speech, and blackouts can occur at levels
between 200 and 300 mg/dL and above 300 mg/dL vital signs are
impaired and death can occur.

Question 7

4.7.
Which of the following signs or symptoms can be noted in
alcohol withdrawal?

A. Bradycardia

B. Hypotension

C. Miotic pupils

D. Renal failure

E. Tremors

Answer 7

4.7. E. Tremors
Classic signs of alcohol withdrawal include irritability, nausea,
vomiting, and autonomic hyperactivity, including sweating, facial
flushing, mydriasis, tachycardia, and hypertension. An alcohol
withdrawal tremor can look like either a physiologic tremor (i.e.,
continuous, high amplitude, more than 8 Hz) or a familial tremor
(i.e., bursts of activity, slower than 8 Hz).

Question 8

4.8.
Long-term severe alcohol abuse can result in a seizure by
lowering which of the following lab values?

A. Albumin

B. Ca

C. Creatinine

D. K

E. Na

Answer 8

4.8. E. Na
Seizures in long-term alcohol abuse can be caused by hyponatremia,
as well as by hypoglycemia and hypomagnesemia

Question 9

4.9.
A psychiatrist refers a middle-aged, alcoholic patient for a
neurology evaluation after gait abnormalities were noted along
with confusion and delusions. No signs of withdrawal are noted
on examination and the patient does not appear acutely
intoxicated and has mostly a linear thought process. Findings
from the neurologist include normal vital signs, bilateral
nystagmus, and pupils reacting unevenly to light. These
findings are most consistent with which diagnosis?

A. Alcohol-induced psychotic disorder

B. Delirium tremens

C. Korsakoff syndrome

D. Unspecified alcohol-related disorder

E. Wernicke encephalopathy

Answer 9

4.9. E. Wernicke encephalopathy
Wernicke encephalopathy is an acute neurologic disorder presenting
as ataxia (mostly gait), vestibular dysfunction, confusion, and ocular
motor abnormalities including nystagmus, gaze palsy, anisocoria
(unequal pupil size), etc. Most remit whereas some progress to
Korsakoff syndrome, consisting of anterograde amnesia and often
confabulation. Symptoms of delirium tremens include confusion and
hallucinations though also autonomic findings would be noted
including tachycardia, diaphoresis, fever, etc. Alcohol-induced
psychotic disorders consist of hallucinations or delusions in the
context of heavy drinking or withdrawal. Unspecified alcohol-related
disorder is the DSM-5 term for alcohol-related disorders not meeting
criteria for any other diagnoses

Question 10

4.10.
A patient with heavy alcohol use reports all of the symptoms
of a major depressive disorder. Which is the most appropriate
initial treatment for most cases?

A. An atypical antipsychotic

B. A selective serotonin reuptake inhibitor

C. Education

D. Interpersonal psychotherapy

E. Naltrexone

Answer 10

4.10. B. Education
Most alcohol-induced depressions, even severe, resolve within a few
days to a month of abstinence without treatment. Typically,
education and cognitive behavioral therapy (CBT) are the initial
appropriate treatment options and there should be a 2- to 4-week
trial of abstinence, education, and CBT before initiation of
antidepressants

Question 11

4.11.
A patient presents with alcohol dependence, fatigue, and
insomnia, along with confusion noted on mental status
examination. Reports of myoclonus and increased muscle
resistance to movement were noted in the primary care
doctor’s notes. This patient should be tested for which of the
following vitamin deficiencies?

A. Cyanocobalamin

B. D

C. Folic acid

D. Pantothenic acid

E. Thiamine

Answer 11

4.11. E. Thiamine
Patients with a history of heavy alcohol use and the above symptoms
should be checked for a thiamine deficiency (vitamin B1). Thiamine
deficiency can cause pellagra and when it gets to the point of
alcoholic pellagra encephalopathy with features of Wernicke–
Korsakoff, often there is no response to thiamine treatment.
Symptoms of alcohol pellagra include general symptoms such as
fatigue, anorexia, insomnia, irritability, etc. along with physical
findings noted above such as myoclonus and oppositional
hypertonia. Confusion seen with thiamine deficiency can range from
mild all the way to a severe delirium.

