Psych EOR Review questions |\ |\ |\ |\
with answers |\
A 47-year-old man is admitted to a psychiatric unit for depression
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
with suicidal ideation and detoxification. He has a long history of
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
dependence upon both alcohol and cocaine. Which of the |\ |\ |\ |\ |\ |\ |\ |\ |\
following signs is most characteristic of early alcohol withdrawal?
|\ |\ |\ |\ |\ |\ |\ |\
A. Decreased blood pressure
|\ |\ |\
B. Hypersomnia
|\
C. Persistent hallucinations
|\ |\
D. Tremor |\
E. Increased appetite
|\ |\
The correct answer is D. |\ |\ |\ |\
Explanation: Tremor is the most characteristic sign of alcohol |\ |\ |\ |\ |\ |\ |\ |\ |\
withdrawal. Vital signs are elevated in alcohol withdrawal |\ |\ |\ |\ |\ |\ |\ |\
because of autonomic hyperactivity. Patients generally have
|\ |\ |\ |\ |\ |\ |\
insomnia as a result, not hypersomnia. Hallucinations associated|\ |\ |\ |\ |\ |\ |\ |\
with alcohol withdrawal usually resolve within a week, while
|\ |\ |\ |\ |\ |\ |\ |\ |\
those occurring in delirium tremens usually resolve with the
|\ |\ |\ |\ |\ |\ |\ |\ |\
delirium. Cocaine withdrawal more typically involves |\ |\ |\ |\ |\ |\
hypersomnia and hyperphagia. |\ |\
A 54-year-old man is admitted to the hospital for elective surgery.
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
He has been through alcohol rehabilitation, but has continued to
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
struggle with his drinking. He alerts the primary service taking
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
care of him that he has continued to drink up to the time of his
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
admission. In what time frame after cessation of all drinking is he |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
at most risk for delirium tremens?
|\ |\ |\ |\ |\ |\
A. 6 to 8 hours
|\ |\ |\ |\
B. 8 to 12 hours
|\ |\ |\ |\
C. 12 to 24 hours
|\ |\ |\ |\
,D. 48 to 96 hours
|\ |\ |\ |\
E. Over 1 week
|\ |\ |\
The correct answer is D.
|\ |\ |\ |\
Explanation: Withdrawal symptoms usually, but not always, occur |\ |\ |\ |\ |\ |\ |\
in stages: tremulousness or jitteriness (6-8 hours), psychosis and
|\ |\ |\ |\ |\ |\ |\ |\ |\
perceptual symptoms (8-12 hours), seizures (12-24 hours), and
|\ |\ |\ |\ |\ |\ |\ |\ |\
DTs (24-72 hours, up to 1 week).
|\ |\ |\ |\ |\ |\
An elderly woman presents to the emergency department due to
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
a hip fracture. She reports that she "hasn't been feeling very
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
well" recently, and is vague and hard to pin down regarding
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
details. You think that there might be the odor of alcohol on her
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
breath and suspect alcohol use disorder. Which of the following
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
findings would be most supportive of your concern? |\ |\ |\ |\ |\ |\ |\
A. A healed scar from a previous fall several years ago
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
B. Microcytic anemia
|\ |\
C. Elevated gamma-glutamyl transpeptidase
|\ |\ |\
D. Slightly elevated aspartate aminotransferase (AST), with
|\ |\ |\ |\ |\ |\ |\
normal alanine aminotransferase (ALT) |\ |\ |\
E. Mini-mental state examination score of 28/30
|\ |\ |\ |\ |\ |\
The correct answer is C.
|\ |\ |\ |\
Explanation: Laboratory tests in alcoholics commonly show |\ |\ |\ |\ |\ |\ |\
macrocytic anemia and elevated liver transaminase levels- |\ |\ |\ |\ |\ |\
particularly gamma-glutamyl transpeptidase. |\ |\
A 63-year-old man presents to the emergency department with
|\ |\ |\ |\ |\ |\ |\ |\ |\
complaints of anxiety. He describes a long history of daily heavy |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
alcohol use and 2 days ago "quit cold turkey." He appears visibly
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
tremulous, flushed, and diaphoretic. His temperature, blood |\ |\ |\ |\ |\ |\ |\
pressure, and pulse rate are elevated. The results of his physical
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
examination are otherwise unremarkable, but his laboratory tests |\ |\ |\ |\ |\ |\ |\
demonstrate low serum albumin and low protein levels, as well
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
as an elevated prothrombin time/partial prothrombin time value.
|\ |\ |\ |\ |\ |\ |\ |\
He is admitted to the medical service for alcohol detoxification.
