CARN UPDATED ACTUAL COMPREHENSIVE EXAM
QUESTIONS AND ANSWERS SURE A+
✔✔Without appropriate treatment, 24 to 48 hours after the last alcoholic drink
symptoms can progress to __________ tremens, which can present with tactile, visual,
or auditory hallucinations and agitation. A patient also may develop generalized tonic-
clonic ___________. - ✔✔delirium
seizures
✔✔Symptoms of delirium tremens can last up to seven to ten days. ______________,
such as diazepam, lorazepam, or chlordiazepoxide, are used to decrease the symptoms
of alcohol withdrawal and to prevent seizures. - ✔✔Benzodiazepines
✔✔A 67-year-old male presents with a vague history of not feeling well, anxiety, and
restlessness. He has had several admissions over the past few months for falls,
hypoglycemia, and abdominal discomfort. He simply is unable to provide any type of
medical history, and his medical chart is not yet available. On a physical exam, you note
that he has tachypnea, marked gynecomastia, and spider angiomas. What is the initial
working diagnosis?
Choices:
1. Opioid abuse
2. Testicular cancer
,3. Alcohol use disorder
4. Digoxin overdose - ✔✔Alcohol use disorder
✔✔When people consume alcohol for at least 1 to 3 months or even consume large
quantities for at least 7 to10 days, a ____________ response can occur within ___ to
24 hours after cessation of alcohol consumption. The withdrawal response is relieved
immediately by consuming additional alcohol. - ✔✔withdrawal
6
✔✔The signs and symptoms of alcohol withdrawal may range from a simple tremor to
delirium tremens characterized by autonomic ___________, diaphoresis, tachypnea,
hyperthermia, and diaphoresis. Other features of alcohol use disorder include ascites,
hepatosplenomegaly, and melena. Thinning of hair, spider ________, and
gynecomastia also are seen. - ✔✔hyperactivity
angioma
✔✔Combining ___________ and ___________ treatments can increase smoking
cessation rates from 8% to14% when compared with minimal behavioral interventions
such as brief advice on quitting - ✔✔behavioral
pharmacological
✔✔Combination interventions usually include behavioral components delivered by
specialized smoking cessation counselors combined with nicotine replacement therapy.
Combination interventions are made up of at least four sessions and are more
successful with more sessions. Adding ___________ interventions to pharmacotherapy
increases cessation rates from 18% in persons receiving pharmacotherapy alone to
21% in those using a combination of pharmacotherapy and behavioral support. -
✔✔behavioral
✔✔A 16-year-old white male comes into your office requesting medical marijuana for
his anxiety and depression. He explains that he has been using it for years and
acquired it from friends. Whenever he is without it for a few days, he finds his
depression and anxiety recur and sometimes even has episodes of severe anxiety with
chest tightening, tingling sensations, racing heart, and dizziness. He has never sought
mental health resources in the past and denies having similar symptoms in grade
school or middle school. Looking back on his life he says his experience growing up at
home and school were great and explicitly denies any traumatic experiences. He
produces some literature published by an academic university he finds online
supporting his reason to use marijuana. What is the most likely cause of his symptoms?
Choices:
1. Generalized anxiety disorder
2. Major Depressive Disorder with anxious features
3. Panic - ✔✔Cannabis withdrawal
, ✔✔Differentiating endogenous psychiatric illnesses from the effects of substance use
requires a timeline of the symptoms. Panic attacks, anxiety, anhedonia, depressed
mood, and insomnia are effects that occur with __________ withdrawal. - ✔✔cannabis
✔✔Cannabis withdrawal typically occurs in heavy users and starts within the first
_______, and symptoms usually peak by day ________. - ✔✔week
three
✔✔A 40-year-old male with a history of alcohol use disorder is admitted to the hospital
for skin lacerations following a motor vehicle accident. Urgent care is given with
intravenous fluids and sutures where required. On physical examination, the blood
pressure is 130/82 mmHg. The pulse is 86/min, respiratory rate is 18/min, and
temperature is 98.7 F. After 5 hours, the nurse goes to draw blood, and the patient
refuses, citing restlessness and agitation. The patient yells and states that his heart is
pounding and he would not let anyone come close to him. He has a previous history of
hepatitis C that has been treated. What is the next step in management?
Choices:
1. Administer lithium
2. Administer oxazepam
3. Administer lactulose
4. Administer diazepam - ✔✔Administer oxazepam
✔✔___________ is an FDA-approved benzodiazepine used for the treatment of alcohol
withdrawal, management of anxiety disorders, and agitation. - ✔✔Oxazepam
✔✔For alcohol withdrawal in adults, administer oxazepam 15 mg PO TID. Diazepam
should not be used in this patient because it is metabolized in the liver. Oxazepam, on
the other hand, is excreted through the _________. - ✔✔kidneys
✔✔CAGE stands for the following: (1) Have you felt the need to _______ down your
drinking?, (2) Have people __________ you or criticized you about your drinking?, (3)
Have you felt ________ about your drinking?, (4) Have you ever used alcohol as an
_______ opener? A max score is a 4 and a low is 0. - ✔✔CUT
ANNOYED
GUILTY
EYE
✔✔Patients in ______________ have not recognized their drinking as an issue and
need help to reach that bridge. - ✔✔precontemplation
✔✔Those in ______________ recognize the issue but have not prepared a plan to
begin crossing the bridge towards recovery. - ✔✔contemplation
QUESTIONS AND ANSWERS SURE A+
✔✔Without appropriate treatment, 24 to 48 hours after the last alcoholic drink
symptoms can progress to __________ tremens, which can present with tactile, visual,
or auditory hallucinations and agitation. A patient also may develop generalized tonic-
clonic ___________. - ✔✔delirium
seizures
✔✔Symptoms of delirium tremens can last up to seven to ten days. ______________,
such as diazepam, lorazepam, or chlordiazepoxide, are used to decrease the symptoms
of alcohol withdrawal and to prevent seizures. - ✔✔Benzodiazepines
✔✔A 67-year-old male presents with a vague history of not feeling well, anxiety, and
restlessness. He has had several admissions over the past few months for falls,
hypoglycemia, and abdominal discomfort. He simply is unable to provide any type of
medical history, and his medical chart is not yet available. On a physical exam, you note
that he has tachypnea, marked gynecomastia, and spider angiomas. What is the initial
working diagnosis?