Question 12

4.12.
Which psychiatric diagnosis is one of the most common
comorbid ones with alcohol-related disorders?

A. Anorexia nervosa

B. Antisocial personality

C. Attention-deficit hyperactivity

D. Autism spectrum

E. Schizophrenia

Answer 12

4.12. B. Antisocial personality
Antisocial personality disorder, along with other substance-related
disorders, mood and anxiety disorders are among the most common
comorbid conditions with alcohol use disorders. Antisocial
personality disorder is particularly common and often precedes the
alcohol disorder. Mood disorders are present in around 30%–40% of
those with alcohol use disorders. Anxiety disorders are also
commonly found in those with alcohol use disorder, at a comorbidity
around 25%–50%.

Question 13

4.13.
A patient with alcohol use disorder comes in for treatment for
depression and insomnia. The psychiatrist highlights how
impairing those symptoms are and then discusses the role that
alcohol has played in these problems and that abstinence is
possible. This approach is most in line with which of the
following therapies?

A. Cognitive behavioral

B. Dialectical behavioral

C. Interpersonal

D. Motivational interviewing

E. Twelve step

Answer 13

4.13. D. Motivational interviewing
The above approach is most in line with motivational interviewing.
This can help the patient to recognize the adverse consequences of
drinking and be motivated to stop. The therapist should explore the
adverse consequences of alcohol with the patient in a persistent but
nonjudgmental manner.

Question 14

4.14.
Which of the following is the current standard treatment of
choice for alcohol-related withdrawal seizures?

A. Anticonvulsants

B. Antipsychotics

C. Barbiturates

D. Benzodiazepines

E. Mood stabilizers

Answer 14

4.14. D. Benzodiazepines
After having a neurologic evaluation to rule out a comorbid or
nonalcohol-related cause of the seizure, benzodiazepines (i.e.,
lorazepam, chlordiazepoxide, diazepam, etc.) are the treatment of
choice that should be used for managing alcoholrelated
withdrawal seizures. Anticonvulsants are not thought to offer
additional benefits. Any CNS depressant such as benzodiazepines,
barbiturates, or alcohol can help minimize alcohol withdrawal,
though benzodiazepines are thought to be safer and offer better
control of the withdrawal symptoms. While carbamazepine at a dose
of 800 mg daily has been shown to be as effective as benzodiazepines
with less abuse potential and is being used more often now, currently
the standard is still a benzodiazepine.

Question 15

4.15.
Aside from motivating the patient to remain abstinent, which
of the following topics is most helpful to focus on initially
during counseling for alcohol rehabilitation?

A. Causes of the disorder

B. Day-to-day life issues

C. Future plans

D. Social anxiety

E. Underlying depression

Answer 15

4.15. B. Day-to-day life issues
Treatment for alcohol rehab should be the same regardless of the
setting. Initial counseling for the first few months should focus on
day-to-day life stressors and helping the patient to function and
maintain abstinence. Psychotherapy to get at the root cause of the
disorder (i.e., no single event is the sole cause of alcoholism),
focusing on depression that caused it (i.e., often it is the other way
around, the alcohol contributed to the mood disorder), or insightoriented
therapy that can provoke anxiety can get in the way of
abstinence and is not indicated within the first 3 to 6 months of
treatment.

Question 16

4.16.
After detoxification for alcoholism, lingering level of anxiety
and insomnia can best be initially treated with which of the
following approaches?

A. An antidepressant

B. An antihistamine

C. A benzodiazepine

D. Behavior modification

E. Melatonin

Answer 16

4.16. D. Behavior modification
After detoxification, unless the patient has an independent
psychiatric disorder, an antidepressant or antianxiety medications
should not be prescribed. Behavior modification and reassurance are
the best approaches to treat residual anxiety and insomnia, as the
effect of these medications may be short term and put the patient at
risk to escalate the dose. The patient should be counseled that
lingering sadness and mood swings can occur for a few months when
abstinence begins and that behavioral therapy and continued
abstinence are most effective.