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
Which of the following medications would be most appropriate in
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
,treating this patient? |\ |\
A. Alprazolam
|\
B. Chlordiazepoxide
|\
C. Diazepam
|\
D. Lorazepam
|\
E. Clonazepam
|\
The correct answer is D.
|\ |\ |\ |\
Explanation: Although all these medications are benzodiazepines, |\ |\ |\ |\ |\ |\
only lorazepam is metabolized solely by glucuronidation, which is
|\ |\ |\ |\ |\ |\ |\ |\ |\
not as dependent on liver functioning. The metabolism of the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
other benzodiazepines is much more dependent on liver function.
|\ |\ |\ |\ |\ |\ |\ |\
In this patient (who has evidence of poor liver function), using
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
high doses of medications that are dependent on liver function
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
for their degradation could result in excessive drug levels in the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
blood of an overly sedated patient.
|\ |\ |\ |\ |\
Delirium tremens onset |\ |\
A. Immediately
|\
B. 6 to 8 hours
|\ |\ |\ |\
C. 8 to 12 hours
|\ |\ |\ |\
D. 12 to 24 hours
|\ |\ |\ |\
E. 24 to 72 hours
|\ |\ |\ |\
The correct answer is E.
|\ |\ |\ |\
Explanation: Withdrawal symptoms usually, but not always, occur |\ |\ |\ |\ |\ |\ |\
in stages: tremulousness or jitteriness (6-8 hours), psychosis and
|\ |\ |\ |\ |\ |\ |\ |\ |\
perceptual symptoms (8-12 hours), seizures (12-24 hours), and
|\ |\ |\ |\ |\ |\ |\ |\ |\
DTs (24-72 hours, up to 1 week).
|\ |\ |\ |\ |\ |\
Hallucinations with intact orientation onset |\ |\ |\ |\
A. Immediately
|\
B. 6 to 8 hours
|\ |\ |\ |\
C. 8 to 12 hours
|\ |\ |\ |\
D. 12 to 24 hours
|\ |\ |\ |\
E. 24 to 72 hours
|\ |\ |\ |\
, The correct answer is C.
|\ |\ |\ |\
Explanation: Withdrawal symptoms usually, but not always, occur
|\ |\ |\ |\ |\ |\ |\
in stages: tremulousness or jitteriness (6-8 hours), psychosis and
|\ |\ |\ |\ |\ |\ |\ |\ |\
perceptual symptoms (8-12 hours), seizures (12-24 hours), and
|\ |\ |\ |\ |\ |\ |\ |\ |\
DTs (24-72 hours, up to 1 week). Of note, alcoholic hallucinosis
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
occurs earlier than hallucinations associated with delirium
|\ |\ |\ |\ |\ |\ |\
tremens, and are not usually associated with a clouded
|\ |\ |\ |\ |\ |\ |\ |\ |\
sensorium or abnormal vital signs. |\ |\ |\ |\
Withdrawal seizures onset |\ |\
A. Immediately
|\
B. 6 to 8 hours
|\ |\ |\ |\
C. 8 to 12 hours
|\ |\ |\ |\
D. 12 to 24 hours
|\ |\ |\ |\
E. 24 to 72 hours
|\ |\ |\ |\
The correct answer is D.
|\ |\ |\ |\
Explanation: Withdrawal symptoms usually, but not always, occur
|\ |\ |\ |\ |\ |\ |\
in stages: tremulousness or jitteriness (6-8 hours), psychosis and
|\ |\ |\ |\ |\ |\ |\ |\ |\
perceptual symptoms (8-12 hours), seizures (12-24 hours), and
|\ |\ |\ |\ |\ |\ |\ |\ |\
DTs (24-72 hours, up to 1 week).
|\ |\ |\ |\ |\ |\
Tremulousness onset |\
A. Immediately
|\
B. 6 to 8 hours
|\ |\ |\ |\
C. 8 to 12 hours
|\ |\ |\ |\
D. 12 to 24 hours
|\ |\ |\ |\
E. 24 to 72 hours
|\ |\ |\ |\
The correct answer is B.
|\ |\ |\ |\
Explanation: Withdrawal symptoms usually, but not always, occur
|\ |\ |\ |\ |\ |\ |\
in stages: tremulousness or jitteriness (6-8 hours), psychosis and
|\ |\ |\ |\ |\ |\ |\ |\ |\
perceptual symptoms (8-12 hours), seizures (12-24 hours), and
|\ |\ |\ |\ |\ |\ |\ |\ |\
DTs (24-72 hours, up to 1 week).
