Substance Use Disorders Practice Questions

Q: Which of the following dependence-causing drugs is most commonly abused worldwide?

Cannabis. ***Cannabis*** - **Cannabis** is the most widely cultivated and consumed illicit drug globally, with the highest prevalence of past-year use. - Its widespread availability, relatively lower perception of harm compared to other drugs, and varied forms of consumption (smoking, edibles) contribute to its extensive abuse. *Heroin* - **Heroin** is a highly addictive opioid that causes severe physical dependence and withdrawal symptoms, but its global prevalence is significantly lower than that of cannabis. - Its high cost, illicit nature, and significant health risks, including overdose, limit its abuse to a smaller, though critically affected, population. *Amphetamine* - **Amphetamines**, including methamphetamine, are potent central nervous system stimulants with a significant abuse potential, leading to psycho-behavioral and physical dependence. - While prevalent in certain regions and among specific populations, their overall global abuse statistics are lower than those for cannabis. *Cocaine* - **Cocaine** is a powerful stimulant derived from the coca plant, known for its strong psychological dependence and significant health consequences. - Its abuse is concentrated in specific geographical areas and demographic groups, making its global prevalence of abuse lower than that of cannabis.

Q: CAGE questionnaire is used in:

Alcohol dependence. ***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.

Q: Magnan's symptom is seen in:

Cocaine. ***Cocaine*** - **Magnan's symptom**, also known as **formication**, is a tactile hallucination where an individual perceives insects crawling under their skin, commonly associated with chronic cocaine use. - This symptom is a manifestation of **cocaine-induced psychosis** or severe intoxication, leading to paranoid delusions and abnormal sensory experiences. *Datura* - **Datura** intoxication primarily causes anticholinergic effects, such as **dry mouth**, **dilated pupils**, confusion, and visual hallucinations, but not typically Magnan's symptom. - The hallucinations associated with Datura are often described as vivid and florid, but distinct from the tactile formication seen with cocaine. *Cannabis* - **Cannabis** use can induce altered perceptions, euphoria, anxiety, and sometimes paranoia, but it is not typically associated with tactile hallucinations like Magnan's symptom. - While high doses can lead to psychotic-like symptoms, **formication** is not a characteristic feature of cannabis intoxication. *Opium* - **Opium** and other opioids primarily cause central nervous system depression, leading to euphoria, sedation, pinpoint pupils, and respiratory depression. - Opioid use is not linked to tactile hallucinations such as **formication** or Magnan's symptom.

Q: Magnan's syndrome is associated with:

Amphetamine. ***Amphetamine*** - **Magnan's syndrome** is a psychotic disorder characterized by **tactile hallucinations** (formication) and delusions of parasitosis, most commonly associated with **chronic amphetamine abuse**. - Users describe a sensation of **small insects crawling under the skin**, often leading to self-mutilation as they try to extract them. *OPC* - **Organophosphate poisoning (OPC)** primarily causes **cholinergic crisis** with symptoms like miosis, lacrimation, salivation, bronchorrhea, and muscle weakness. - It is not typically associated with chronic tactile hallucinations or delusions of parasitosis. *Snake bite* - **Snake bites** can cause a wide range of symptoms depending on the venom type, including localized pain, swelling, tissue necrosis, coagulopathy, and neurological effects. - However, they do not typically lead to the specific pattern of tactile hallucinations and delusions characteristic of Magnan's syndrome. *Alcohol* - Chronic **alcohol abuse** can lead to various psychological and neurological complications, including **alcohol withdrawal delirium (delirium tremens)**, which can involve visual and auditory hallucinations. - While it can manifest with tactile sensations, the classic "bugs crawling" sensation with delusional parasitosis (Magnan's syndrome) is more specifically linked to stimulant abuse, like amphetamines.

Q: Which is NOT a common symptom of opioid withdrawal?

