Cannabis use disorder US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Cannabis use disorder. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Cannabis use disorder US Medical PG Question 1: A 20-year-old college student presents to the emergency room complaining of insomnia for the past 48 hours. He explains that although his body feels tired, he is "full of energy and focus" after taking a certain drug an hour ago. He now wants to sleep because he is having hallucinations. His vital signs are T 100.0 F, HR 110 bpm, and BP of 150/120 mmHg. The patient states that he was recently diagnosed with "inattentiveness." Which of the following is the mechanism of action of the most likely drug causing the intoxication?
- A. Blocks NMDA receptors
- B. Activates mu opioid receptors
- C. Displaces norepinephrine from secretory vesicles leading to norepinephrine depletion
- D. Binds to cannabinoid receptors
- E. Increases presynaptic dopamine and norepinephrine release from vesicles (Correct Answer)
Cannabis use disorder Explanation: ***Increases presynaptic dopamine and norepinephrine releases from vesicles***
- The patient's presentation with **insomnia**, feeling "full of energy and focus," **hallucinations**, tachycardia (HR 110 bpm), and hypertension (BP 150/120 mmHg) after taking a drug, especially in the context of a recent diagnosis of "inattentiveness," strongly suggests **amphetamine intoxication**. Amphetamines are commonly prescribed for **ADHD**, and their mechanism involves increasing the release of **dopamine** and **norepinephrine** from presynaptic vesicles.
- This increased release of **catecholamines** leads to the stimulant effects observed, including heightened energy, improved focus, and the adverse effects of agitation, psychosis (hallucinations), and sympathetic overdrive.
*Blocks NMDA receptors*
- Drugs that block **NMDA receptors**, such as **phencyclidine (PCP)** or **ketamine**, can cause dissociative and hallucinatory effects.
- However, the patient's primary complaint of feeling "full of energy and focus" in the context of "inattentiveness" points more towards a classical stimulant rather than a dissociative anesthetic.
*Activates mu opioid receptors*
- Activating **mu opioid receptors** (e.g., by heroin, morphine, fentanyl) typically causes central nervous system **depression**, respiratory depression, miosis, and euphoria, not the stimulant and hyperactive state described.
- The patient's symptoms of increased energy, focus, and elevated vital signs are the opposite of opioid effects.
*Displaces norepinephrine from secretory vesicles leading to norepinephrine depletion*
- This mechanism is characteristic of drugs like **reserpine**, which deplete catecholamines and lead to sedative or antihypertensive effects, not the stimulant and sympathomimetic presentation described.
- Such a mechanism would cause a **decrease** in sympathetic activity, contrary to the patient's elevated heart rate and blood pressure.
*Binds to cannabinoid receptors*
- Binding to **cannabinoid receptors** (e.g., by marijuana)
typically leads to effects such as euphoria, altered perception, impaired memory, and sometimes anxiety or paranoia.
- While hallucinations can occur, the prominent "full of energy and focus" and significant sympathetic activation (tachycardia, hypertension) are not typical of cannabinoid intoxication.
Cannabis use disorder US Medical PG Question 2: A 23-year-old man is brought to the emergency department by his girlfriend because of acute agitation and bizarre behavior. The girlfriend reports that, over the past 3 months, the patient has become withdrawn and stopped pursuing hobbies that he used to enjoy. One month ago, he lost his job because he stopped going to work. During this time, he has barely left his apartment because he believes that the FBI is spying on him and controlling his mind. He used to smoke marijuana occasionally in high school but quit 5 years ago. Physical and neurologic examinations show no abnormalities. On mental status examination, he is confused and suspicious with marked psychomotor agitation. His speech is disorganized and his affect is labile. Which of the following is the most likely diagnosis?
- A. Schizophreniform disorder (Correct Answer)
- B. Schizoid personality disorder
- C. Delusional disorder
- D. Schizoaffective disorder
- E. Brief psychotic disorder
Cannabis use disorder Explanation: **Correct: Schizophreniform disorder**
- This patient presents with ***psychotic symptoms*** (delusions, disorganized speech, agitation) and ***negative symptoms*** (withdrawal, anhedonia, loss of job), which have been present for approximately ***3 months***.