Choices:
1. Opioid abuse
2. Testicular cancer
,3. Alcohol use disorder
4. Digoxin overdose - ✔✔Alcohol use disorder
✔✔When people consume alcohol for at least 1 to 3 months or even consume large
quantities for at least 7 to10 days, a ____________ response can occur within ___ to
24 hours after cessation of alcohol consumption. The withdrawal response is relieved
immediately by consuming additional alcohol. - ✔✔withdrawal
6
✔✔The signs and symptoms of alcohol withdrawal may range from a simple tremor to
delirium tremens characterized by autonomic ___________, diaphoresis, tachypnea,
hyperthermia, and diaphoresis. Other features of alcohol use disorder include ascites,
hepatosplenomegaly, and melena. Thinning of hair, spider ________, and
gynecomastia also are seen. - ✔✔hyperactivity
angioma
✔✔Combining ___________ and ___________ treatments can increase smoking
cessation rates from 8% to14% when compared with minimal behavioral interventions
such as brief advice on quitting - ✔✔behavioral
pharmacological
✔✔Combination interventions usually include behavioral components delivered by
specialized smoking cessation counselors combined with nicotine replacement therapy.
Combination interventions are made up of at least four sessions and are more
successful with more sessions. Adding ___________ interventions to pharmacotherapy
increases cessation rates from 18% in persons receiving pharmacotherapy alone to
21% in those using a combination of pharmacotherapy and behavioral support. -
✔✔behavioral
✔✔A 16-year-old white male comes into your office requesting medical marijuana for
his anxiety and depression. He explains that he has been using it for years and
acquired it from friends. Whenever he is without it for a few days, he finds his
depression and anxiety recur and sometimes even has episodes of severe anxiety with
chest tightening, tingling sensations, racing heart, and dizziness. He has never sought
mental health resources in the past and denies having similar symptoms in grade
school or middle school. Looking back on his life he says his experience growing up at
home and school were great and explicitly denies any traumatic experiences. He
produces some literature published by an academic university he finds online
supporting his reason to use marijuana. What is the most likely cause of his symptoms?
Choices:
1. Generalized anxiety disorder
2. Major Depressive Disorder with anxious features
3. Panic - ✔✔Cannabis withdrawal
, ✔✔Differentiating endogenous psychiatric illnesses from the effects of substance use
requires a timeline of the symptoms. Panic attacks, anxiety, anhedonia, depressed
mood, and insomnia are effects that occur with __________ withdrawal. - ✔✔cannabis
✔✔Cannabis withdrawal typically occurs in heavy users and starts within the first
_______, and symptoms usually peak by day ________. - ✔✔week
three
✔✔A 40-year-old male with a history of alcohol use disorder is admitted to the hospital
for skin lacerations following a motor vehicle accident. Urgent care is given with
intravenous fluids and sutures where required. On physical examination, the blood
pressure is 130/82 mmHg. The pulse is 86/min, respiratory rate is 18/min, and
temperature is 98.7 F. After 5 hours, the nurse goes to draw blood, and the patient
refuses, citing restlessness and agitation. The patient yells and states that his heart is
pounding and he would not let anyone come close to him. He has a previous history of
hepatitis C that has been treated. What is the next step in management?
Choices:
1. Administer lithium
2. Administer oxazepam
3. Administer lactulose
4. Administer diazepam - ✔✔Administer oxazepam
✔✔___________ is an FDA-approved benzodiazepine used for the treatment of alcohol
withdrawal, management of anxiety disorders, and agitation. - ✔✔Oxazepam
✔✔For alcohol withdrawal in adults, administer oxazepam 15 mg PO TID. Diazepam
should not be used in this patient because it is metabolized in the liver. Oxazepam, on
the other hand, is excreted through the _________. - ✔✔kidneys
✔✔CAGE stands for the following: (1) Have you felt the need to _______ down your
drinking?, (2) Have people __________ you or criticized you about your drinking?, (3)
Have you felt ________ about your drinking?, (4) Have you ever used alcohol as an
_______ opener? A max score is a 4 and a low is 0. - ✔✔CUT
ANNOYED
GUILTY
EYE
✔✔Patients in ______________ have not recognized their drinking as an issue and
need help to reach that bridge. - ✔✔precontemplation
✔✔Those in ______________ recognize the issue but have not prepared a plan to
begin crossing the bridge towards recovery. - ✔✔contemplation