Seizures. ***Seizures*** - Seizures are **not typical** of opioid withdrawal; they are more characteristic of withdrawal from substances like **alcohol** or **benzodiazepines**. - Opioid withdrawal symptoms are primarily **autonomic** and **flu-like**, not neurological in the sense of causing seizures. *Yawning* - **Frequent yawning** is a common and early **autonomic symptom** of opioid withdrawal, indicating central nervous system overactivity. - It is often accompanied by other signs of hyperarousal and discomfort. *Insomnia* - **Insomnia** (difficulty sleeping) is a very common and distressing symptom during opioid withdrawal due to heightened central nervous system activity and generalized discomfort. - Patients often experience **restlessness** and an inability to achieve restful sleep. *Diarrhea* - **Diarrhea** is a prominent gastrointestinal symptom of opioid withdrawal, resulting from the cessation of opioid-induced slowing of gut motility. - This symptom reflects the **autonomic hyperactivity** caused by opioid cessation.

Q: Which of the following is NOT true about alcohol withdrawal?

Hallucinations occur on day 5. ***Hallucinations occur on day 5*** - **NOT TRUE** - Alcoholic hallucinosis typically occurs **12-24 hours** after the last drink, not on day 5 - Hallucinations are an **early-to-mid withdrawal symptom** that manifest well before day 5 - They can be **auditory, visual, or tactile** in nature - Day 5 would be far too late in the withdrawal timeline for hallucinations to first appear *Tremors are an early symptom* - TRUE - **Tremors** are one of the **earliest symptoms** of alcohol withdrawal - They appear within **6-12 hours** after the last drink - Often accompanied by anxiety, nausea, sweating, and increased heart rate *Delirium tremens appears after 48 hours* - TRUE - **Delirium tremens (DTs)** typically manifests **48-96 hours** (2-4 days) after cessation - Peak occurrence at **72-96 hours** - Characterized by profound **confusion**, disorientation, severe agitation, autonomic instability, and high mortality if untreated *Seizures occur within 24-48 hours* - TRUE - **Alcohol withdrawal seizures** typically occur **12-48 hours** after the last drink - May extend up to **72 hours** in some cases - Usually **generalized tonic-clonic seizures** - Can be an early indicator of severe withdrawal requiring medical intervention

Q: Which of the following is not associated with Korsakoff psychosis?

Ophthalmoplegia. ***Ophthalmoplegia*** - **Ophthalmoplegia** is a key feature of **Wernicke encephalopathy**, the acute phase preceding Korsakoff psychosis, but is not directly a symptom of Korsakoff psychosis itself. - While both conditions are linked to thiamine deficiency, **Korsakoff psychosis** primarily manifests as chronic memory deficits. *Amnesia* - **Anterograde amnesia** (inability to form new memories) and **retrograde amnesia** (loss of past memories) are defining characteristics of Korsakoff psychosis. - This severe memory impairment is a result of damage to areas like the **mammillary bodies** and **thalamus**. *Confabulation* - **Confabulation**, the fabrication of distorted or misinterpreted memories without an intention to deceive, is a common symptom in patients with Korsakoff psychosis. - This occurs as patients attempt to fill in gaps in their memory loss, often believing their own stories. *Polyneuropathy* - **Polyneuropathy**, nerve damage affecting multiple peripheral nerves, causing symptoms like pain, numbness, and muscle weakness, is associated with chronic **alcoholism** and **thiamine deficiency**. - While not a direct psychological symptom, it is frequently seen in the same patient population that develops Korsakoff psychosis due to shared etiology.

Q: A 40-year-old man presents with a history of regular and heavy alcohol use for 10 years and morning drinking for one year. The last alcohol intake was three days ago. On examination, the patient exhibits coarse tremors, visual hallucinations, and disorientation to time. What is the best medication to prescribe?

Diazepam. ***Diazepam*** - The patient's symptoms (tremors, visual hallucinations, disorientation) three days after his last drink are consistent with **delirium tremens (DTs)**, a severe form of alcohol withdrawal. - **Benzodiazepines** like diazepam are the first-line treatment for DTs as they act on GABA receptors to reduce neuronal hyperexcitability and prevent seizures. *Haloperidol* - **Haloperidol**, an antipsychotic, can worsen withdrawal symptoms and lower the seizure threshold in patients with alcohol withdrawal, making it an inappropriate first-line treatment. - While it can be used for psychotic symptoms, benzodiazepines are prioritized in alcohol withdrawal due to the risk of seizures and efficacy in managing the core withdrawal syndrome. *Imipramine* - **Imipramine** is a tricyclic antidepressant and is not indicated for the acute management of alcohol withdrawal or delirium tremens. - It would not address the acute physiological symptoms, such as tremors or potential seizures associated with alcohol withdrawal. *Naltrexone* - **Naltrexone** is an opioid antagonist used for alcohol *craving reduction* and relapse prevention in individuals with alcohol use disorder *after* detoxification. - It does not treat acute alcohol withdrawal symptoms and would not be effective in managing delirium tremens.

