SOLUTIONS GRADED A+
✔✔Psychiatric medications such as monoamine oxidase inhibitors (MAOI), selective
serotonin reuptake inhibitors (SSRI), serotonin-norepinephrine reuptake inhibitors
(SNRI), and tricyclic antidepressants (TCA) manipulate serotonin levels to improve
__________, but too much can produce clonus as part of serotonin ____________. -
✔✔mood
syndrome
✔✔____________ nervous system depressants like alcohol and opiates can diminish
deep tendon __________ as opposed to producing clonus. - ✔✔Central
reflexes
✔✔A 66-year-old male was prescribed pain medication after a fracture followed by
surgery 6 months ago. Since then, his primary care provider has noticed frequent visits
to the office asking for pain medication and multiple injuries justifying the use of it. Every
time there are different vague complaints, but that of pain is consistent. On his last visit,
the primary care took a firm stand and did not agree to continue prescribing the opioids.
Today he visits in a restless state. Which of the following do you suspect to see on
history or physical exam in this patient?
Choices:
1. Constipation
2. Miosis
3. Dilated pupils
4. Bradycardia - ✔✔Dilated pupils
✔✔Opioid withdrawal onset varies with the type of opioid used. Heroin withdrawal
begins in as little as ___ hours, whereas methadone may take 2 to 3 _______. - ✔✔5
days
✔✔Opiod withdrawal symptoms may last days to weeks known as protracted
abstinence syndrome. Signs and symptoms of withdrawal include ___________
cramps, agitation, anxiety, cravings, diarrhea, dilated pupils, high blood pressure,
insomnia, goosebumps, muscle pains, ________ nose, shakiness, sneezing, sweating,
tachycardia, and tearing. - ✔✔abdominal
runny
✔✔A pregnant female, admitted for possible pyelonephritis, is complaining of significant
anxiety, tremulousness, and irritability. Upon assessment, she is noted to have a blood
pressure of 156/94 mmHg, pulse 103 bpm, and is complaining of nausea. Which of the
following screening tools for this patient's most likely substance use disorder has been
empirically validated for use in pregnant females?
,Choices:
1. AUDIT
2. CAGE
3. T-ACE/T-ACER-3
4. PHQ-9 - ✔✔T-ACE/T-ACER-3
✔✔T-ACE and T-ACER-3, CAGE, and AUDIT are screening tools for __________ use
disorder. - ✔✔alcohol
✔✔T-ACE and T-ACER-3 were designed by an obstetrician with a goal of better
identifying alcohol use disorder in __________ females. - ✔✔pregnant
✔✔A 66-year-old male presents to the hospital complaining of bilateral upper extremity
tremors, sweating, and nausea. These symptoms have been present for the last several
hours and are worsening in intensity. He has a history of heavy alcohol use, and his last
drink was 12 hours ago. Which of the following should be anticipated if the patient does
not receive appropriate treatment?
Choices:
1. Tactile hallucinations
2. Hypotension
3. Bradycardia
4. Hypothermia - ✔✔Tactile hallucinations
✔✔Alcohol withdrawal begins about ____ hours after the last alcoholic drink. Tremors,
sweating, insomnia, elevated blood pressure, and tachycardia are common symptoms
early in the presentation of alcohol withdrawal due to the removal of the ethanol as a
__________ leading to overexcitation of the central nervous system. Patients also may
complain of nausea, anxiety, and headache. - ✔✔6
depressant
✔✔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