Question 17

4.17.
Which of the following medical conditions is a
contraindication to being on naltrexone for treating alcohol
dependence?

A. Being on metronidazole

B. Continued use of alcohol

C. Coronary artery disease

D. Currently using opioids

E. Renal failure

Answer 17

4.17. D. Currently using opioids
Contraindications to using naltrexone include currently using
opioids or withdrawing from opioids, or an anticipated need for
opioid medications. Liver failure or hepatitis is also a
contraindication for use. The other contraindications listed are for
alternative medications used to treat alcohol dependence including
acamprosate (i.e., severe renal impairment) or disulfiram (i.e., use
with alcohol or metronidazole, coronary artery disease, or a severe
myocardial infarction).

Question 18

4.18.
Which of the following is the leading cause of preventable
death in the United States?

A. Alcohol use

B. Car accidents

C. Gun violence

D. Suicides

E. Tobacco use

Answer 18

4.18. E. Tobacco use
Tobacco use is the leading cause of preventable death in the United
States, followed by poor diet/physical inactivity, and the third
leading cause is alcohol use, which accounts for 10% of deaths among
all working adults, and contributes to 25% of all suicides and 31% of
automobile fatalities.

Question 19

4.19.
Even modest amounts of cannabis can have which of the
following physical effects on the brain or body during
intoxication?

A. Delayed reaction time

B. Depressed mood

C. Impaired long-term memory

D. Increased goal-directed activity

E. Physical tenseness

Answer 19

4.19. A. Delayed reaction time
Cannabis intoxication can impair cognition and performance and
result in impaired reaction times and perceptions, along with motor
coordination issues. During a classic cannabis “high,” many
experience mild euphoria and relaxation, not tenseness. Depression
can be a symptom of cannabis withdrawal. Short-term memory
impairment is common along with difficulty sustaining goaldirected
mental activity.

Question 19

4.20.
A cannabis-induced psychotic disorder is most commonly
associated with which of the following premorbid psychiatric
disorders?

A. Anxiety

B. Bipolar

C. Depressive

D. Eating

E. Personality

Answer 19

4.20. E. Personality
While transient paranoia is common with cannabis use, a cannabisinduced
psychotic disorder is rare and is typically associated with a
pre-existing personality disorder. Unlike hallucinogens, cannabis use
is rarely associated with an adverse psychological reaction

Question 19

4.21.
Apathy, low-energy, psychomotor retardation, and weight
gain are often part of a syndrome associated with which of the
following substances?

A. Barbiturates

B. Caffeine

C. Cannabis

D. Hallucinogens

E. Opioids

Answer 19

4.21. C. Cannabis
Amotivational syndrome can be seen with cannabis use. It is unclear
if the amotivation symptoms are directly an effect of the cannabis use
versus traits of those who use cannabis heavily. Symptoms include
apathy, anergia, and weight gain, with a slothful appearance

Question 20

4.22.
Synthetic THC’s FDA approval in the United States is limited
to a few medical conditions, including which of the following
indications?

A. Chronic insomnia

B. Nausea in chemotherapy

C. Obstructive sleep apnea

D. Treatment-resistant back pain

E. Weight loss in anorexia nervosa

Answer 20

4.22. B. Nausea in chemotherapy
The FDA has approved dronabinol, a synthetic form of THC, for
treatment of chemotherapy-related nausea and vomiting. While it is
also approved for anorexia-related weight loss in HIV, it is not
approved for weight loss due to other medical or psychiatric
conditions including anorexia nervosa. Dronabinol is being studied
as a treatment for obstructive sleep apnea, though is not yet
approved. Other countries have approved other synthetic THC
versions to help with neuropathic pain and multiple sclerosis.

