Drugs of Abuse and Addiction — MCQs
A 55-year-old drug addict from California presents with euphoria, altered time perception, and conjunctival injection, along with impairment of judgment. The most likely cause of this is addiction to which substance?
A patient presents to the emergency department with vomiting, diarrhea, lacrimation, abdominal cramps, and piloerection. The family members report a history of substance use for the past month. The clinical presentation is due to what?
A person presents to the outpatient department with tremors and visual hallucinations after a 2-day history of alcohol cessation. What is the diagnosis?
A female was given morphine sulphate during labour for pain but she developed respiratory distress. Which of the following will be the correct antidote?
Increased dopamine levels are associated with which of the following conditions?
A 30-year-old drug addict presents to the emergency department with signs of unknown drug poisoning. The patient exhibits dilated pupils, diaphoresis, tachycardia, and tremors. On examination, the blood pressure is 180/110 mmHg, and the heart rate is 120 beats per minute. What is the most likely diagnosis?
Delirium tremens is most commonly seen in:
The following symptoms may be seen in opium withdrawal:
A 45-year-old male with a history of chronic alcohol use is admitted to the hospital. He presents with anxiety, tremors, and agitation after his last drink 24 hours ago. Which of the following medications is most appropriate for controlling alcohol withdrawal symptoms?
Which of the following is NOT true regarding ‘Renal Carbuncle’?
Drugs of Abuse and Addiction Indian Medical PG Practice Questions and MCQs
Question 1: A 55-year-old drug addict from California presents with euphoria, altered time perception, and conjunctival injection, along with impairment of judgment. The most likely cause of this is addiction to which substance?
- A. Marijuana (Correct Answer)
- B. Cocaine
- C. Phencyclidine
- D. Benzodiazepine
Explanation: ***Marijuana*** - **Euphoria**, altered time perception, and **conjunctival injection** are classic symptoms associated with marijuana use. - Impairment of judgment and coordination are also common effects of **cannabis intoxication**. *Cocaine* - Cocaine intoxication typically presents with **psychomotor agitation**, **tachycardia**, **hypertension**, and **dilated pupils**, not conjunctival injection. - While it causes euphoria and altered perception, the specific combination of symptoms points away from cocaine. *Phencyclidine* - **Phencyclidine (PCP)** often causes **nystagmus**, violence, and **dissociative symptoms** like derealization and depersonalization, which are not described. - It can also lead to severe agitation and unpredictable behavior, distinct from the patient's presentation. *Benzodiazepine* - Benzodiazepine intoxication or abuse typically leads to **sedation**, ataxia, and **respiratory depression**, rather than euphoria and conjunctival injection. - The effects are more consistent with central nervous system depression.
Question 2: A patient presents to the emergency department with vomiting, diarrhea, lacrimation, abdominal cramps, and piloerection. The family members report a history of substance use for the past month. The clinical presentation is due to what?
- A. opioid withdrawal (Correct Answer)
- B. cocaine intoxication
- C. cocaine withdrawal
- D. opioid intoxication
Explanation: ***Opioid withdrawal*** - The constellation of **vomiting, diarrhea, lacrimation, abdominal cramps, and piloerection** (gooseflesh) are classic signs and symptoms of **opioid withdrawal**. - These symptoms reflect a **hyperactive sympathetic nervous system** as the body attempts to compensate for the absence of exogenous opioids. *Cocaine intoxication* - Cocaine intoxication typically presents with **euphoria, hyperactivity, tachycardia, hypertension, and paranoia**, which are not seen here. - It is characterized by **sympathomimetic effects**, leading to an agitated and stimulated state, rather than the distress seen in withdrawal. *Cocaine withdrawal* - Cocaine withdrawal typically manifests as **dysphoria, fatigue, increased appetite, psychomotor retardation or agitation, and vivid unpleasant dreams**, not the GI and autonomic symptoms described. - The primary symptoms are psychological and energetic, often described as a "crash" rather than the physical distress of opioid withdrawal. *Opioid intoxication* - Opioid intoxication primarily causes **CNS depression**, including **respiratory depression, meiosis (pinpoint pupils), sedation, and constipation**. - The patient's symptoms of vomiting, diarrhea, and lacrimation are contrary to the effects of opioid intoxication.
Question 3: A person presents to the outpatient department with tremors and visual hallucinations after a 2-day history of alcohol cessation. What is the diagnosis?
