CARN MAIN EXAMINATION SET QUESTIONS AND
SOLUTIONS GRADED A+
✔✔Some antipsychotics such as ____________ are effective but have _____________
side effects. Other antipsychotics such as haloperidol may affect the QTc interval. -
✔✔chlorpromazine
anticholinergic
✔✔___________ also is effective but leads to blood pressure and heart rate elevation.
This may exacerbate the methamphetamine-induced hyperadrenergic symptoms.
_______________________ may worsen tachycardia induced by methamphetamine. -
✔✔Ketamine
Diphenhydramine
✔✔The last stage of methamphetamine abuse happens when the person who abuse
methamphetamine become __________ and irritable because of lack of sleep for about
3 to 15 days. This behavior is called "tweaking," and the person with this behavior is
known as the "__________" - ✔✔paranoid
tweaker
✔✔A _________ toxicology study may provide important information as to why the
patient has been experiencing these symptoms. Many substances, specifically
cannabis, cocaine, and amphetamines, can induce severe psychotic symptoms. -
✔✔urinary
✔✔Antipsychotics and to a lesser extent, antidepressants, can cause _________. It can
present mildly whereby patients may tolerate it without wanting any intervention
whatsoever, or severely such that a person cannot cope whatsoever. A rapidly
absorbed benzodiazepine could be - ✔✔akathisia
✔✔A 32-year-old young male presents to the emergency department with complaints of
rhinorrhea, diarrhea, and malaise. History reveals that he had recent surgery for an
ankle fracture after a fall and required intensive physical therapy along with high doses
of opiate medications for pain control. On examination, he is afebrile with normal blood
pressure and heart rate. The physical exam is essentially normal except for mild pupil
dilation. What is the next step in the management of this patient?
Choices:
1. Recommend admission to the hospital for close monitoring
2. Prescribe short course of azithromycin
3. Prescribe clonidine for symptoms control
4. Prescribe tapering dose of methadone - ✔✔Prescribe clonidine for symptoms control
,✔✔Opiate withdrawal is usually mild and not life-threatening. It usually resembles a flu-
like illness characterized by yawning, sneezing, rhinorrhea, nausea, diarrhea, vomiting,
and dilated pupils. Depending on the half-life of the drug, the symptoms may last for
three to ten days. For mild symptoms, __________ can be prescribed on an as needed
basis. - ✔✔clonidine
✔✔For severe Opiate withdrawal, usually from long term high potency opiate abuse,
patients may require a methadone or ______________ taper. - ✔✔buprenorphine
✔✔__________ intoxication is commonly associated with injected conjunctiva and a
temporary increase in appetite. - ✔✔Cannabis
✔✔Cannabis use has also been shown to cause lethargy, impairment of attention,
memory, executive functioning, and short-term memory, which can lead to problems in
school for students. Chronic use may lead to long-term effects on ____________
performance, "amotivational syndrome," a loss of energy and will to work. - ✔✔cognitive
✔✔Urine drug screen is the most efficient test to assess for THC toxicity, as positive
results for THC have been reported up to ____ days after weekly use and up to ____
days after daily use. - ✔✔10
56
✔✔A 17-year-old female with borderline personality disorder is in an inpatient
psychiatric unit secondary to a recent heroin overdose. Upon a routine physical exam,
she is found to have superficial skin scratches on her forearm bilaterally. What is the
appropriate management?