Question 21

4.23.
Which of the following medical risks can commonly occur
with using higher dosages of cannabis?

A. Appetite suppression

B. Death

C. Diaphoresis

D. Mild bradycardia

E. Orthostatic hypotension

Answer 21

4.23. E. Orthostatic hypotension
Orthostatic hypotension is thought to be a common side effect from
high doses of cannabis. Other common side effects include increased
appetite, dry mouth, and a mild tachycardia. There are no
documented cases of death from cannabis intoxication, though the
greatest risk with chronic use is of chronic respiratory disease and
lung cancer.

Question 22

4.24.
Which of the following signs or symptoms is common in
opioid withdrawal?

A. Constipation

B. Hypotension

C. Lacrimation

D. Psychosis

E. Pupillary constriction

Answer 22

4.24. C. Lacrimation
Lacrimation, along with piloerection (goosebumps), rhinorrhea,
yawning, and muscle cramps are all possible symptoms of opioid
withdrawal. Diarrhea rather than constipation can be a symptom of
opioid withdrawal as well. Changes in vital signs in opioid
withdrawal include hypertension, tachycardia, hypothermia, or
hyperthermia. Pupillary dilation is noted in opioid withdrawal, not
pupillary constriction. Psychotic symptoms including hallucinations
can be a sign of delirium tremens in alcohol withdrawal

Question 23

4.25.
A patient presents to the ER after an overdose of an unknown
substance. His pupils appear constricted, and he is sedated
with slurred speech and has trouble focusing and answering
questions. His vital signs are significant for bradycardia and
hypotension and he reports being constipated. Which of the
following medications would best reverse this overdose?

A. Flumazenil

B. N-acetylcysteine

C. Naloxone

D. Naltrexone

E. Varenicline

Answer 23

4.25. C. Naloxone
The above signs and symptoms are consistent with opioid
intoxication. Naloxone is a short-acting intravenous medication that
can reverse opioid overdoses. Often repeat doses are needed given
the duration of action is short compared to the long half-life of many
opioids. Naltrexone is a longacting
agent that is used after detox to help prevent a relapse. Nacetylcysteine
is used in Tylenol overdoses. Flumazenil is used to
reverse benzodiazepine overdoses. Varenicline is used to treat
nicotine dependence.

Question 24

4.26.
Which of the following is a main advantage of opioid
substitution therapy?

A. Drowsiness is minimal.

B. Outpatient treatment is guaranteed.

C. Parental formulations are never needed.

D. There is no risk of dependence.

E. Treatment can be done quickly in 2 weeks

Answer 24

4.26. A. Drowsiness is minimal
Opioid substitution therapy, including methadone and
buprenorphine, can eliminate the need to use opioids in illegal and
injectable forms, minimizing HIV and hepatitis risk. Other positives
include that they cause minimal euphoria and drowsiness and can
help the patient to engage in employment instead of criminal activity
to obtain the opioid. These agonists are utilized for both inpatient
and outpatient detoxification and buprenorphine comes in a
parenteral form. They do still carry risks of dependence and abuse.
The combination of buprenorphine plus naloxone can help decrease
the risk of diversion and abuse. Often, a period of at least 4 weeks is needed with demonstration of stabilization prior to lowering the dose
of the agonist.

Question 25

4.28.
Suicide attempts and unintentional overdoses are often most
lethal with which of the following substances of abuse?

A. Alcohol

B. Barbiturates

C. Benzodiazepines

D. Lysergic acid diethylamide (LSD)

E. Stimulants

Answer 25

4.28. B. Barbiturates
Barbiturates are lethal in overdose because they lead to respiratory
depression. They are a common cause of fatal drug overdoses,
especially in children when found in medicine cabinets. They lead to
coma, respiratory arrest, cardiovascular failure, and death. In
contrast, the benzodiazepines when taken alone have a large margin
of safety due to less respiratory suppression. However, most lethal
overdoses occur when benzodiazepines are combined with other
sedatives, including alcohol.

Question 26

4.27.
Meperidine can interact with which of the following classes of
psychiatric medications leading to agitation, seizures, coma,
and death?

A. Benzodiazepines

B. Monoamine oxidase inhibitors (MAOIs)

C. SSRIs

D. Stimulants

E. TCAs

Answer 26

4.27. B. MAOIs
An idiosyncratic drug interaction between meperidine, an opioid,
and MAOIs (monoamine oxidase inhibitors) can result in autonomic
instability, agitation, seizures, coma, and death. These two
medications should never be given together.