- The ***duration of symptoms (1-6 months)*** is the key differentiating factor for schizophreniform disorder compared to brief psychotic disorder (<1 month) or schizophrenia (>6 months).
- Meets DSM-5 criteria: psychotic symptoms with functional impairment lasting between 1 and 6 months.
*Incorrect: Schizoid personality disorder*
- Characterized by a pervasive pattern of ***detachment from social relationships*** and a restricted range of emotional expression, which are ***ego-syntonic*** and typically stable over time.
- This is a personality disorder with chronic traits, not an acute psychotic disorder.
- Does not include acute psychotic symptoms like delusions or disorganized speech.
*Incorrect: Delusional disorder*
- Defined by the presence of ***non-bizarre delusions*** for at least one month, without other significant psychotic symptoms or major functional impairment.
- This patient has ***bizarre delusions*** (FBI controlling his mind), ***disorganized speech***, ***psychomotor agitation***, and ***marked functional impairment***, which exceed the criteria for delusional disorder.
*Incorrect: Schizoaffective disorder*
- Requires the presence of a ***major mood episode*** (depressive or manic) concurrent with symptoms of schizophrenia, AND ***delusions or hallucinations for at least 2 weeks*** in the absence of a major mood episode.
- While the patient exhibits labile affect, there is no evidence of a distinct, prolonged major mood episode (major depression or mania) as required for schizoaffective disorder.
*Incorrect: Brief psychotic disorder*
- Characterized by the sudden onset of psychotic symptoms (delusions, hallucinations, disorganized speech or behavior) that last for ***at least one day but less than one month***, followed by full return to premorbid functioning.
- The patient's symptoms have been ongoing for approximately ***3 months***, which exceeds the duration criteria for brief psychotic disorder.
Cannabis use disorder US Medical PG Question 3: A 28-year-old man presents to the emergency department with vomiting. He states that he has experienced severe vomiting starting last night that has not been improving. He states that his symptoms improve with hot showers. The patient has presented to the emergency department with a similar complaint several times in the past as well as for intravenous drug abuse. His temperature is 99.5°F (37.5°C), blood pressure is 127/68 mmHg, pulse is 110/min, respirations are 22/min, and oxygen saturation is 98% on room air. Physical exam is deferred as the patient is actively vomiting. Which of the following is associated with the most likely diagnosis?
- A. Viral gastroenteritis
- B. Marijuana use (Correct Answer)
- C. Substance withdrawal
- D. Alcohol use
- E. Toxin ingestion
Cannabis use disorder Explanation: ***Marijuana use***
- The patient's history of recurrent vomiting, improvement with hot showers, and a history of intravenous drug abuse are highly suggestive of **cannabinoid hyperemesis syndrome (CHS)**. **Marijuana use** is directly associated with CHS, which presents with cyclical vomiting in chronic cannabis users.
- While the patient has a history of intravenous drug use, the specific pattern of recurrent vomiting relieved by hot showers points strongly towards **CHS**, which is caused by long-term cannabis use.
*Viral gastroenteritis*
- Although **viral gastroenteritis** can cause severe vomiting, it typically resolves within a few days and does not usually present as a recurrent issue relieved by hot showers.
- This condition does not explain the patient's history of multiple similar presentations or the specific alleviating factor of hot showers.
*Substance withdrawal*
- While some **substance withdrawal syndromes** can cause nausea and vomiting, the characteristic relief with hot showers is not typical for withdrawal symptoms.
- The patient's symptoms are more indicative of a syndrome directly linked to substance use rather than withdrawal.
*Alcohol use*
- **Alcohol use** can cause vomiting in episodes of acute intoxication or withdrawal; however, repeated episodes of severe vomiting relieved specifically by hot showers are not a classic presentation of alcohol-related vomiting.
- There is no specific mention of alcohol abuse in the patient's history as a cause for these symptoms.
*Toxin ingestion*
- **Toxin ingestion** can indeed cause severe vomiting, but it would not typically be a recurring problem that improves with hot showers.
- The recurrent nature and specific relieving factor point away from a one-time toxic exposure.
