Cannabis Use Disorder — MCQs
Which of the following is NOT a diagnostic criterion for drug dependence?
What is the primary role of marijuana in the management of AIDS-related cachexia?
Which of the following treatments cannot be used for management of Obsessive Compulsive Disorder (OCD)?
Which of the following does not refer to a cannabis preparation?
Behavioural problems caused by senility, drug damage, brain injury or disease, and the toxic effects of poisons are classified as __________ disorders
CAGE questionnaire is used in:
A patient with bronchial asthma develops osteoporosis. Most likely mechanism?
What is the most common illicit drug that causes dependence?
Under which one of the following conditions, the HPA axis suppression is likely to result in crisis due to adrenal insufficiency following withdrawal of glucocorticoids?
What is the simplest and most commonly used measure of mortality?
Cannabis Use Disorder Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following is NOT a diagnostic criterion for drug dependence?
- A. Taking substance in larger amounts than intended
- B. Tolerance
- C. Withdrawal symptoms
- D. Early completion of tasks (Correct Answer)
Explanation: ***Early completion of tasks*** - This is not a recognized diagnostic criterion for **drug dependence (substance use disorder)** according to standardized diagnostic manuals like the DSM-5. - While it might reflect an individual's productivity or efficiency, it has no direct link to the compulsive drug-seeking and use behaviors characteristic of dependence. *Tolerance* - **Tolerance** is a core criterion, defined as a need for markedly increased amounts of the substance to achieve intoxication or desired effect, or a markedly diminished effect with continued use of the same amount of the substance. - This indicates a physiological adaptation to the presence of the drug. *Withdrawal symptoms* - **Withdrawal symptoms** refer to the characteristic physiological and psychological symptoms that occur when a person stops or reduces their use of a substance after prolonged or heavy use. - The presence of a withdrawal syndrome or taking the substance (or a closely related one) to relieve or avoid withdrawal symptoms is a key diagnostic indicator. *Taking substance in larger amounts than intended* - This criterion reflects the **impaired control** over substance use, where the individual uses the substance more often or in larger quantities than they initially intended. - It demonstrates a loss of conscious regulation over drug intake, which is a hallmark of substance dependence.
Question 2: What is the primary role of marijuana in the management of AIDS-related cachexia?
- A. Produces euphoric effects
- B. Acts as a psycho-stimulant
- C. Stimulates appetite (Correct Answer)
- D. Reduces nausea
Explanation: ***Stimulates appetite*** - Marijuana, particularly through its cannabinoid components like THC, is well-known for its **appetite-stimulating effects**, often referred to as "the munchies." - For patients with AIDS-related cachexia (wasting syndrome), increasing appetite can help in **gaining weight** and improving nutritional status, which is crucial for overall health. *Produces euphoric effects* - While marijuana can produce euphoric effects, this is a **side effect** and not the primary therapeutic role sought for managing **cachexia**. - The euphoria might temporarily improve mood but does not directly address the physiological wasting. *Acts as a psycho-stimulant* - Marijuana is generally considered a **depressant** or **hallucinogen**, not a psycho-stimulant. - Psycho-stimulants increase alertness and focus, which is not the desired action for treating AIDS-related cachexia. *Reduces nausea* - While marijuana can effectively **reduce nausea** and vomiting, particularly in chemotherapy patients, this is a secondary benefit in the context of cachexia. - The primary goal in cachexia is to increase food intake and weight, which the appetite stimulation directly addresses.
Question 3: Which of the following treatments cannot be used for management of Obsessive Compulsive Disorder (OCD)?
- A. Fluoxetine
- B. Carbamazepine (Correct Answer)
- C. Cognitive Behaviour Therapy
- D. Clomipramine
Explanation: ***Carbamazepine*** - **Carbamazepine** is an **anticonvulsant** and **mood stabilizer** primarily used for epilepsy and bipolar disorder. - It does not have established efficacy for the treatment of **Obsessive-Compulsive Disorder (OCD)**. *Fluoxetine* - **Fluoxetine** is a **Selective Serotonin Reuptake Inhibitor (SSRI)** and is a **first-line pharmacotherapy** for OCD. - SSRIs, including fluoxetine, are effective in reducing the severity of **obsessions and compulsions**. *Cognitive Behaviour Therapy* - **Cognitive Behavioural Therapy (CBT)**, specifically **Exposure and Response Prevention (ERP)**, is the **gold standard psychotherapy** for OCD. - It involves gradually exposing patients to feared situations or thoughts while preventing their ritualistic responses. *Clomipramine* - **Clomipramine** is a **tricyclic antidepressant (TCA)** that has potent inhibitory effects on **serotonin reuptake**. - It is one of the **most effective medications** for OCD, often used when SSRIs are insufficient.
Question 4: Which of the following does not refer to a cannabis preparation?