Question 27

4.29.
Bath salts lead to a high by increasing levels of which of the
following substances?

A. Catecholamines

B. Enkephalin

C. GABA

D. Glutamate

E. Oxytocin

Answer 27

4.29. A. Catecholamines
Bath salts release a variety of chemicals including cathinone and
cathine. Similar to the mechanism
of action of cocaine, the
cathinones increase synaptic catecholamine levels by inhibiting
dopamine, serotonin, and norepinephrine reuptake transporters

Question 28

4.30.
An adolescent is brought to the ER after disrobing and
shouting in the streets. Vital signs are significant for an
elevated heart rate and low weight, along with a decreased
respiratory rate. Neurologic examination is significant for
dilated pupils and muscle weakness. Mental stats examination
is significant for confusion with complaints of chest pain and
the adolescent is profusely diaphoretic. Intoxication with what
class of substances is most likely to have caused the above
symptoms?

A. Alcohol

B. Barbiturates

C. Hallucinogens

D. Opioids

E. Stimulants

Answer 28

4.30. E. Stimulants
The above signs and symptoms are classic for stimulant intoxication,
along with others such as euphoria, dangerous sexual behavior, and
possible mania. Alcohol, barbiturates, and opioids are sedatives.
Pinpoint pupils are associated with opioid intoxication.

Question 29

4.31.
Bruxism and poor dentition can most directly be a result of
abusing which of the following substances?

A. Clonazepam

B. Heroin

C. Ketamine

D. Methamphetamine

E. Psilocybin

Answer 29

4.31. D. Methamphetamine
With intranasal use, methamphetamine can cause vasoconstriction
which can lead to mucosal alteration and bruxism (tooth grinding),
resulting in poor dentition, also referred to as “meth mouth.”

Question 30

4.32.
A 50-year-old female with a past psych history significant for
bulimia nervosa is interested in medication to help her quit
smoking. Her medical history is significant for a heart attack
in the past and most recently, she has been suffering from
allergies and rashes. Which of the following medications
would best be indicated to help her to quit smoking?

A. Bupropion SR

B. Nicotine inhaler

C. Nicotine patch

D. Polacrilex gum

E. Varenicline

Answer 30

4.32. D. Polacrilex gum
Nicotine replacement therapies double the rates of cessation.
Nicotine polacrilex gum would be a good choice for this patient since
the other medications are contraindicated given her medical and
psychiatric history. Bupropion, an antidepressant medication is
contraindicated in those with a history of bulimia (or anorexia
nervosa), due to increased risk of seizures. Varenicline can relieve
cravings and withdrawal. It has a small but increased risk of causing
cardiovascular events in those with pre-existing disease. Nicotine
patches should be avoided in this patient as rashes are common
adverse side effects. Nicotine nasal spray should also be avoided in
this patient as it can cause watery eyes and coughing in up to 70% of
patients.

Question 31

4.33.
Which of the following is a known risk of lysergic acid
diethylamide (LSD) use?

A. Cerebrovascular events

B. Chronic hallucinations

C. Cross-tolerance with amphetamines

D. Hypotension

E. Liver failure

Answer 31

4.33. A. Cerebrovascular events
LSD can cause death via cardiac or cerebrovascular pathology given
it is a sympathomimetic, which can lead to hypertension, as well as
hyperthermia. There is no evidence that LSD can cause chronic
psychosis, though it can lead to chronic depression and anxiety.
While cross-tolerance between certain hallucinogens can develop, it
is not found to develop between LSD and amphetamines.

Question 32

4.34.
A patient in the ER for cardiovascular monitoring is being
given supportive care for intoxication with an unknown
substance. On examination, the patient is hypertensive and
tachycardic. Nystagmus is noted along with increased
salivation. The patient was found walking in the middle of the
road and was biting himself and did not appear to be in pain.
Which of the following is the most likely substance the patient
took?