- A. Korsakoff’s psychosis
- B. Delirium tremens (Correct Answer)
- C. Wernicke encephalopathy
- D. Alcoholic hallucinosis
Explanation: ***Delirium tremens*** - Delirium tremens is a severe form of **alcohol withdrawal** characterized by **tremors**, disorientation, and **visual hallucinations**, typically appearing **48 to 96 hours** (2-4 days) after the last drink. - This is a medical emergency with potential for **seizures**, **hyperthermia**, and **cardiovascular collapse** due to dysregulation of neurotransmitters (decreased **GABA** activity and increased **glutamate** activity). - Autonomic hyperactivity (tachycardia, hypertension, diaphoresis) is a key feature distinguishing it from other alcohol-related conditions. *Korsakoff's psychosis* - This is a chronic **neuropsychiatric syndrome** typically occurring after an episode of **Wernicke encephalopathy**, characterized by severe **memory impairment** (anterograde and retrograde amnesia) and **confabulation**. - It develops over weeks to months in the course of chronic alcoholism and is **not an acute withdrawal syndrome**, unlike the symptoms described in this 2-day presentation. *Wernicke encephalopathy* - This is an acute neurological condition caused by **thiamine (vitamin B1) deficiency**, commonly seen in chronic alcoholics, characterized by the classic triad of **ophthalmoplegia** (especially nystagmus), **ataxia**, and **confusion**. - While it can precede Korsakoff's psychosis and involves confusion, it does not typically present with the prominent **tremors** and **visual hallucinations** characteristic of alcohol withdrawal, and the timing (2 days post-cessation) points more toward withdrawal rather than nutritional deficiency. *Alcoholic hallucinosis* - Alcoholic hallucinosis involves primarily **auditory hallucinations** (often threatening voices) that occur without significant clouding of consciousness, typically within **12-24 hours** of alcohol cessation. - Unlike delirium tremens, it **lacks autonomic instability**, severe tremors, and global disorientation, and the hallucinations are predominantly auditory rather than visual.
Question 4: A female was given morphine sulphate during labour for pain but she developed respiratory distress. Which of the following will be the correct antidote?
- A. Naloxone (Correct Answer)
- B. Epinephrine
- C. Pralidoxime
- D. Atropine
Explanation: ***Naloxone*** - **Naloxone** is a pure opioid antagonist that rapidly reverses the effects of **opioid overdose** [1, 3], including **respiratory depression** [2], by competitively binding to opioid receptors [1]. - Its short half-life may necessitate repeated doses, especially with longer-acting opioids like morphine, to prevent recurrence of respiratory depression [1]. *Epinephrine* - **Epinephrine** is an adrenergic agonist used to treat **anaphylaxis** and severe allergic reactions, as it causes **vasoconstriction** and **bronchodilation**. - It is not an antidote for opioid-induced respiratory depression, which primarily results from central nervous system effects rather than allergic reactions. *Pralidoxime* - **Pralidoxime** is a **cholinesterase reactivator** used to treat poisoning by **organophosphates**, which inhibit acetylcholinesterase, leading to cholinergic crisis. - It works by restoring the function of the enzyme, thereby breaking down excess acetylcholine, and is not indicated for opioid overdose. *Atropine* - **Atropine** is an **anticholinergic agent** that blocks muscarinic acetylcholine receptors, used to treat **bradycardia** and **organophosphate poisoning**. - It would not reverse opioid-induced respiratory depression, as it primarily affects the parasympathetic nervous system and does not antagonize opioid receptor effects.
Question 5: Increased dopamine levels are associated with which of the following conditions?
- A. Depression
- B. Mania
- C. Delirium
- D. Schizophrenia (Correct Answer)
Explanation: ***Schizophrenia*** - The **dopamine hypothesis of schizophrenia** is the most well-established association with increased dopamine levels, particularly in the **mesolimbic pathway**, which contributes to positive symptoms such as **hallucinations** and **delusions**. - Antipsychotic medications, which are **dopamine D2 receptor antagonists**, effectively reduce these positive symptoms by blocking dopamine activity. - This is the **classic and primary answer** when considering increased dopamine levels in psychiatry. *Depression* - Depression is primarily associated with **decreased levels of monoamines**, including **serotonin**, **norepinephrine**, and **dopamine**. - Treatments for depression often aim to increase these neurotransmitter levels, not related to dopamine excess. *Mania* - Mania, a hallmark of **bipolar disorder**, is associated with **increased dopamine activity** along with elevated **norepinephrine** and **serotonin** levels. - While mania does involve dopamine elevation, **schizophrenia** remains the **primary and most established** condition associated with the dopamine hypothesis in psychiatric literature. - The distinction is that schizophrenia's pathophysiology is more centrally and specifically linked to dopamine dysregulation. *Delirium* - Delirium is a state of **acute brain failure** characterized by a fluctuating course and disturbances in attention and cognition. - While neurotransmitter imbalances, including dopamine, **acetylcholine deficiency**, and GABA alterations, can contribute to delirium, it is not primarily defined by increased dopamine as the main pathophysiological mechanism.