- A. Charas
- B. Afeem (Correct Answer)
- C. Reefer
- D. Sinsemilla
Explanation: ***Afeem*** - **Afeem** is a preparation of **opium**, which is derived from the **opium poppy** (Papaver somniferum), not cannabis. - Opium contains **opiates** like morphine and codeine, which have different psychoactive and pharmacological effects than cannabis. *Charas* - **Charas** is a form of **hashish** made from the resin of the cannabis plant, primarily from Indian cannabis strains. - It involves hand-rubbing the live plant to collect the resin, which is then rolled into balls or sticks. *Reefer* - **Reefer** is a slang term for a **marijuana cigarette** or a **joint**. - It refers to dried cannabis flowers rolled in paper for smoking. *Sinsemilla* - **Sinsemilla** refers to **unpollinated female cannabis plants** that produce a higher concentration of tetrahydrocannabinol (THC). - The term literally means "without seeds" (from Spanish "sin semilla") and is prized for its potency.
Question 5: Behavioural problems caused by senility, drug damage, brain injury or disease, and the toxic effects of poisons are classified as __________ disorders
- A. Psychosomatic
- B. Substance use
- C. Organic (Correct Answer)
- D. Psychotic
Explanation: ***Organic*** - **Organic disorders** are characterized by behavioral or psychological symptoms that are directly attributable to a **physiological dysfunction** or structural change in the brain. - This category includes conditions arising from **senility**, drug-induced damage, brain injury, disease (e.g., **dementia**), or exposure to **neurotoxins**. *Psychosomatic* - **Psychosomatic disorders** involve physical symptoms that are caused or aggravated by **psychological factors**, like stress. - The primary cause is not a direct physiological injury or disease of the brain itself. *Substance use* - **Substance use disorders** describe maladaptive patterns of substance use leading to clinically significant impairment or distress. - While drug damage is mentioned in the question, this category focuses specifically on the **addiction** and related behaviors, not the broad range of organic causes. *Psychotic* - **Psychotic disorders** are characterized by a significant loss of contact with reality, often involving **hallucinations** or **delusions**. - While some organic conditions can cause psychotic symptoms, the term "psychotic disorders" refers to a specific symptom cluster rather than the underlying physical cause.
Question 6: CAGE questionnaire is used in:
- A. Opiate poisoning
- B. Alcohol dependence (Correct Answer)
- C. Dhatura poisoning
- D. Barbiturate poisoning
Explanation: ***Alcohol dependence*** - The **CAGE questionnaire** is a widely used screening tool for identifying potential **alcohol problems** and dependence. - The acronym CAGE stands for Cutting down, Annoyance by criticism, Guilty feelings, and Eye-openers, all related to drinking habits. *Opiate poisoning* - Screening for opiate use or poisoning typically involves asking about **drug use history**, conducting **urine drug screens**, and observing specific clinical signs like **pinpoint pupils** and **respiratory depression**. - The CAGE questionnaire is not designed to screen for opiate use. *Dhatura poisoning* - **Dhatura poisoning** is characterized by anticholinergic symptoms like **dilated pupils**, **dry mouth**, **tachycardia**, and **delirium**. - Diagnosis relies on clinical presentation and a history of exposure, not a specific questionnaire like CAGE. *Barbiturate poisoning* - **Barbiturate poisoning** presents with central nervous system depression, including **sedation**, **respiratory depression**, and **hypotension**. - Diagnosis involves a clinical assessment, history of barbiturate use, and toxicology screens, not the CAGE questionnaire.
Question 7: A patient with bronchial asthma develops osteoporosis. Most likely mechanism?
- A. Calcium malabsorption
- B. Inflammatory mediators
- C. Physical inactivity
- D. Chronic steroid use (Correct Answer)
Explanation: ***Chronic steroid use*** - **Glucocorticoids**, commonly used in the treatment of bronchial asthma, can directly inhibit **osteoblast activity** and promote **osteoclast activity**, leading to bone loss [1]. - They also reduce intestinal **calcium absorption** and increase **renal calcium excretion**, further disrupting calcium homeostasis and contributing to osteoporosis [1]. *Calcium malabsorption* - While **malabsorption syndromes** can cause osteoporosis, asthma itself does not directly lead to primary calcium malabsorption. - Steroids used in asthma treatment can *contribute* to reduced calcium absorption, but the primary mechanism of steroid-induced osteoporosis involves broader effects on bone metabolism, not solely malabsorption [1]. *Inflammatory mediators* - **Inflammatory mediators** associated with asthma may play a role in bone density loss, but their direct impact is less significant and less common than the effects of chronic steroid use [2]. - While chronic inflammation can indirectly affect bone remodeling, it is not the most likely or direct mechanism for osteoporosis in this clinical scenario compared to steroid exposure [1]. *Physical inactivity* - **Physical inactivity** can contribute to osteoporosis due to reduced mechanical loading on bones, but it is not a direct or primary cause specific to bronchial asthma [3]. - While severe asthma may lead to some activity limitation, the primary mechanism linking asthma treatment to osteoporosis is typically medication-related, rather than lifestyle factors alone.
