Stimulant use disorders — 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 24-year-old graduate student is brought to the emergency department by her boyfriend because of chest pain that started 90 minutes ago. Her boyfriend says she has been taking medication to help her study for an important exam and has not slept in several days. On examination, she is diaphoretic, agitated, and attempts to remove her IV lines and ECG leads. Her temperature is 37.6°C (99.7°F), pulse is 128/min, and blood pressure is 163/97 mmHg. Her pupils are dilated. The most appropriate next step in management is the administration of which of the following?

A 23-year-old man is brought to the emergency department by the police for impaired cognition and agitation after being struck in the head at a local nightclub. The patient refuses to respond to questions and continues to be markedly agitated. An alcoholic smell is noted. His temperature is 36.9°C (98.4°F), pulse is 104/min, respirations are 24/min, and blood pressure is 148/95 mm Hg. He is confused and oriented only to person. Neurological examination shows miosis and nystagmus but is quickly aborted after the patient tries to attack several members of the care team. CT scan of the head shows no abnormalities. Ingestion of which of the following substances most likely explains this patient's symptoms?

A 55-year-old woman comes to the physician because of involuntary hand movements that improve with alcohol consumption. Physical examination shows bilateral hand tremors that worsen when the patient is asked to extend her arms out in front of her. The physician prescribes a medication that is associated with an increased risk of bronchospasms. This drug has which of the following immediate effects on the cardiovascular system? Stroke volume | Heart rate | Peripheral vascular resistance

A 25-year-old man is brought to the emergency department by police for aggressive behavior. The patient is combative and shouts sexually aggressive remarks at the nursing staff. While obtaining the patient’s vitals, it is noted that he has markedly dilated pupils. His temperature is 98.2°F (36.8°C), pulse is 112/min, blood pressure is 130/70 mmHg, respirations are 18/min, and oxygen saturation is 98% on room air. Urine toxicology is obtained and sent off. Physical exam is notable for an energetic patient with dilated pupils and increased sweating. The patient spends the night in the emergency department. In the morning the patient is withdrawn and has a notable depressed affect. He apologizes for his behavior the previous night and states that he is concerned about his problem and wants help. Which of the following is appropriate management of this patient?

A 19-year-old man presents to a psychiatrist for the management of substance abuse. He reports that he started using the substance 2 years ago and that he smokes it after sprinkling it on his cigarette. He describes that after smoking the substance, he feels excited and as if he does not belong to himself. He also reports that when he is in his room, he sees vivid colors on the walls after using the substance; if he listens to his favorite music, he clearly sees colors and shapes in front of his eyes. There is no history of alcohol or nicotine abuse. The psychiatrist goes through his medical records and notes that he had presented with acute substance intoxication 1 month prior. At that point, his clinical features included delusions, amnesia, generalized erythema of his skin, tachycardia, hypertension, dilated pupils, dysarthria, and ataxia. Which of the following signs is also most likely to have been present on physical examination while the man was intoxicated with the substance?

A 65-year old man comes to the emergency department because of altered mental status for 1 day. He has had headaches, severe nausea, vomiting, and diarrhea for 2 days. He has a history of hypertension, insomnia, and bipolar disorder. His medications include lisinopril, fluoxetine, atorvastatin, lithium, olanzapine, and alprazolam. His temperature is 37.2 °C (99.0 °F), pulse is 90/min, respirations are 22/min, and blood pressure is 102/68 mm Hg. He is somnolent and confused. His mucous membranes are dry. Neurological examination shows dysarthria, decreased muscle strength throughout, and a coarse tremor of the hands bilaterally. The remainder of the examination shows no abnormalities. In addition to IV hydration and electrolyte supplementation, which of the following is the next best step in management?

A 24-year-old man is brought to the emergency department by his roommates for aggressive and unusual behavior. His roommates state that he has been under a lot of stress lately from his final exams and has been more reclusive. They state that this evening he was very irritable and was yelling at his computer prior to breaking it, followed by him spending several hours at the gym. His temperature is 101°F (38.3°C), blood pressure is 137/98 mmHg, pulse is 120/min, respirations are 23/min, and oxygen saturation is 99% on room air. Physical exam is notable for an irritable young man. Cardiopulmonary exam is notable for tachycardia and bilateral clear breath sounds. Neurological exam reveals dilated pupils. The patient is notably diaphoretic and speaks very rapidly during the physical exam and is aggressive. He is given haloperidol, diphenhydramine, and diazepam for sedation and placed in soft restraints. His symptoms resolved over the next 10 hours in the emergency department. Which of the following is the most likely diagnosis?

A 28-year-old man is brought to the emergency department after he was found half dressed and incoherent in the middle of the road. In the emergency department he states that he has not slept for 36 hours and that he has incredible ideas that will make him a billionaire within a few months. He also states that secret agents from Russia are pursuing him and that he heard one of them speaking through the hospital intercom. His past medical history is significant only for a broken arm at age 13. On presentation, his temperature is 102.2°F (39°C), blood pressure is 139/88 mmHg, pulse is 112/min, and respirations are 17/min. Physical exam reveals pupillary dilation and psychomotor agitation. Which of the following mechanisms is most likely responsible for this patient's symptoms?

A 22-year-old man presents to the emergency department with anxiety. The patient states that he is very anxious and has not been able to take his home anxiety medications. He is requesting to have his home medications administered. The patient has a past medical history of anxiety and depression. His current medications include clonazepam, amitriptyline, and lorazepam. Notably, the patient has multiple psychiatric providers who currently care for him. His temperature is 99.2°F (37.3°C), blood pressure is 130/85 mmHg, pulse is 112/min, respirations are 22/min, and oxygen saturation is 100% on room air. Physical exam is notable for an anxious, sweating, and tremulous young man who becomes more confused during his stay in the emergency department. Which of the following should be given to this patient?