Cannabis use disorder US Medical PG Question 4: A 35-year-old woman comes to the physician accompanied by her husband after he started noticing strange behavior. He first noticed her talking to herself 8 months ago. For the past 6 months, she has refused to eat any packaged foods out of fear that the government is trying to poison her. She has no significant past medical history. She smoked marijuana in college but has not smoked any since. She appears restless. Mental status examination shows a flat affect. Her speech is clear, but her thought process is disorganized with many loose associations. The patient is diagnosed with schizophrenia and started on olanzapine. This patient is most likely to experience which of the following adverse effects?
- A. Dyslipidemia (Correct Answer)
- B. Diabetes insipidus
- C. Agranulocytosis
- D. Myoglobinuria
- E. Seizures
Cannabis use disorder Explanation: ***Dyslipidemia***
- **Olanzapine** is a **second-generation antipsychotic** commonly associated with significant **metabolic side effects**, including **weight gain**, **dyslipidemia**, and **insulin resistance**.
- These metabolic disturbances increase the risk of cardiovascular disease.
*Diabetes insipidus*
- This is a rare side effect, not typically associated with **olanzapine** or other **second-generation antipsychotics**.
- **Lithium** is an antimanic agent that can cause **nephrogenic diabetes insipidus**, but it is not relevant here.
*Agranulocytosis*
- While a serious side effect of some antipsychotics, **agranulocytosis** is most notably associated with **clozapine**,
- **Olanzapine** has a much lower risk of causing **agranulocytosis** compared to clozapine.
*Myoglobinuria*
- **Myoglobinuria** is associated with conditions like significant muscle damage (e.g., rhabdomyolysis).
- It is not a direct or common adverse effect of **olanzapine** therapy.
*Seizures*
- While some antipsychotics can lower the **seizure threshold**, **olanzapine** generally has a relatively low risk of inducing seizures.
- The risk is higher with certain other antipsychotics, particularly at high doses, or in patients with pre-existing seizure disorders.
Cannabis use disorder US Medical PG Question 5: A 23-year-old woman is brought to the emergency department by her friend because of strange behavior. Two hours ago, she was at a night club where she got involved in a fight with the bartender. Her friend says that she was smoking a cigarette before she became irritable and combative. She repeatedly asked “Why are you pouring blood in my drink?” before hitting the bartender. She has no history of psychiatric illness. Her temperature is 38°C (100.4°F), pulse is 100/min, respirations are 19/min, and blood pressure is 158/95 mm Hg. Examination shows muscle rigidity. She has a reduced degree of facial expression. She has no recollection of her confrontation with the bartender. Which of the following is the most likely primary mechanism responsible for this patient's symptoms?
- A. Stimulation of cannabinoid receptors
- B. Inhibition of NMDA receptors (Correct Answer)
- C. Inhibition of norepinephrine, serotonin, and dopamine reuptake
- D. Stimulation of 5HT2A and dopamine D2 receptors
- E. Inhibition of dopamine D2 receptors
Cannabis use disorder Explanation: ***Inhibition of NMDA receptors***
- The patient's symptoms, including **combativeness**, **erratic behavior**, **delusions** ("Why are you pouring blood in my drink?"), **hypertension**, **tachycardia**, and **muscle rigidity**, are characteristic of **PCP intoxication**.
- **Phencyclidine (PCP)** acts primarily as an **NMDA receptor antagonist**, blocking calcium channels and leading to these neurotoxic effects.
*Stimulation of cannabinoid receptors*
- **Cannabis intoxication** typically involves **euphoria**, distorted perception, impaired memory, and increased appetite, which are not the primary features described here.
- While agitation can occur, the severe combativeness, delusions, and specific vital sign changes point away from cannabinoid receptor stimulation as the primary mechanism for this presentation.
*Inhibition of norepinephrine, serotonin, and dopamine reuptake*
- This mechanism is characteristic of stimulants like **cocaine** or **amphetamines**. While these drugs can cause agitation, paranoia, hypertension, and tachycardia, they typically do not cause the prominent **muscle rigidity** and **delusional thought** content as described.
- The "smoking a cigarette" context might suggest stimulants, but the overall clinical picture is more consistent with PCP.