|\ |\ |\ |\ |\ |\
Hallucinations with delirium onset |\ |\ |\
A. Immediately
|\
with answers |\
A 47-year-old man is admitted to a psychiatric unit for depression
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
with suicidal ideation and detoxification. He has a long history of
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
dependence upon both alcohol and cocaine. Which of the |\ |\ |\ |\ |\ |\ |\ |\ |\
following signs is most characteristic of early alcohol withdrawal?
|\ |\ |\ |\ |\ |\ |\ |\
A. Decreased blood pressure
|\ |\ |\
B. Hypersomnia
|\
C. Persistent hallucinations
|\ |\
D. Tremor |\
E. Increased appetite
|\ |\
The correct answer is D. |\ |\ |\ |\
Explanation: Tremor is the most characteristic sign of alcohol |\ |\ |\ |\ |\ |\ |\ |\ |\
withdrawal. Vital signs are elevated in alcohol withdrawal |\ |\ |\ |\ |\ |\ |\ |\
because of autonomic hyperactivity. Patients generally have
|\ |\ |\ |\ |\ |\ |\
insomnia as a result, not hypersomnia. Hallucinations associated|\ |\ |\ |\ |\ |\ |\ |\
with alcohol withdrawal usually resolve within a week, while
|\ |\ |\ |\ |\ |\ |\ |\ |\
those occurring in delirium tremens usually resolve with the
|\ |\ |\ |\ |\ |\ |\ |\ |\
delirium. Cocaine withdrawal more typically involves |\ |\ |\ |\ |\ |\
hypersomnia and hyperphagia. |\ |\
A 54-year-old man is admitted to the hospital for elective surgery.
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
He has been through alcohol rehabilitation, but has continued to
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
struggle with his drinking. He alerts the primary service taking
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
care of him that he has continued to drink up to the time of his
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
admission. In what time frame after cessation of all drinking is he |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
at most risk for delirium tremens?
|\ |\ |\ |\ |\ |\
A. 6 to 8 hours
|\ |\ |\ |\
B. 8 to 12 hours
|\ |\ |\ |\
C. 12 to 24 hours
|\ |\ |\ |\
,D. 48 to 96 hours
|\ |\ |\ |\
E. Over 1 week
|\ |\ |\
The correct answer is D.
|\ |\ |\ |\
Explanation: Withdrawal symptoms usually, but not always, occur |\ |\ |\ |\ |\ |\ |\
in stages: tremulousness or jitteriness (6-8 hours), psychosis and
|\ |\ |\ |\ |\ |\ |\ |\ |\
perceptual symptoms (8-12 hours), seizures (12-24 hours), and
|\ |\ |\ |\ |\ |\ |\ |\ |\
DTs (24-72 hours, up to 1 week).
|\ |\ |\ |\ |\ |\
An elderly woman presents to the emergency department due to
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
a hip fracture. She reports that she "hasn't been feeling very
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
well" recently, and is vague and hard to pin down regarding
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
details. You think that there might be the odor of alcohol on her
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
breath and suspect alcohol use disorder. Which of the following
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
findings would be most supportive of your concern? |\ |\ |\ |\ |\ |\ |\
A. A healed scar from a previous fall several years ago
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
B. Microcytic anemia
|\ |\
C. Elevated gamma-glutamyl transpeptidase
|\ |\ |\
D. Slightly elevated aspartate aminotransferase (AST), with
|\ |\ |\ |\ |\ |\ |\
normal alanine aminotransferase (ALT) |\ |\ |\
E. Mini-mental state examination score of 28/30
|\ |\ |\ |\ |\ |\
The correct answer is C.
|\ |\ |\ |\
Explanation: Laboratory tests in alcoholics commonly show |\ |\ |\ |\ |\ |\ |\
macrocytic anemia and elevated liver transaminase levels- |\ |\ |\ |\ |\ |\
particularly gamma-glutamyl transpeptidase. |\ |\
A 63-year-old man presents to the emergency department with
|\ |\ |\ |\ |\ |\ |\ |\ |\
complaints of anxiety. He describes a long history of daily heavy |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
alcohol use and 2 days ago "quit cold turkey." He appears visibly
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
tremulous, flushed, and diaphoretic. His temperature, blood |\ |\ |\ |\ |\ |\ |\
pressure, and pulse rate are elevated. The results of his physical
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
examination are otherwise unremarkable, but his laboratory tests |\ |\ |\ |\ |\ |\ |\
demonstrate low serum albumin and low protein levels, as well
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
as an elevated prothrombin time/partial prothrombin time value.
|\ |\ |\ |\ |\ |\ |\ |\
He is admitted to the medical service for alcohol detoxification.