Choices:
1. Seclude and restrain her to prevent further self-harm
2. First aid, then a team conference to confront her
3. First aid, then explore preceding emotions and actions with her
4. Restrict her to her room to provide an opportunity to reflect on her behavior - ✔✔First
aid, then explore preceding emotions and actions with her
✔✔Evidence suggests that patients who are of the _______ gender, of adolescent age,
or age older than 50 years are at increased risk of persistent _______ use. A pre-
existing history of depression or illicit drug, alcohol, antidepressant, or benzodiazepine
use are also at increased risk - ✔✔female
opioid
✔✔A __________ approach and individualized plan for managing postoperative pain
should be emphasized to help reduce opioid demand while optimizing the adequacy of
pain relief. - ✔✔multimodal
, ✔✔Serotonin syndrome typically is caused by a combination of an _______ with other
serotonergic substances such as serotonin-norepinephrine reuptake inhibitors, MAOIs,
tricyclic antidepressants, amphetamines, buspirone, triptans, St. John's wort, ecstasy, or
cocaine - ✔✔SSRI
✔✔Varenicline, ____________, and nicotine patches/gum remain the only treatment
options that have consistently been shown in the literature to help reduce the
consumption of tobacco. - ✔✔bupropion
✔✔____________ in patients with cirrhosis is believed to arise from hyperestrinism due
to the increased adrenal production of androstenedione with aromatization and
conversion to estradiol. - ✔✔Gynecomastia
✔✔Altered mental status in cirrhosis is likely from ____________
_____________________, which is due to a buildup of ammonium toxins from the gut
that fail excretion by the liver. - ✔✔hepatic encephalopathy
✔✔__________ hypertension is due to distorted hepatic architecture causing resistance
to portal flow at the sinusoids. This causes increased hydrostatic pressure at the
portosystemic collateral veins in the anterior abdomen (caput medusa). - ✔✔Portal
✔✔_________ _____ are caused by estrogen's effects on arteriolar dilation. Lower
extremity edema is due to decreased oncotic pressure secondary to the decreased
synthesis of albumin by the liver. - ✔✔Spider nevi
✔✔______________ ____________ syndrome is described as a triad of vomiting,
abdominal pain, and compulsive bathing in the setting of chronic cannabis use. This
actually distinguishes it from other causes of cyclic vomiting. These include cyclic
vomiting syndrome, drug withdrawal syndrome, bulimia nervosa, Addison disease and
other metabolic conditions, psychogenic vomiting, and migraine headaches. -
✔✔Cannabinoid hyperemesis
✔✔___________ ___________ usually present with autonomic excitation, tremors,
agitation, and an altered sensorium 48 - 96 hours after the last alcohol drink
consumption. - ✔✔Delirium tremens
✔✔Those with alcohol use disorder can present in ______ fibrillation due to both
underlying electrolyte abnormalities from malnourishment as well as the potential for
nonischemic dilated cardiomyopathy. - ✔✔atrial
✔✔__________ ketoacidosis is very common due to a diet of "tea and toast" and
overall malnourishment. Patients may have mild hyperglycemia but the typical
symptoms of diabetic ketoacidosis are not present. Therapy for these patients is
SOLUTIONS GRADED A+
✔✔Some antipsychotics such as ____________ are effective but have _____________
side effects. Other antipsychotics such as haloperidol may affect the QTc interval. -
✔✔chlorpromazine
anticholinergic
✔✔___________ also is effective but leads to blood pressure and heart rate elevation.
This may exacerbate the methamphetamine-induced hyperadrenergic symptoms.
_______________________ may worsen tachycardia induced by methamphetamine. -
✔✔Ketamine
Diphenhydramine
✔✔The last stage of methamphetamine abuse happens when the person who abuse
methamphetamine become __________ and irritable because of lack of sleep for about
3 to 15 days. This behavior is called "tweaking," and the person with this behavior is
known as the "__________" - ✔✔paranoid
tweaker
✔✔A _________ toxicology study may provide important information as to why the
patient has been experiencing these symptoms. Many substances, specifically
cannabis, cocaine, and amphetamines, can induce severe psychotic symptoms. -
✔✔urinary
✔✔Antipsychotics and to a lesser extent, antidepressants, can cause _________. It can
present mildly whereby patients may tolerate it without wanting any intervention
whatsoever, or severely such that a person cannot cope whatsoever. A rapidly
absorbed benzodiazepine could be - ✔✔akathisia
✔✔A 32-year-old young male presents to the emergency department with complaints of
rhinorrhea, diarrhea, and malaise. History reveals that he had recent surgery for an
ankle fracture after a fall and required intensive physical therapy along with high doses
of opiate medications for pain control. On examination, he is afebrile with normal blood
pressure and heart rate. The physical exam is essentially normal except for mild pupil
dilation. What is the next step in the management of this patient?
