Substance Use Disorders — MCQs

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?

Q390

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?

Substance Use Disorders Indian Medical PG Practice Questions and MCQs

Question 381: Which of the following dependence-causing drugs is most commonly abused worldwide?

A. Cannabis (Correct Answer)
B. Heroin
C. Amphetamine
D. Cocaine

Explanation: ***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.

Question 382: 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 383: Magnan's symptom is seen in:

A. Cocaine (Correct Answer)
B. Datura
C. Cannabis
D. Opium

Explanation: ***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.

Question 384: Magnan's syndrome is associated with:

A. OPC
B. Snake bite
C. Alcohol
D. Amphetamine (Correct Answer)

Explanation: ***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.

Question 385: What is the cause of delirium tremens in alcoholics?

A. Abrupt cessation of heavy and prolonged consumption of alcohol (Correct Answer)
B. Small doses of consumption
C. Fatty liver
D. Gradual withdrawal of alcohol

Explanation: **Abrupt cessation of heavy and prolonged consumption of alcohol** - Delirium tremens (DTs) is a severe form of alcohol withdrawal, primarily caused by the **sudden discontinuation** of chronic, heavy alcohol use. - Chronic alcohol intake leads to **neurotransmitter adaptation** (e.g., downregulation of GABA receptors), and abrupt cessation results in an excitatory state that manifests as DTs. *Small doses of consumption* - Consuming small doses of alcohol, especially in individuals who are not heavy users, does **not lead to the physiological changes** necessary to precipitate delirium tremens. - DTs are a phenomenon of **withdrawal** from sustained high-level exposure, not direct effects of small intake. *Fatty liver* - **Fatty liver** is a common consequence of chronic alcohol consumption, representing early alcoholic liver disease. - While it's related to alcoholism, it is a **hepatic manifestation** and does not directly cause the acute neurological symptoms of delirium tremens. *Gradual withdrawal of alcohol* - **Gradual withdrawal** of alcohol, under medical supervision, is the recommended approach to *prevent* delirium tremens. - Slow tapering allows the central nervous system to **gradually adapt**, reducing the risk of severe withdrawal symptoms.

Question 386: Which is NOT a common symptom of opioid withdrawal?

A. Seizures (Correct Answer)
B. Yawning
C. Insomnia
D. Diarrhea

Explanation: ***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.

Question 387: Which of the following is NOT true about alcohol withdrawal?

A. Tremors are an early symptom
B. Delirium tremens appears after 48 hours
C. Hallucinations occur on day 5 (Correct Answer)
D. Seizures occur within 24-48 hours

Explanation: ***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

Question 388: Which of the following is not associated with Korsakoff psychosis?

A. Ophthalmoplegia (Correct Answer)
B. Amnesia
C. Confabulation
D. Polyneuropathy

Explanation: ***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.

Question 389: 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?

A. Diazepam (Correct Answer)
B. Haloperidol
C. Imipramine
D. Naltrexone

Explanation: ***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.

Question 390: 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?

A. To achieve complete abstinence from all opioids
B. To prevent withdrawal symptoms and reduce cravings (Correct Answer)
C. To induce aversion to opioid use
D. To substitute heroin with a safer opioid

Explanation: ***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.

Practice by Chapter

Neurobiology of Addiction

Practice Questions

Alcohol Use Disorder

Practice Questions

Opioid Use Disorder

Practice Questions

Cannabis Use Disorder

Practice Questions

Stimulant Use Disorders

Practice Questions

Sedative, Hypnotic, and Anxiolytic Use Disorders

Practice Questions

Tobacco Use Disorder

Practice Questions

Hallucinogen-Related Disorders

Practice Questions

Substance Withdrawal Syndromes

Practice Questions

Pharmacotherapy for Substance Use Disorders

Practice Questions

Psychosocial Interventions

Practice Questions

Dual Diagnosis Management

Practice Questions

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