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
Which of the following medications would be most appropriate in
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
,treating this patient? |\ |\
A. Alprazolam
|\
B. Chlordiazepoxide
|\
C. Diazepam
|\
D. Lorazepam
|\
E. Clonazepam
|\
The correct answer is D.
|\ |\ |\ |\
Explanation: Although all these medications are benzodiazepines, |\ |\ |\ |\ |\ |\
only lorazepam is metabolized solely by glucuronidation, which is
|\ |\ |\ |\ |\ |\ |\ |\ |\
not as dependent on liver functioning. The metabolism of the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
other benzodiazepines is much more dependent on liver function.
|\ |\ |\ |\ |\ |\ |\ |\
In this patient (who has evidence of poor liver function), using
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
high doses of medications that are dependent on liver function
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
for their degradation could result in excessive drug levels in the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
blood of an overly sedated patient.
|\ |\ |\ |\ |\
Delirium tremens onset |\ |\
A. Immediately
|\
B. 6 to 8 hours
|\ |\ |\ |\
C. 8 to 12 hours
|\ |\ |\ |\
D. 12 to 24 hours
|\ |\ |\ |\
E. 24 to 72 hours
|\ |\ |\ |\
The correct answer is E.
|\ |\ |\ |\
Explanation: Withdrawal symptoms usually, but not always, occur |\ |\ |\ |\ |\ |\ |\
in stages: tremulousness or jitteriness (6-8 hours), psychosis and
|\ |\ |\ |\ |\ |\ |\ |\ |\
perceptual symptoms (8-12 hours), seizures (12-24 hours), and
|\ |\ |\ |\ |\ |\ |\ |\ |\
DTs (24-72 hours, up to 1 week).
|\ |\ |\ |\ |\ |\
Hallucinations with intact orientation onset |\ |\ |\ |\
A. Immediately
|\
B. 6 to 8 hours
|\ |\ |\ |\
C. 8 to 12 hours
|\ |\ |\ |\
D. 12 to 24 hours
|\ |\ |\ |\
E. 24 to 72 hours
|\ |\ |\ |\
, The correct answer is C.
|\ |\ |\ |\
Explanation: Withdrawal symptoms usually, but not always, occur
|\ |\ |\ |\ |\ |\ |\
in stages: tremulousness or jitteriness (6-8 hours), psychosis and
|\ |\ |\ |\ |\ |\ |\ |\ |\
perceptual symptoms (8-12 hours), seizures (12-24 hours), and
|\ |\ |\ |\ |\ |\ |\ |\ |\
DTs (24-72 hours, up to 1 week). Of note, alcoholic hallucinosis
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
occurs earlier than hallucinations associated with delirium
|\ |\ |\ |\ |\ |\ |\
tremens, and are not usually associated with a clouded
|\ |\ |\ |\ |\ |\ |\ |\ |\
sensorium or abnormal vital signs. |\ |\ |\ |\
Withdrawal seizures onset |\ |\
A. Immediately
|\
B. 6 to 8 hours
|\ |\ |\ |\
C. 8 to 12 hours
|\ |\ |\ |\
D. 12 to 24 hours
|\ |\ |\ |\
E. 24 to 72 hours
|\ |\ |\ |\
The correct answer is D.
|\ |\ |\ |\
Explanation: Withdrawal symptoms usually, but not always, occur
|\ |\ |\ |\ |\ |\ |\
in stages: tremulousness or jitteriness (6-8 hours), psychosis and
|\ |\ |\ |\ |\ |\ |\ |\ |\
perceptual symptoms (8-12 hours), seizures (12-24 hours), and
|\ |\ |\ |\ |\ |\ |\ |\ |\
DTs (24-72 hours, up to 1 week).
|\ |\ |\ |\ |\ |\
Tremulousness onset |\
A. Immediately
|\
B. 6 to 8 hours
|\ |\ |\ |\
C. 8 to 12 hours
|\ |\ |\ |\
D. 12 to 24 hours
|\ |\ |\ |\
E. 24 to 72 hours
|\ |\ |\ |\
The correct answer is B.
|\ |\ |\ |\
Explanation: Withdrawal symptoms usually, but not always, occur
|\ |\ |\ |\ |\ |\ |\
in stages: tremulousness or jitteriness (6-8 hours), psychosis and
|\ |\ |\ |\ |\ |\ |\ |\ |\
perceptual symptoms (8-12 hours), seizures (12-24 hours), and
|\ |\ |\ |\ |\ |\ |\ |\ |\
DTs (24-72 hours, up to 1 week).
|\ |\ |\ |\ |\ |\
Hallucinations with delirium onset |\ |\ |\
A. Immediately
|\