*Stimulation of 5HT2A and dopamine D2 receptors*
- Stimulation of **5HT2A receptors** is associated with **hallucinogens** like LSD, causing perceptual distortions and altered consciousness, but typically not the intense combativeness, muscle rigidity, and specific delusions seen here.
- While **dopamine D2 receptor stimulation** can contribute to psychosis, it's not the primary mechanism that brings together all the described symptoms in this acute, severe presentation.
*Inhibition of dopamine D2 receptors*
- **Dopamine D2 receptor inhibition** is the mechanism of action for antipsychotic medications and generally leads to a reduction in psychotic symptoms, not the intense agitation, combativeness, and psychotic features observed in this patient.
- Such inhibition can lead to extrapyramidal symptoms, but not the acute, substance-induced presentation described.
Cannabis use disorder US Medical PG Question 6: A 30-year-old man is brought to the emergency department by the police after starting a fight at a local bar. He has several minor bruises and he appears agitated. He talks incessantly about his future plans. He reports that he has no history of disease and that he is "super healthy" and "never felt better". His temperature is 38.0°C (100.4°F), pulse is 110/min, respirations are 16/min, and blood pressure is 155/80 mm Hg. On physical examination reveals a euphoric and diaphoretic man with slightly dilated pupils. An electrocardiogram is obtained and shows tachycardia with normal sinus rhythm. A urine toxicology screen is positive for cocaine. The patient is held in the ED for observation. Which of the following symptoms can the patient expect to experience as he begins to withdraw from cocaine?
- A. Psychosis
- B. Seizures
- C. Lacrimation
- D. Increased appetite (Correct Answer)
- E. Increased sympathetic stimulation
Cannabis use disorder Explanation: ***Increased appetite***
- **Cocaine withdrawal** is characterized by a "crash" phase, which includes severe fatigue, **dysphoria**, and increased appetite, often leading to binge eating as the body attempts to replenish depleted neurotransmitters.
- This symptom, combined with **hypersomnia** and a reduction in pleasure, represents a rebound effect from the intense stimulation caused by cocaine use.
*Psychosis*
- While acute cocaine intoxication can induce **psychotic symptoms** like paranoia and hallucinations, psychosis is not a typical feature of the *withdrawal* phase.
- Instead, the withdrawal period is often marked by a decrease in stimulation, leading to symptoms like depression and anhedonia rather than further agitation or psychosis.
*Seizures*
- **Seizures** are a potential complication of acute cocaine intoxication due to its stimulant effects on the central nervous system, but they are generally not a primary symptom of uncomplicated **cocaine withdrawal**.
- Withdrawal is more commonly associated with a state of brain hyperexcitability that manifests as cravings and dysphoria, not typically grand mal seizures.
*Lacrimation*
- **Lacrimation** (tearing) is a common symptom of **opioid withdrawal**, often accompanied by rhinorrhea, muscle aches, and piloerection.
- These **cholinergic rebound** symptoms are not characteristic of cocaine withdrawal, which primarily involves dopaminergic and noradrenergic system dysregulation.
*Increased sympathetic stimulation*
- Acute cocaine use directly causes increased sympathetic stimulation, resulting in **tachycardia**, **hypertension**, and dilated pupils, as seen in this patient.
- **Cocaine withdrawal**, conversely, leads to a *decrease* in sympathetic tone, often accompanied by fatigue, bradycardia, and a general depressive state, as the body rebounds from overstimulation.
Cannabis use disorder US Medical PG Question 7: An 18-year-old male was brought to the emergency room after he caused an accident by driving at a slow speed as he was entering the freeway. He appears to have sustained no major injuries just minor scratches and lacerations, but appears to be paranoid, anxious, and is complaining of thirst. He has conjunctival injection and has slowed reflexes. A police officer explained that he had confiscated contraband from the vehicle of the male. Which of the following substances was most likely used by the male?
- A. Cocaine
- B. Heroin
- C. Phencyclidine (PCP)
- D. Marijuana (Correct Answer)
- E. Alprazolam
Cannabis use disorder Explanation: ***Marijuana***
- The combination of **paranoia, anxiety, conjunctival injection, slowed reflexes, and thirst (dry mouth)** is highly characteristic of **marijuana intoxication**.
- Driving at a **slow speed** and causing an accident also aligns with the impaired judgment and motor skills associated with cannabis use.