Q: A 28-year-old male with a history of heroin use is started on methadone maintenance therapy. What is the primary goal of this treatment?

To prevent withdrawal symptoms and reduce cravings. ***To prevent withdrawal symptoms and reduce cravings*** - **Methadone maintenance therapy** is a harm reduction approach designed to stabilize individuals with opioid use disorder. - Its primary goal is to **prevent unpleasant withdrawal symptoms** and significantly **reduce opioid cravings**, allowing patients to focus on recovery and integrate into society. *To achieve complete abstinence from all opioids* - While abstinence may be a long-term goal for some, the immediate and primary goal of methadone maintenance is not always complete opioid abstinence, but rather **stabilization and harm reduction**. - Methadone is itself an opioid, so this option doesn't accurately reflect the direct and initial aim of the therapy. *To induce aversion to opioid use* - Methadone does not induce an aversive reaction to opioids like **disulfiram** does for alcohol. - Its mechanism involves **agonist effects** at opioid receptors to manage dependence, not to create an unpleasant experience. *To substitute heroin with a safer opioid* - While methadone is a safer, legally prescribed opioid compared to illicit heroin, the primary goal goes beyond mere substitution. - It aims to provide a **stable pharmacological platform** for recovery by managing dependence and cravings, thus reducing the harms associated with illicit opioid use.

Question 1

Which of the following dependence-causing drugs is most commonly abused worldwide?

Accepted Answer

Cannabis

Answer

Heroin

Answer

Amphetamine

Answer

Cocaine

Question 2

CAGE questionnaire is used in:

Accepted Answer

Alcohol dependence

Answer

Opiate poisoning

Answer

Dhatura poisoning

Answer

Barbiturate poisoning

Question 3

Magnan's symptom is seen in:

Accepted Answer

Cocaine

Answer

Datura

Answer

Cannabis

Answer

Opium

Question 4

Magnan's syndrome is associated with:

Accepted Answer

Amphetamine

Answer

OPC

Answer

Snake bite

Answer

Alcohol

Question 5

What is the cause of delirium tremens in alcoholics?

Accepted Answer

Abrupt cessation of heavy and prolonged consumption of alcohol

Answer

Small doses of consumption

Answer

Fatty liver

Answer

Gradual withdrawal of alcohol

Question 6

Which is NOT a common symptom of opioid withdrawal?

Accepted Answer

Seizures

Answer

Yawning

Answer

Insomnia

Answer

Diarrhea

Question 7

Which of the following is NOT true about alcohol withdrawal?

Accepted Answer

Hallucinations occur on day 5

Answer

Tremors are an early symptom

Answer

Delirium tremens appears after 48 hours

Answer

Seizures occur within 24-48 hours

Question 8

Which of the following is not associated with Korsakoff psychosis?

Accepted Answer

Ophthalmoplegia

Answer

Amnesia

Answer

Confabulation

Answer

Polyneuropathy

Question 9

A 40-year-old man presents with a history of regular and heavy alcohol use for 10 years and morning drinking for one year. The last alcohol intake was three days ago. On examination, the patient exhibits coarse tremors, visual hallucinations, and disorientation to time. What is the best medication to prescribe?

Accepted Answer

Diazepam

Answer

Haloperidol

Answer

Imipramine

Answer

Naltrexone

Question 10

A 28-year-old male with a history of heroin use is started on methadone maintenance therapy. What is the primary goal of this treatment?

Accepted Answer

To prevent withdrawal symptoms and reduce cravings

Answer

To achieve complete abstinence from all opioids

Answer

To induce aversion to opioid use

Answer

To substitute heroin with a safer opioid

Substance Use Disorders — MCQs

Substance Use Disorders — MCQs

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