Substance Use Disorders — MCQs
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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?
Which of the following is NOT a feature of delirium tremens?
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?
What is the primary psychoactive component found in cannabis?
Korsakoff's psychosis is associated with which of the following conditions?
Most common type of hallucination seen in alcoholic hallucinosis is:
A person presents to the outpatient department with tremors and visual hallucinations after a 2-day history of alcohol cessation. What is the diagnosis?
Substance Use Disorders Indian Medical PG Practice Questions and MCQs
Question 431: 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?
- A. Schizophrenia
- B. Delirium tremens (Correct Answer)
- C. Dementia praecox
- D. Korsakoff psychosis
Explanation: ***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.
Question 432: Which of the following is NOT a feature of delirium tremens?
- A. Hallucinations, particularly visual
- B. Tremors, especially coarse
- C. Confusion or clouding of consciousness
- D. Cranial nerve deficits, such as oculomotor nerve palsy (Correct Answer)
Explanation: ***Cranial nerve deficits, such as oculomotor nerve palsy*** - **Cranial nerve deficits are NOT features of delirium tremens itself**, though they can occur in chronic alcoholics with other complications. - **Abducens nerve (CN VI) palsy** is the classic cranial nerve finding in **Wernicke's encephalopathy**, which is a distinct thiamine deficiency syndrome that can coexist with or precede delirium tremens in chronic alcoholism. - While **oculomotor (CN III) palsies** can also occur in Wernicke's, the **abducens nerve palsy** is the most characteristic finding, along with ataxia and confusion (Wernicke's triad). - **Delirium tremens** is an acute alcohol withdrawal syndrome without cranial nerve involvement as a diagnostic criterion. *Confusion or clouding of consciousness* - **Confusion** and **altered sensorium** are **hallmark features** of delirium tremens, representing severe acute brain dysfunction during alcohol withdrawal. - Patients typically exhibit **disorientation** to time, place, and person, with **fluctuating levels of consciousness**. - This is a **core diagnostic criterion** for DTs. *Hallucinations, particularly visual* - **Visual hallucinations** are a **characteristic and common feature** of delirium tremens. - Classic descriptions include **Lilliputian hallucinations** (seeing small animals, insects, or people), which are vivid, often terrifying, and contribute to **agitation** and **fear**. - These hallucinations are typically **vivid and elaborate**, unlike the simpler visual disturbances in milder withdrawal. *Tremors, especially coarse* - **Coarse tremors** are a **prominent feature** of alcohol withdrawal that becomes more severe as delirium tremens develops. - These tremors typically affect the **hands, tongue, and eyelids**, worsening with intentional movement or stress. - **Coarse generalized tremors** distinguish DTs from the milder fine tremors of early alcohol withdrawal.
Question 433: 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?
- A. Cocaine, a stimulant that can cause heightened sensory perception and euphoria.
- B. PCP, a dissociative drug that can cause hallucinations and altered sensory perceptions.
- C. Marijuana, a psychoactive substance that can alter perception and cause mild hallucinations.
- D. LSD, a hallucinogen known for causing synesthesia and intense sensory distortions. (Correct Answer)
Explanation: **LSD, a hallucinogen known for causing synesthesia and intense sensory distortions.** - **LSD (lysergic acid diethylamide)** is a classic **psychedelic** known for inducing profound alterations in perception, mood, and thought. - **Synesthesia**, the experience of a crossover of sensory perceptions (e.g., seeing sounds, hearing colors), is a hallmark effect of LSD, directly aligning with the patient's symptoms. *Cocaine, a stimulant that can cause heightened sensory perception and euphoria.* - **Cocaine** primarily acts as a stimulant, leading to increased alertness, euphoria, and sometimes paranoia or tactile hallucinations (e.g., **cocaine bugs**). - It does not typically cause synesthesia or the profound cross-sensory distortions described, which are more characteristic of hallucinogens. *PCP, a dissociative drug that can cause hallucinations and altered sensory perceptions.* - **PCP (phencyclidine)** is a dissociative anesthetic that can cause detachment, hallucinations, and altered perception of reality, often leading to bizarre or aggressive behavior. - While it causes altered sensory perceptions, the specific symptom of cross-sensory experiences like seeing sounds or hearing colors (**synesthesia**) is less characteristic of PCP and more strongly associated with classic hallucinogens. *Marijuana, a psychoactive substance that can alter perception and cause mild hallucinations.* - **Marijuana** (cannabis) can alter perception, enhance sensory experiences, and, at higher doses, produce mild hallucinations or distortions. - However, the intense and distinct cross-sensory phenomenon of synesthesia, where sounds are seen and colors heard, is rarely (if ever) the primary or most pronounced effect of marijuana use.