Choices:
1. Recommend admission to the hospital for close monitoring
2. Prescribe short course of azithromycin
3. Prescribe clonidine for symptoms control
4. Prescribe tapering dose of methadone - ✔✔Prescribe clonidine for symptoms control
,✔✔Opiate withdrawal is usually mild and not life-threatening. It usually resembles a flu-
like illness characterized by yawning, sneezing, rhinorrhea, nausea, diarrhea, vomiting,
and dilated pupils. Depending on the half-life of the drug, the symptoms may last for
three to ten days. For mild symptoms, __________ can be prescribed on an as needed
basis. - ✔✔clonidine
✔✔For severe Opiate withdrawal, usually from long term high potency opiate abuse,
patients may require a methadone or ______________ taper. - ✔✔buprenorphine
✔✔__________ intoxication is commonly associated with injected conjunctiva and a
temporary increase in appetite. - ✔✔Cannabis
✔✔Cannabis use has also been shown to cause lethargy, impairment of attention,
memory, executive functioning, and short-term memory, which can lead to problems in
school for students. Chronic use may lead to long-term effects on ____________
performance, "amotivational syndrome," a loss of energy and will to work. - ✔✔cognitive
✔✔Urine drug screen is the most efficient test to assess for THC toxicity, as positive
results for THC have been reported up to ____ days after weekly use and up to ____
days after daily use. - ✔✔10
56
✔✔A 17-year-old female with borderline personality disorder is in an inpatient
psychiatric unit secondary to a recent heroin overdose. Upon a routine physical exam,
she is found to have superficial skin scratches on her forearm bilaterally. What is the
appropriate management?
Choices:
1. Seclude and restrain her to prevent further self-harm
2. First aid, then a team conference to confront her
3. First aid, then explore preceding emotions and actions with her
4. Restrict her to her room to provide an opportunity to reflect on her behavior - ✔✔First
aid, then explore preceding emotions and actions with her
✔✔Evidence suggests that patients who are of the _______ gender, of adolescent age,
or age older than 50 years are at increased risk of persistent _______ use. A pre-
existing history of depression or illicit drug, alcohol, antidepressant, or benzodiazepine
use are also at increased risk - ✔✔female
opioid
✔✔A __________ approach and individualized plan for managing postoperative pain
should be emphasized to help reduce opioid demand while optimizing the adequacy of
pain relief. - ✔✔multimodal
, ✔✔Serotonin syndrome typically is caused by a combination of an _______ with other
serotonergic substances such as serotonin-norepinephrine reuptake inhibitors, MAOIs,
tricyclic antidepressants, amphetamines, buspirone, triptans, St. John's wort, ecstasy, or
cocaine - ✔✔SSRI
✔✔Varenicline, ____________, and nicotine patches/gum remain the only treatment
options that have consistently been shown in the literature to help reduce the
consumption of tobacco. - ✔✔bupropion
✔✔____________ in patients with cirrhosis is believed to arise from hyperestrinism due
to the increased adrenal production of androstenedione with aromatization and
conversion to estradiol. - ✔✔Gynecomastia
✔✔Altered mental status in cirrhosis is likely from ____________
_____________________, which is due to a buildup of ammonium toxins from the gut
that fail excretion by the liver. - ✔✔hepatic encephalopathy
✔✔__________ hypertension is due to distorted hepatic architecture causing resistance
to portal flow at the sinusoids. This causes increased hydrostatic pressure at the
portosystemic collateral veins in the anterior abdomen (caput medusa). - ✔✔Portal
✔✔_________ _____ are caused by estrogen's effects on arteriolar dilation. Lower
extremity edema is due to decreased oncotic pressure secondary to the decreased
synthesis of albumin by the liver. - ✔✔Spider nevi
✔✔______________ ____________ syndrome is described as a triad of vomiting,
abdominal pain, and compulsive bathing in the setting of chronic cannabis use. This
actually distinguishes it from other causes of cyclic vomiting. These include cyclic
vomiting syndrome, drug withdrawal syndrome, bulimia nervosa, Addison disease and
other metabolic conditions, psychogenic vomiting, and migraine headaches. -
✔✔Cannabinoid hyperemesis
✔✔___________ ___________ usually present with autonomic excitation, tremors,
agitation, and an altered sensorium 48 - 96 hours after the last alcohol drink
consumption. - ✔✔Delirium tremens
✔✔Those with alcohol use disorder can present in ______ fibrillation due to both
underlying electrolyte abnormalities from malnourishment as well as the potential for
nonischemic dilated cardiomyopathy. - ✔✔atrial
✔✔__________ ketoacidosis is very common due to a diet of "tea and toast" and
overall malnourishment. Patients may have mild hyperglycemia but the typical
symptoms of diabetic ketoacidosis are not present. Therapy for these patients is