Question 6: A 30-year-old drug addict presents to the emergency department with signs of unknown drug poisoning. The patient exhibits dilated pupils, diaphoresis, tachycardia, and tremors. On examination, the blood pressure is 180/110 mmHg, and the heart rate is 120 beats per minute. What is the most likely diagnosis?
- A. Cocaine intoxication (Correct Answer)
- B. Dhatura poisoning
- C. Cannabis poisoning
- D. Alcohol intoxication
- E. Amphetamine intoxication
Explanation: ***Cocaine intoxication*** - Cocaine is a potent **sympathomimetic** drug that leads to a hyperadrenergic state, causing symptoms like **dilated pupils**, diaphoresis, tachycardia, and hypertension. - The patient's presentation with significant **tachycardia (120 bpm)** and **hypertension (180/110 mmHg)**, along with a history of drug abuse, strongly points towards cocaine. - Cocaine has a **shorter duration of action** (30-90 minutes) compared to amphetamines, but the clinical presentation is nearly identical. *Amphetamine intoxication* - **Amphetamines** also cause a sympathomimetic toxidrome very similar to cocaine, with mydriasis, diaphoresis, tachycardia, and hypertension. - However, the acute presentation is clinically indistinguishable from cocaine, though amphetamines typically have a **longer duration of action** (4-8 hours). - Both diagnoses would be managed similarly in the acute setting. *Dhatura poisoning* - **Dhatura** causes an **anticholinergic toxidrome**, characterized by symptoms such as "hot, dry, blind, red, and mad." - Key features of dhatura poisoning include **dry mucous membranes**, dilated pupils (mydriasis), flushed skin, but typically a **normal or elevated temperature** rather than diaphoresis and less pronounced hypertension. *Cannabis poisoning* - **Cannabis intoxication** typically leads to symptoms like **conjunctival injection**, dry mouth, increased appetite, and impaired coordination. - While it can cause mild tachycardia, it generally does not result in the severe **hypertension**, profound diaphoresis, or significant tremors seen in this patient. *Alcohol intoxication* - **Alcohol intoxication** usually presents with central nervous system depression, such as **slurred speech**, ataxia, nystagmus, and drowsiness. - While alcohol can affect blood pressure and heart rate, it typically causes **hypotension** or mild hypertension, and it does not produce the marked sympathomimetic effects such as **mydriasis** and profound diaphoresis observed here.
Question 7: Delirium tremens is most commonly seen in:
- A. Opioid withdrawal
- B. Alcohol withdrawal (Correct Answer)
- C. Opioid intoxication
- D. Alcohol intoxication
Explanation: ***Alcohol withdrawal*** - **Delirium tremens (DTs)** is the most severe form of **alcohol withdrawal syndrome**, characterized by **severe disorientation**, **agitation**, and **autonomic instability**. - It typically manifests 2-5 days after the cessation or significant reduction of alcohol intake in individuals with chronic alcohol dependence. *Opioid withdrawal* - Opioid withdrawal symptoms include **dysphoria**, **nausea**, **vomiting**, **diarrhea**, **muscle aches**, **lacrimation**, and **rhinorrhea**. - It does not typically involve the profound **delirium**, **hallucinations**, and **autonomic hyperactivity** seen in DTs. *Opioid intoxication* - Opioid intoxication presents with **central nervous system depression**, including **respiratory depression**, **miosis**, and **decreased level of consciousness**. - These symptoms are opposite to the hyperactive and agitated state characteristic of delirium tremens. *Alcohol intoxication* - Alcohol intoxication causes **central nervous system depression**, leading to **sedation**, **impaired coordination**, and **decreased judgment**. - This is a state of acute impairment from alcohol, not a withdrawal syndrome, and thus presents very differently from delirium tremens.
