Substance Use Disorders — MCQs

Substance Use Disorders Indian Medical PG Practice Questions and MCQs

Question 411: 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 412: Which of the following is not typically associated with delirium tremens?

A. Tremors
B. Visual hallucination
C. Clouding of consciousness
D. Ocular muscle paralysis (Correct Answer)

Explanation: ***Ocular muscle paralysis*** - **Ocular muscle paralysis**, specifically **ophthalmoplegia**, is a hallmark symptom of **Wernicke's encephalopathy**, a distinct condition caused by **thiamine deficiency** often seen in chronic alcoholics. - While both conditions are alcohol-related, **delirium tremens** primarily involves **autonomic instability**, **alterations in consciousness**, and **hallucinations**, not direct muscle paralysis. *Tremors* - **Coarse tremors** are a very common and early sign of **alcohol withdrawal syndrome**, which can escalate to **delirium tremens**. - These are typically **fine to coarse tremors of the hands**, tongue, and eyelids, often present during agitation. *Visual hallucination* - **Visual hallucinations** are characteristic features of **delirium tremens**, often described as vivid, frightening, and involving small animals or insects. - They occur due to severe **autonomic hyperactivity** and **neurotransmitter dysregulation** during withdrawal. *Clouding of consciousness* - **Clouding of consciousness**, ranging from disorientation to profound confusion, is a central diagnostic criterion for **delirium tremens**. - This **altered mental status** distinguishes it from less severe forms of alcohol withdrawal.

Question 413: Which of the following is NOT a feature of Korsakoff syndrome?

A. Retrograde amnesia
B. Confabulation
C. Antegrade amnesia
D. Ataxia (Correct Answer)

Explanation: ***Ataxia*** - While **ataxia** is a cardinal feature of **Wernicke encephalopathy** (part of the classic triad: confusion, ataxia, ophthalmoplegia), it is **not a primary defining feature** of **Korsakoff syndrome**. - Korsakoff syndrome is primarily characterized by **severe memory deficits** and **confabulation**. - Although ataxia may persist as a residual sign in some patients with Wernicke-Korsakoff syndrome, it is not considered a core diagnostic criterion for Korsakoff syndrome itself. - Among the given options, ataxia is the feature most appropriately classified as "NOT a feature" of Korsakoff syndrome in the classical sense. *Antegrade amnesia* - This is the **primary and most prominent feature** of Korsakoff syndrome, referring to the **severe inability to form new memories** after the onset of the condition. - Patients cannot retain information for more than a few seconds to minutes. - This profound deficit in new learning is the hallmark of the syndrome. *Retrograde amnesia* - This is also a **key feature**, indicating **impaired recall of memories** from before the onset of the condition. - Typically follows a temporal gradient, with recent memories more affected than remote ones. - The extent varies but can span several years prior to onset. *Confabulation* - This is a **highly characteristic symptom** of Korsakoff syndrome, where patients **unconsciously fabricate memories** to fill gaps in their recall. - These fabricated stories are not intentional lies but rather the brain's attempt to make sense of missing information. - Confabulations are often delivered with conviction but are inconsistent when the patient is asked again later.

Question 414: A patient has been a known alcoholic for the last 20 years. He suddenly develops restlessness, tremors, and agitation. What is the most likely diagnosis?

A. Alcoholic hallucinosis
B. Wernicke's encephalopathy
C. Korsakoff's syndrome
D. Delirium tremens (Correct Answer)

Explanation: ***Delirium tremens*** - This condition is characterized by **restless tremors**, **agitation**, and often hallucinations, occurring in chronic alcoholics after sudden cessation or reduction of alcohol intake. - The symptoms typically appear **48-96 hours** after the last drink and can include severe autonomic hyperactivity such as tachycardia, hypertension, and hyperthermia. *Alcoholic hallucinosis* - This involves vivid auditory, visual, or tactile hallucinations that occur in a **clear sensorium**, typically 12-48 hours after decreased alcohol intake. - Unlike delirium tremens, there is usually **no significant disorientation** or severe autonomic instability. *Wernicke's encephalopathy* - This is an acute neurological condition due to **thiamine deficiency**, common in chronic alcoholics, presenting with the classical triad of **ocular disturbances** (nystagmus, ophthalmoplegia), **ataxia**, and **confusion**. - While confusion can be present, the primary symptoms described (restless tremors, agitation) are not the hallmark features. *Korsakoff's syndrome* - This is a chronic neuropsychiatric disorder that often follows untreated Wernicke's encephalopathy, characterized by **severe memory impairment** (anterograde and retrograde amnesia) and **confabulation**. - It primarily affects memory and learning, rather than acute agitation and tremors.

Question 415: Which of the following develop first during dependence of a substance ?

A. Tolerance
B. Physical dependence
C. Psychological dependence (Correct Answer)
D. Withdrawal symptoms

Explanation: ***Psychological dependence*** - **Psychological dependence** often develops first, characterized by an emotional need for the substance to experience pleasure or avoid discomfort. - This involves a strong **craving** and compulsive drug-seeking behavior despite negative consequences, driven by the substance's effect on brain reward pathways. *Tolerance* - **Tolerance** means that increasing doses of the substance are required to achieve the same effect previously achieved with lower doses. - While it often develops early in substance use, the initial "need" to use the substance is often psychological before physiological adaptations occur. *Physical dependence* - **Physical dependence** describes the body's physiological adaptation to the substance, leading to withdrawal symptoms if use is stopped or reduced. - It typically develops after consistent, prolonged use and is usually preceded by psychological dependence and often tolerance. *Withdrawal symptoms* - **Withdrawal symptoms** are the physiological and psychological signs that occur when a dependent person stops or drastically reduces their substance intake. - These are a direct manifestation of physical dependence and thus develop once physical dependence has been established.