Question 8: What is the most common illicit drug that causes dependence?
- A. Cannabis (Correct Answer)
- B. Cocaine
- C. Heroin
- D. Amphetamine
Explanation: ***Cannabis*** - **Cannabis** is the most widely used illicit drug globally, and despite common misconceptions, it can certainly lead to **cannabis use disorder** characterized by dependence. - The high prevalence of its use contributes to it being the illicit drug that most commonly causes clinical dependence, as a larger user base means more individuals will develop problematic use patterns. *Cocaine* - While cocaine is known for its **highly addictive potential** and rapid development of dependence, its overall prevalence of use is lower than cannabis. - The intense psychological dependence associated with cocaine can lead to severe withdrawal symptoms and compulsive drug-seeking behavior. *Heroin* - **Heroin**, an opioid, is highly addictive, causing both **physical and psychological dependence** very quickly due to its potent effects on the brain's reward system. - However, its illicit use is less widespread compared to cannabis, making it responsible for fewer overall cases of dependence. *Amphetamine* - **Amphetamines** also have a high potential for **psychological dependence**, leading to compulsive use and significant withdrawal symptoms upon cessation. - Like cocaine and heroin, the overall number of people who use amphetamines illicitly is significantly lower than those who use cannabis.
Question 9: Under which one of the following conditions, the HPA axis suppression is likely to result in crisis due to adrenal insufficiency following withdrawal of glucocorticoids?
- A. If glucocorticoids have been prescribed repeatedly within the previous year (Correct Answer)
- B. If the dose is less than equivalent of 5 mg prednisolone per day
- C. If glucocorticoids have been given by intravenous route for five days
- D. If glucocorticoids have been administered orally for one week
Explanation: ***Correct: If glucocorticoids have been prescribed repeatedly within the previous year*** - While a **single short course** of glucocorticoids typically does not cause significant HPA axis suppression, **repeated exposure over time** (multiple courses within a year) can lead to **cumulative suppression** of the hypothalamic-pituitary-adrenal axis - This is particularly true if the courses are **frequent, prolonged, or at high doses** without adequate recovery periods between treatments - **Chronic or repeated suppression** impairs the body's ability to produce sufficient endogenous cortisol when exogenous glucocorticoids are withdrawn, increasing the risk of **adrenal insufficiency crisis** - Among the given options, this represents the **highest risk scenario** for HPA axis suppression requiring careful withdrawal management *Incorrect: If the dose is less than equivalent of 5 mg prednisolone per day* - Doses **< 5 mg prednisolone equivalent per day** are considered **physiologic replacement doses** - Such low doses do **NOT suppress** the HPA axis significantly - This represents a **low-risk scenario** for adrenal insufficiency - Standard teaching: HPA suppression risk increases with doses **> 20 mg/day prednisolone equivalent** *Incorrect: If glucocorticoids have been given by intravenous route for five days* - **Short-course therapy (< 7-10 days)**, even at high doses and by IV route, typically does **NOT cause prolonged HPA axis suppression** - The HPA axis usually **recovers rapidly** after brief exposure - Abrupt discontinuation after 5 days **does not typically require tapering** and is unlikely to cause adrenal crisis - The route of administration (IV vs oral) is less important than **duration and total dose** *Incorrect: If glucocorticoids have been administered orally for one week* - Similar to the IV scenario, **one week of oral therapy** is considered a **short course** - Such brief duration typically does not cause significant HPA axis suppression requiring taper - The adrenal glands usually maintain responsiveness after only **7 days** of treatment - **Duration > 3 weeks** at supraphysiologic doses is the traditional threshold for concern about HPA suppression
Question 10: What is the simplest and most commonly used measure of mortality?
- A. Crude death rate (Correct Answer)
- B. Case fatality rate
- C. Specific death rate
- D. Proportional mortality rate
Explanation: ***Crude death rate*** - This is the simplest and most commonly used measure because it reflects the **total number of deaths** in a population over a specified period, relative to the mid-period population. - Its calculation requires only the total number of deaths and the total population size, making it easily accessible and widely applicable for **general mortality comparisons**. *Case fatality rate* - This measures the **proportion of individuals diagnosed with a specific disease** who die from that disease, rather than overall mortality in a population. - It is often used to assess the **severity of a disease** and is not a general measure of mortality. *Proportional mortality rate* - This indicates the **proportion of all deaths due to a specific cause** or age group, rather than the overall death rate in the population. - It does not represent the absolute risk of dying and is influenced by the prevalence of other causes of death. *Specific death rate* - This measure calculates the death rate for a **particular subgroup** (e.g., age-specific, cause-specific, or sex-specific), making it more detailed but not the simplest or most commonly used overall measure. - While more precise for specific analyses, it requires more granular data than the crude death rate.
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