Substance Use Disorders Practice Questions

Q: An alcoholic is brought to the casualty, 3 days after quitting alcohol, with complaints of irrelevant talking. On examination, he is found to be disoriented to time, place, and person, and also exhibits visual illusions and hallucinations. There is no history of head injury. What is the most probable diagnosis?

Delirium tremens. ***Delirium tremens*** - This patient's symptoms, including **disorientation, irrelevant talking, visual illusions, and hallucinations**, occurring 3 days after quitting alcohol, are classic features of **delirium tremens (DTs)**. - DTs represent the most severe form of alcohol withdrawal, typically manifesting 48-96 hours after the last drink, and are a medical emergency. *Schizophrenia* - Schizophrenia is a **chronic psychiatric disorder** characterized by a breakdown in thought processes and poor emotional responsiveness. - While it can involve hallucinations and delusions, its onset is typically more gradual, not acutely precipitated by alcohol cessation, and patients are often younger or with a long history of mental illness. *Dementia praecox* - **Dementia praecox** is an older term for what is now known as **schizophrenia**. - As with schizophrenia, it does not typically present as an acute withdrawal syndrome with rapid onset after substance cessation. *Korsakoff psychosis* - **Korsakoff psychosis** (also known as Korsakoff syndrome) is a chronic neurological disorder caused by severe **thiamine deficiency**, often associated with alcoholism. - Its primary symptoms include **severe memory impairment (anterograde and retrograde amnesia)**, confabulation, and apathy, rather than acute disorientation, illusions, and hallucinations seen in the acute withdrawal phase.

Q: What is the primary psychoactive component found in cannabis?

Tetrahydrocannabinol (THC). ***Tetrahydrocannabinol (THC)*** - **THC** is the primary psychoactive cannabinoid in cannabis, responsible for the "high" associated with its use - Exerts its effects primarily by binding to **CB1 receptors** in the brain, influencing mood, perception, and cognition - This is the most abundant and potent psychoactive compound in cannabis *Cannabidiol (CBD)* - **CBD** is a non-psychoactive cannabinoid and does not produce the "high" associated with cannabis - Often studied for its potential therapeutic effects, including anti-inflammatory, anxiolytic, and anti-seizure properties - Does not bind significantly to CB1 receptors *Cannabinol (CBN)* - **CBN** is a degradation product of THC, forming as THC breaks down over time when exposed to heat and light - Has some mild psychoactive properties but is significantly **less potent** than THC - Often associated with sedative effects rather than the typical cannabis "high" *Delta-8 THC* - **Delta-8 THC** is a minor cannabinoid and an isomer of Delta-9 THC (the main psychoactive component) - Psychoactive but generally considered **less potent** than Delta-9 THC, leading to a milder "high" - Found in much smaller quantities in cannabis compared to Delta-9 THC

Q: Most common type of hallucination seen in alcoholic hallucinosis is:

Auditory hallucinations. ***Auditory hallucinations*** - **Auditory hallucinations** are the most characteristic and frequent type of hallucinations experienced in **alcoholic hallucinosis**. - These often involve **voices** that may be threatening, accusatory, or commenting on the patient's actions, leading to significant distress. *Visual hallucinations* - While visual hallucinations can occur, they are **less common** than auditory hallucinations in alcoholic hallucinosis. - Visual hallucinations are more typical of **delirium tremens**, where they might involve small, moving objects or terrifying images. *Tactile hallucinations* - **Tactile hallucinations**, such as the sensation of insects crawling on the skin (formication), are characteristic of **delirium tremens** or severe **cocaine intoxication**. - They are generally **not the predominant type** of hallucination in alcoholic hallucinosis. *Reflex hallucinations* - **Reflex hallucinations** refer to a rare phenomenon where a hallucination is consistently triggered by a specific stimulus in another sensory modality. - This is a **highly unusual** and specific type of hallucination not typically associated with alcoholic hallucinosis.

Q: Korsakoff's psychosis is associated with which of the following conditions?

Chronic alcohol use. ***Chronic alcohol use*** - **Korsakoff's psychosis** is a severe form of **Wernicke-Korsakoff syndrome**, primarily caused by a deficiency of **thiamine (vitamin B1)**. - **Chronic alcohol abuse** is the most common cause of thiamine deficiency in developed countries due to poor nutritional intake and impaired absorption. *Chronic renal failure* - While chronic renal failure can lead to various neurological complications, it is not directly associated with **Korsakoff's psychosis**. - Renal failure can cause uremic encephalopathy or peripheral neuropathy, but not the specific memory deficits seen in Korsakoff's. *Marasmus* - **Marasmus** is a form of severe undernutrition characterized by **energy deficiency and muscle wasting**. - Although it involves nutrient deficiencies, it typically does not lead to the specific neurological syndrome of **Korsakoff's psychosis**, which is linked to thiamine deficiency. *Cirrhosis* - **Cirrhosis** is advanced liver disease, often caused by chronic alcohol use, but it is not the direct cause of **Korsakoff's psychosis**. - While patients with cirrhosis may have nutritional deficiencies, the direct cause of Korsakoff's is **thiamine deficiency**, not the liver damage itself.

Question 1

An alcoholic is brought to the casualty, 3 days after quitting alcohol, with complaints of irrelevant talking. On examination, he is found to be disoriented to time, place, and person, and also exhibits visual illusions and hallucinations. There is no history of head injury. What is the most probable diagnosis?

Accepted Answer

Delirium tremens

Answer

Schizophrenia

Answer

Dementia praecox

Answer

Korsakoff psychosis

Question 2

Which of the following is NOT a feature of delirium tremens?

Accepted Answer

Cranial nerve deficits, such as oculomotor nerve palsy

Answer

Hallucinations, particularly visual

Answer

Tremors, especially coarse

Answer

Confusion or clouding of consciousness

Question 3

A 16-year-old boy suffering from drug abuse presents with a cross-over of sensory perceptions, where sounds can be seen and colors can be heard. Which of the following is the most likely agent responsible for the drug abuse?

Accepted Answer

LSD, a hallucinogen known for causing synesthesia and intense sensory distortions.

Answer

Cocaine, a stimulant that can cause heightened sensory perception and euphoria.

Answer

PCP, a dissociative drug that can cause hallucinations and altered sensory perceptions.

Answer

Marijuana, a psychoactive substance that can alter perception and cause mild hallucinations.

Question 4

What is the primary psychoactive component found in cannabis?

Accepted Answer

Tetrahydrocannabinol (THC)

Answer

Cannabidiol (CBD)

Answer

Cannabinol (CBN)

Answer

Delta-8 THC

Question 5

Most common type of hallucination seen in alcoholic hallucinosis is:

Accepted Answer

Auditory hallucinations

Answer

Visual hallucinations

Answer

Tactile hallucinations

Answer

Reflex hallucinations

Question 6

Korsakoff's psychosis is associated with which of the following conditions?

Accepted Answer

Chronic alcohol use

Answer

Marasmus

Answer

Chronic renal failure

Answer

Cirrhosis

Question 7

A person presents to the outpatient department with tremors and visual hallucinations after a 2-day history of alcohol cessation. What is the diagnosis?

Accepted Answer

Delirium tremens

Answer

Korsakoff’s psychosis

Answer

Wernicke encephalopathy

Answer

Alcoholic hallucinosis

Substance Use Disorders — MCQs

Substance Use Disorders — MCQs

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