A. Alprazolam

B. Caffeine

C. Cannabis

D. Heroin

E. Ketamine

Answer 32

4.34. E. Ketamine
Ketamine, a dissociative anesthetic agent, causes cardiovascular
stimulation. Findings on examination include tachycardias and
hypertension along with increased salivation and nystagmus.
Dystonic reactions can also be seen. A common complication is a lack
of concern for the environment and personal safety.

Question 33

4.35.
Which of the following substances can lead to flashbacks of
the substance-induced experience even long after use?

A. Alcohol

B. Hallucinogens

C. Inhalants

D. Opioids

E. Stimulants

Answer 33

4.35. B. Hallucinogens
Long after ingesting hallucinogens, flashbacks of the symptoms can
be experienced in 15% to 80% of users, known as hallucinogenpersisting
perception disorder. DSM-5 criteria include
reexperiencing symptoms following cessation of use, causing
significant distress or functional impairment. Complications of this
disorder can include major depression and suicidal ideation, along
with panic disorder.

Question 34

4.36.
A patient presents to the emergency room with intense
emotions after continued flashbacks of being intoxicated. The
patient reports feeling confused, as the last reported substance
use was many weeks ago. The patient describes flashbacks of
different experiences including seeing flashes of color, seeing
trails of images moving, and hearing sounds. Before
diagnosing this patient with a substance-related
disorder, which of the following medical or psychiatric
diagnoses should be ruled out first?

A. Asthma

B. Borderline personality disorder

C. Hepatic failure

D. Migraines

E. Schizophrenia

Answer 34

4.36. D. Migraines
The patient described above has hallucinogenpersisting
perception disorder. Migraines and seizures can lead to
flashback-like experiences and are important medical conditions that
should be ruled out prior to diagnosing this disorder. Posttraumatic
stress disorder can also cause flashbacks and should be ruled out

Question 35

4.37.
A patient presenting to the ER with psychosis and agitation is
refusing PO intake. The patient reports muscle pain and
trouble walking after receiving treatment for PCP intoxication.
Which of the following medical conditions has most likely
occurred from the treatment?

A. A dystonic reaction

B. Convulsions

C. Hallucinogen-persisting perception
disorder

D. Rhabdomyolysis

E. Serotonin syndrome

Answer 35

4.37. D. Rhabdomyolysis
Trapping ionized PCP via urinary acidification has been used for
treatment of PCP intoxication. This strategy is no longer
recommended because metabolic acidosis can lead to
rhabdomyolysis and result in renal failure. Trapping ionized PCP in
the stomach via NG suction is also not recommended due to
induction of electrolyte imbalances. Administration of charcoal is
now the treatment of choice for PCP intoxication

Question 36

4.38.
A patient is brought to the ER with aggression and amnesia.
Examination is significant for nystagmus and decreased
reflexes, malodorous breath, and a rash around the nose and
mouth. These findings are most consistent with intoxication
from which of the following substances?

A. Alcohol

B. Benzodiazepines

C. Hallucinogens

D. Opioids

E. Inhalants

Answer 36

4.38. E. Inhalants
The diagnostic criteria for inhalant intoxication include a
maladaptive behavioral change and at least two physical symptoms.
Behavioral changes can include apathy, impaired judgment or
functioning, or aggression. Physical symptoms include nausea,
anorexia, nystagmus, diplopia, and decreased reflexes. Rashes
around the nose and mouth and an unusual breath odor, along with
findings of residue on the hands, face, or close, are all signs of
inhalant abuse.

Question 37

4.39.
Which of the following substances of abuse can cause a type
of leukoencephalopathy showing diffuse cerebral, cerebellar,
and brainstem atrophy on CT or MRI?

A. Barbiturates

B. Hallucinogens

C. Inhalants

D. Simulants

E. Steroids

Answer 37

4.39. C. Inhalants
Chronic inhalants can cause many dangerous medical complications,
including death. Chronic inhalant use can lead to a
leukoencephalopathy showing diffuse cerebral, cerebellar, and
brainstem atrophy on neuroimaging