Opioid use disorder — MCQs

A 32-year-old man is brought to the emergency department because he was found stumbling in the street heedless of oncoming traffic. On arrival, he is found to be sluggish and has slow and sometimes incoherent speech. He is also drowsy and falls asleep several times during questioning. Chart review shows that he has previously been admitted after getting a severe cut during a bar fight. Otherwise, he is known to be intermittently homeless and has poorly managed diabetes. Serum testing reveals the presence of a substance that increases the duration of opening for an important channel. Which of the following symptoms may be seen if the most likely substance in this patient is abruptly discontinued?

A 25-year-old woman comes into her family doctor’s clinic confused as to how she failed her work-required urine drug test. The patient has no significant past medical history and takes no medications. She states that she does not smoke and denies ever using any alcohol or recreational drugs. The patient’s social history reveals a recent change in her diet. For the past 2-weeks, she was experimenting with a ketogenic diet and using poppy seed bagels as her only source of carbohydrates. Her vital signs and physical examination are within normal limits. Which of the following physical exam findings might be present had this patient really been abusing the class of drug for which she most likely tested positive?

A 22-year-old man seeks help from a physician for his heroin addiction. He tells the doctor that he started using heroin at the age of 17 and gradually started increasing the dose. He has been trying to quit for the last 6 months after realizing the negative consequences of his addiction but has not succeeded because of the withdrawal symptoms. The physician suggests a drug that can be taken within a supervised rehabilitation program as a substitute for heroin to help alleviate withdrawal symptoms. The drug will then be tapered over time. He is further informed by the physician that this drug is not to be taken by the patient on his own and is not used for emergency reversal of opioid overdose. Which of the following drugs is most likely to have been recommended by the physician?

A 25-year-old man is brought to the emergency department by police for abnormal behavior in a mini-market. The patient was found passed out in the aisle, and police were unable to arouse him. The patient has a past medical history of alcohol abuse and is not currently taking any medications according to his medical records. His temperature is 99.5°F (37.5°C), blood pressure is 120/87 mmHg, pulse is 50/min, respirations are 5/min, and oxygen saturation is 93% on room air. On physical exam, the patient is minimally responsive. He responds to painful stimuli by retracting his limbs and groaning, but otherwise does not answer questions or obey commands. Which of the following is most likely to be found in this patient?

A 28-year-old woman comes to the physician because of an 8-hour history of painful leg cramping, a runny nose, and chills. She has also had diarrhea and abdominal pain. She appears irritable and yawns frequently. Her pulse is 115/min. Examination shows cool, damp skin with piloerection. The pupils are 7 mm in diameter and equal in size. Bowel sounds are hyperactive. Deep tendon reflexes are 3+ bilaterally. Withdrawal from which of the following substances is most likely the cause of this patient's symptoms?

A 36-year-old man presents to a psychiatrist for management of nicotine dependence. He has been a heavy smoker for the past 20 years. He has unsuccessfully attempted to quit smoking many times. He has seen multiple physicians for nicotine dependence. They prescribed nicotine replacement therapy and varenicline. He has also taken two antidepressants and participated in talk therapy. He asks the psychiatrist whether there are other alternatives. The psychiatrist explains that nicotine replacement therapy, non-nicotine pharmacotherapy, and talk therapy are the best options for the management of nicotine dependence. He tells the patient he can take a second-line medication for non-nicotine pharmacotherapy because the first-line medication failed. Which of the following medications would the psychiatrist most likely use to manage this patient’s nicotine dependence?

A 22-year-old man is brought to the emergency department by his roommate 20 minutes after being discovered unconscious at home. On arrival, he is unresponsive to painful stimuli. His pulse is 65/min, respirations are 8/min, and blood pressure is 110/70 mm Hg. Pulse oximetry shows an oxygen saturation of 75%. Despite appropriate lifesaving measures, he dies. The physician suspects that he overdosed. If the suspicion is correct, statistically, the most likely cause of death is overdose with which of the following groups of drugs?

A middle-aged homeless man is found lying unresponsive on the streets by the police and is rushed to the emergency department. His vital signs include: blood pressure 110/80 mm Hg, pulse rate 100/min, and respirations 10/min and shallow. On physical examination, his extremities are cold and clammy. Pupils are constricted and non-reactive. His blood glucose is 55 mg/dL. IV access is established immediately with the administration of dextrose and naloxone. In half an hour, the patient is fully conscious, alert and responsive. He denies any medical illnesses, hospitalizations, or surgeries in the past. Physical examination reveals injection track marks along both arms. He admits to the use of cocaine and heroin. He smokes cigarettes and consumes alcohol. His vital signs are now stable. A urine sample is sent for toxicology screening. Which of the following was the most likely cause of this patient’s respiratory depression?

A 40-year-old woman with a recent history of carcinoma of the breast status post mastectomy and adjuvant chemotherapy one week ago presents for follow-up. She reports adequate pain control managed with the analgesic drug she was prescribed. Past medical history is significant for hepatitis C and major depressive disorder. The patient denies any history of smoking or alcohol use but says she is currently using intravenous heroin and has been for the past 10 years. However, she reports that she has been using much less heroin since she started taking the pain medication, which is confirmed by the toxicology screen. Which of the following is the primary mechanism of action of the analgesic drug she was most likely prescribed?

A 30-year-old man presents to his family physician admitting to using heroin. He says he started using about 6-months ago when his back pain medication ran out. At first, he says he would borrow his wife’s Percocet but, eventually, that ran out and he had to find a different source. Since then, he has been having more and more issues related to his heroin use, and it has started to affect his work and home life. He is concerned that, if he continues like this, he might end up in real trouble. He denies sharing needles and is sincerely interested in quitting. He recalls trying to quit last month but recounts how horrible the withdrawal symptoms were. Because of this and the strong cravings, he relapsed shortly after his initial attempt. Methadone maintenance therapy is prescribed. Which of the following would most likely be the most important benefit of this new treatment plan in this patient?