*Cocaine*
- Cocaine intoxication typically causes **euphoria, increased energy, dilated pupils (mydriasis), and tachycardia**, not slowed reflexes or conjunctival injection.
- Users would generally exhibit **agitation and paranoia** but not the sedating effects of driving slowly.
*Heroin*
- Heroin (an opioid) intoxication is characterized by **respiratory depression, pinpoint pupils (miosis), sedation, and euphoria**, which are not seen in this patient.
- The patient's paranoia and anxiety are not typical features of acute opioid intoxication.
*Phencyclidine (PCP)*
- PCP intoxication often presents with severe **agitation, aggression, nystagmus, hypertension, and dissociative symptoms**, along with a high tolerance to pain.
- While paranoia can occur, the overall clinical picture, especially the absence of aggression and nystagmus, makes PCP less likely.
*Alprazolam*
- Alprazolam, a benzodiazepine, primarily causes **sedation, drowsiness, ataxia, and slurred speech**.
- While it can impair driving and cause slowed reflexes, it typically does not cause paranoia, conjunctival injection, or thirst.
Cannabis use disorder US Medical PG Question 8: A 30-year-old man is brought to the emergency department by his brother for the evaluation of progressive confusion over the past 6 hours. The patient is lethargic and unable to answer questions. His brother states that there is no personal or family history of serious illness. His temperature is 37°C (98.6°F), pulse is 110/min, and blood pressure 135/80 mm Hg. Physical examination shows warm, dry skin and dry mucous membranes. The pupils are dilated. The abdomen is distended and bowel sounds are hypoactive. Laboratory studies are within normal limits. An ECG shows no abnormalities. Intoxication with which of the following substances is the most likely cause of this patient's symptoms?
- A. Cannabis
- B. Amphetamine
- C. Opioid
- D. Carbon monoxide
- E. Antihistamine (Correct Answer)
Cannabis use disorder Explanation: ***Antihistamine***
- The patient's symptoms, including **dilated pupils**, confusion, lethargy, dry skin and mucous membranes, distended abdomen, and hypoactive bowel sounds, are consistent with an **anticholinergic toxidrome**. This pattern is often seen with antihistamine overdose due to their anticholinergic properties.
- The elevated pulse despite normal blood pressure and temperature also aligns with anticholinergic effects.
*Cannabis*
- Cannabis intoxication typically causes **conjunctival injection**, xerostomia, increased appetite, and impaired coordination.
- While it can cause lethargy, it does not explain the dilated pupils, dry mucous membranes, or hypoactive bowel sounds.
*Amphetamine*
- Amphetamine intoxication usually presents with **tachycardia**, hypertension, agitation, paranoia, and diaphoresis, not dry skin or hypoactive bowel sounds.
- Though pupils are typically dilated, the overall clinical picture points away from amphetamine overdose.
*Opioid*
- Opioid overdose is characterized by **respiratory depression**, **miosis (pinpoint pupils)**, and altered mental status, which contradict the dilated pupils and normal respiratory effort (implied by normal oxygenation and stable vital signs) in this case.
- While it can cause lethargy and hypoactive bowel sounds, other key features are missing or are opposite.
*Carbon monoxide*
- Carbon monoxide poisoning classically presents with **headache**, nausea, vomiting, confusion, and sometimes the classic "**cherry-red skin**" (though this is rare and late).
- It does not cause dilated pupils, dry mucous membranes, or hypoactive bowel sounds as seen in this patient.
Cannabis use disorder US Medical PG Question 9: A 20-year-old man comes to the physician because of decreasing academic performance at his college for the past 6 months. He reports a persistent fear of “catching germs” from his fellow students and of contracting a deadly disease. He finds it increasingly difficult to attend classes. He avoids handshakes and close contact with other people. He states that when he tries to think of something else, the fears “keep returning” and that he has to wash himself for at least an hour when he returns home after going outside. Afterwards he cleans the shower and has to apply disinfectant to his body and to the bathroom. He does not drink alcohol. He used to smoke cannabis but stopped one year ago. His vital signs are within normal limits. He appears anxious. On mental status examination, he is oriented to person, place, and time. In addition to starting an SSRI, which of the following is the most appropriate next step in management?