Question 416: Formication is primarily associated with which condition?

A. Acute amphetamine intoxication
B. Alcohol withdrawal
C. Cannabis poisoning
D. Chronic use of amphetamine (Correct Answer)

Explanation: ***Chronic use of amphetamine*** - **Formication** (the sensation of insects crawling under the skin) is a classic symptom of **chronic amphetamine abuse**, often leading to excoriations due to scratching. - This **tactile hallucination** is part of the psychosis that can develop with prolonged high-dose amphetamine use. *Acute amphetamine intoxication* - While acute intoxication can cause psychosis and paranoia, **formication** is more strongly associated with the **chronic effects** and withdrawal of amphetamines. - Acute effects typically include euphoria, increased energy, and hypervigilance, rather than persistent tactile hallucinations. *Alcohol withdrawal* - **Alcohol withdrawal** can cause a range of symptoms including tremors, hallucinations (often visual or auditory), and seizures. - While some tactile disturbances can occur, **formication** is not a primary or characteristic symptom of alcohol withdrawal; **delirium tremens** often features visual or auditory hallucinations. *Cannabis poisoning* - **Cannabis poisoning** (or acute intoxication) typically presents with euphoria, altered perception of time, impaired coordination, and increased appetite. - It does not characteristically cause **formication** or other significant tactile hallucinations.

Question 417: What does the term 'etheromania' refer to?

A. Ether addiction (Correct Answer)
B. Acute psychosis following ether anesthesia
C. Excessive use of ether as an anesthetic
D. Delirium tremens from ether withdrawal

Explanation: ***Ether addiction*** - **Etheromania** specifically refers to the compulsive use and dependence on **ether** for its psychoactive effects. - This term was historically used to describe individuals who developed a significant **addiction** to ether. - The suffix "-mania" in psychiatric terminology often denotes an obsessive or compulsive behavior pattern related to a specific substance. *Acute psychosis following ether anesthesia* - While ether anesthesia can sometimes lead to transient psychomotor agitation or emergence delirium, **acute psychosis** is not the primary definition of etheromania. - Etheromania describes a long-term pattern of **addictive behavior**, not an acute post-anesthesia complication. *Excessive use of ether as an anesthetic* - This describes a medical application of ether, albeit potentially misused, but does not primarily denote the **addictive state** of the person using it. - **Etheromania** focuses on the individual's psychological and physiological dependence, not merely the quantity used for medical purposes. *Delirium tremens from ether withdrawal* - Delirium tremens is specifically associated with **alcohol withdrawal**, not ether withdrawal. - While ether withdrawal can cause symptoms, the term **etheromania** refers to the addiction itself, not withdrawal complications.

Question 418: Muttering delirium is seen with: NEET 13

A. Datura (Correct Answer)
B. Castor oil plant
C. Cocaine (stimulant)
D. Monkshood (Aconitum)

Explanation: ***Datura*** - **Datura poisoning** is characterized by an **anticholinergic toxidrome**, which includes central nervous system effects like **muttering delirium, hallucinations**, and disorientation. - The patient exhibits features like **dilated pupils, dry mouth, flushed skin**, and **tachycardia** due to the blockage of muscarinic acetylcholine receptors. *Castor oil plant* - The **castor oil plant** contains **ricin**, a potent toxin that causes **gastrointestinal symptoms** (nausea, vomiting, abdominal pain, bloody diarrhea) and eventually multi-organ failure. - It does not typically cause the central nervous system effects like **muttering delirium** seen with Datura poisoning. *Cocaine (stimulant)* - **Cocaine** is a central nervous system stimulant that causes **euphoria, agitation, paranoia, dilated pupils**, and **tachycardia**. - While it can cause psychosis, the specific **muttering delirium** is not its hallmark presentation; instead, it is associated with a hyperadrenergic state. *Monkshood (Aconitum)* - **Monkshood** contains **aconitine**, a neurotoxin that primarily affects cardiac and neurological function, causing **paresthesias, muscle weakness, bradycardia**, and potentially fatal arrhythmias. - It does not typically cause the **muttering delirium** with features of an anticholinergic syndrome.

Question 419: What is the most commonly abused drug in India?

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

Explanation: ***Cannabis*** - Cannabis (bhang, ganja, charas) is the **most commonly abused illicit drug in India** according to national surveys including the National Survey on Extent and Pattern of Substance Use. - It has **widespread social and cultural acceptance** in certain contexts, contributing to its higher prevalence across diverse populations. - Cannabis use is distributed across **all socioeconomic strata** and geographic regions, making it more prevalent than other illicit drugs. *Heroin* - While heroin is a **highly addictive opioid** with severe health consequences, its overall prevalence is **lower than cannabis** at the national level. - Heroin abuse is more concentrated in **specific regions** (northern states like Punjab, northeastern states) rather than being uniformly distributed. - The National Survey data shows opioid abuse (including heroin) affects a **smaller percentage** of the population compared to cannabis. *Amphetamine* - Amphetamines are **stimulant drugs** that are significantly less commonly abused in India compared to cannabis and opioids. - Their use is **highly localized** and represents a much smaller proportion of substance abuse cases. *Cocaine* - Cocaine is a **powerful stimulant** that is expensive and less accessible in India, making it one of the **least commonly abused** drugs. - Its use is typically limited to **affluent urban populations** and represents minimal prevalence in national substance abuse statistics.

Question 420: 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.

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

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Sedative, Hypnotic, and Anxiolytic Use Disorders

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Tobacco Use Disorder

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Hallucinogen-Related Disorders

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Substance Withdrawal Syndromes

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Pharmacotherapy for Substance Use Disorders

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Psychosocial Interventions

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Dual Diagnosis Management

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