Question 434: What is the primary psychoactive component found in cannabis?
- A. Cannabidiol (CBD)
- B. Cannabinol (CBN)
- C. Delta-8 THC
- D. Tetrahydrocannabinol (THC) (Correct Answer)
Explanation: ***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
Question 435: Korsakoff's psychosis is associated with which of the following conditions?
- A. Marasmus
- B. Chronic renal failure
- C. Chronic alcohol use (Correct Answer)
- D. Cirrhosis
Explanation: ***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 436: Most common type of hallucination seen in alcoholic hallucinosis is:
- A. Visual hallucinations
- B. Auditory hallucinations (Correct Answer)
- C. Tactile hallucinations
- D. Reflex hallucinations
Explanation: ***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.
Question 437: A person presents to the outpatient department with tremors and visual hallucinations after a 2-day history of alcohol cessation. What is the diagnosis?
- A. Korsakoff’s psychosis
- B. Delirium tremens (Correct Answer)
- C. Wernicke encephalopathy
- D. Alcoholic hallucinosis
Explanation: ***Delirium tremens*** - Delirium tremens is a severe form of **alcohol withdrawal** characterized by **tremors**, disorientation, and **visual hallucinations**, typically appearing **48 to 96 hours** (2-4 days) after the last drink. - This is a medical emergency with potential for **seizures**, **hyperthermia**, and **cardiovascular collapse** due to dysregulation of neurotransmitters (decreased **GABA** activity and increased **glutamate** activity). - Autonomic hyperactivity (tachycardia, hypertension, diaphoresis) is a key feature distinguishing it from other alcohol-related conditions. *Korsakoff's psychosis* - This is a chronic **neuropsychiatric syndrome** typically occurring after an episode of **Wernicke encephalopathy**, characterized by severe **memory impairment** (anterograde and retrograde amnesia) and **confabulation**. - It develops over weeks to months in the course of chronic alcoholism and is **not an acute withdrawal syndrome**, unlike the symptoms described in this 2-day presentation. *Wernicke encephalopathy* - This is an acute neurological condition caused by **thiamine (vitamin B1) deficiency**, commonly seen in chronic alcoholics, characterized by the classic triad of **ophthalmoplegia** (especially nystagmus), **ataxia**, and **confusion**. - While it can precede Korsakoff's psychosis and involves confusion, it does not typically present with the prominent **tremors** and **visual hallucinations** characteristic of alcohol withdrawal, and the timing (2 days post-cessation) points more toward withdrawal rather than nutritional deficiency. *Alcoholic hallucinosis* - Alcoholic hallucinosis involves primarily **auditory hallucinations** (often threatening voices) that occur without significant clouding of consciousness, typically within **12-24 hours** of alcohol cessation. - Unlike delirium tremens, it **lacks autonomic instability**, severe tremors, and global disorientation, and the hallucinations are predominantly auditory rather than visual.
Practice by Chapter
Neurobiology of Addiction
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Alcohol Use Disorder
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Opioid Use Disorder
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Cannabis Use Disorder
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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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