- A. Cognitive-behavioral therapy (Correct Answer)
- B. Psychodynamic psychotherapy
- C. Motivational interviewing
- D. Interpersonal therapy
- E. Group therapy
Cannabis use disorder Explanation: **Cognitive-behavioral therapy**
- **Cognitive-behavioral therapy (CBT)**, specifically **Exposure and Response Prevention (ERP)**, is the most effective psychotherapy for **obsessive-compulsive disorder (OCD)**, which this patient's symptoms strongly suggest.
- CBT helps patients challenge distorted thoughts and gradually expose themselves to feared situations while preventing compulsive rituals, thus breaking the cycle of obsessions and compulsions.
*Psychodynamic psychotherapy*
- This therapy focuses on **unconscious conflicts** and **past experiences** to understand current symptoms.
- While it can be helpful for some mental health conditions, it is generally **less effective** than CBT for the specific, highly ritualized symptoms of OCD.
*Motivational interviewing*
- **Motivational interviewing** is a patient-centered counseling style designed to address **ambivalence about change** and enhance intrinsic motivation.
- It is often used in substance abuse or lifestyle changes, but it does not directly teach coping skills for OCD symptoms or address the underlying thought patterns.
*Interpersonal therapy*
- **Interpersonal therapy (IPT)** focuses on the patient's **current interpersonal relationships** and social functioning.
- While social difficulties can arise from OCD, IPT does not directly target the obsessions and compulsions that are central to the disorder.
*Group therapy*
- **Group therapy** can provide support and a sense of community, but for a severe condition like OCD, **individual therapy** (especially CBT/ERP) is typically recommended first due to the highly individualized nature of obsessions and compulsions.
- It may be a complementary approach, but usually not the most appropriate initial next step given the intensity of the patient's symptoms.
Cannabis use disorder US Medical PG Question 10: A 35-year-old man presents to his primary care physician for a routine visit. He is in good health but has a 15 pack-year smoking history. He has tried to quit multiple times and expresses frustration in his inability to do so. He states that he has a 6-year-old son that was recently diagnosed with asthma and that he is ready to quit smoking. What is the most effective method of smoking cessation?
- A. Nicotine replacement therapy alone
- B. Quitting cold turkey
- C. Bupropion in conjunction with nicotine replacement therapy and cognitive behavioral therapy (Correct Answer)
- D. Participating in a smoking-cessation support group
- E. Bupropion alone
Cannabis use disorder Explanation: ***Bupropion in conjunction with nicotine replacement therapy and cognitive behavioral therapy***
- The combination of **pharmacological therapies** (Bupropion and NRT) with **behavioral support** (CBT) is consistently shown to be the most effective strategy for smoking cessation. This approach addresses both the physiological addiction and the psychological habits associated with smoking.
- **Bupropion** helps reduce cravings and withdrawal symptoms, while **nicotine replacement therapy (NRT)** manages nicotine withdrawal. **Cognitive behavioral therapy (CBT)** provides coping mechanisms and strategies to deal with triggers and prevent relapse.
*Nicotine replacement therapy alone*
- While **nicotine replacement therapy (NRT)** is an effective treatment, its efficacy significantly increases when combined with behavioral therapy or other pharmacotherapies.
- NRT alone primarily addresses the **physical dependence** on nicotine but may not fully address the psychological and behavioral aspects of addiction.
*Quitting 'cold-turkey'*
- **Quitting cold turkey** has a very low success rate, with only about 3-5% of individuals managing to quit long-term using this method.
- This method provides no support for severe **withdrawal symptoms** or cravings, making relapse highly likely, especially for heavy smokers.
*Participating in a smoking-cessation support group*
- **Support groups** provide valuable behavioral and social support, which is an important component of successful cessation.
- However, behavioral support alone is often less effective than when combined with **pharmacological interventions** that address the physiological addiction.
*Bupropion alone*
- **Bupropion** is an effective pharmacotherapy that helps reduce cravings and withdrawal symptoms and has been shown to improve cessation rates.
- While effective, its success rate is typically lower than when used in combination with **nicotine replacement therapy** and comprehensive behavioral support.
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