Question 8: The following symptoms may be seen in opium withdrawal:
- A. Tremors
- B. Constipation
- C. Lacrimation (Correct Answer)
- D. Dry nose and mouth
Explanation: ***Lacrimation*** - Opioid withdrawal is characterized by **autonomic hyperactivity**, leading to symptoms like **lacrimation** (tearing), rhinorrhea (runny nose), and piloerection. - This is a rebound effect from the chronic opioid suppression of the parasympathetic nervous system. *Tremors* - While tremors can occur in various withdrawal syndromes, they are more characteristic of **alcohol** or **benzodiazepine withdrawal**, which involve GABAergic systems. - Opioid withdrawal can cause muscle aches and spasms, but **significant, sustained tremors** are not a primary diagnostic criterion. *Dry nose and mouth* - **Dry mouth** is a common side effect of opioid use, due to their anticholinergic effects, but during **withdrawal**, patients experience increased secretions like rhinorrhea and **lacrimation**. - **Dry nose** is also contrary to the typical presentation of opioid withdrawal, which involves a **runny nose**. *Constipation* - **Constipation** is a well-known side effect of chronic opioid use due to reduced gut motility. - During withdrawal, patients typically experience **diarrhea** and abdominal cramping, as gut motility returns and often becomes hyperactive.
Question 9: A 45-year-old male with a history of chronic alcohol use is admitted to the hospital. He presents with anxiety, tremors, and agitation after his last drink 24 hours ago. Which of the following medications is most appropriate for controlling alcohol withdrawal symptoms?
- A. Lorazepam (Correct Answer)
- B. Fomepizole
- C. Disulfiram
- D. Buspirone
- E. Naltrexone
Explanation: ***Lorazepam*** - **Lorazepam**, a **benzodiazepine**, is the first-line treatment for alcohol withdrawal symptoms due to its ability to enhance **GABAergic activity**, which is deficient during withdrawal. - Its **intermediate half-life** and **lack of active metabolites** make it suitable for patients with liver impairment, common in chronic alcohol users. *Fomepizole* - **Fomepizole** is an antidote used to treat poisoning from **methanol** or **ethylene glycol**, not alcohol withdrawal. - It works by inhibiting **alcohol dehydrogenase**, an enzyme involved in the metabolism of these toxic alcohols. *Disulfiram* - **Disulfiram** is an **aldehyde dehydrogenase inhibitor** used to deter alcohol consumption in recovering alcoholics by causing unpleasant reactions if alcohol is consumed. - It is **not used to treat acute alcohol withdrawal symptoms** and can be dangerous if given during withdrawal due to potential interactions. *Buspirone* - **Buspirone** is an **anxiolytic** that acts as a **serotonin receptor agonist** and is used for generalized anxiety disorder. - It is **ineffective for acute alcohol withdrawal** due to its slow onset of action and lack of anticonvulsant properties. *Naltrexone* - **Naltrexone** is an **opioid receptor antagonist** used for relapse prevention and reducing alcohol craving in patients with alcohol use disorder. - It is **not effective for acute alcohol withdrawal symptoms** and does not prevent seizures or delirium tremens, which are life-threatening complications of withdrawal.
Question 10: Which of the following is NOT true regarding ‘Renal Carbuncle’?
- A. It occurs in diabetic patient
- B. It occurs in intravenous drug abusers
- C. It is a type of renal tuberculosis (Correct Answer)
- D. It is an abscess in renal parenchyma
Explanation: A **renal carbuncle** is essentially a **renal abscess** caused by bacterial infection, typically *Staphylococcus aureus* or *Escherichia coli*, not *Mycobacterium tuberculosis*. Renal tuberculosis manifests differently, often with **sterile pyuria** and granulomatous inflammation, and is not synonymous with a carbuncle. Patients with **diabetes mellitus** are at an increased risk of developing bacterial infections, including **renal carbuncles**, due to impaired immune function and glucose-rich urine. Poorly controlled diabetes is a significant **predisposing factor** for severe renal infections. **Intravenous drug users** are at higher risk of bloodstream infections, including **septic emboli** that can disseminate to the kidneys and form renal carbuncles. **Skin contaminants** and unsterile injection practices can introduce bacteria into the bloodstream that eventually localize in renal tissue. A **renal carbuncle** is defined as a focal collection of **pus** and necrotic tissue within the renal parenchyma, essentially a **renal abscess**. It results from the **hematogenous spread** of bacteria or, less commonly, from an ascending urinary tract infection [1].
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free