LATEST ADDICTION PSYCHIATRY
CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF PSYCHIATRY &
NEUROLOGY | COMPLETE EXAM Q&A WITH
RATIONALES
1. A 34-year-old male with alcohol use disorder
reports craving, anxiety, and insomnia for 3 days
after his last drink. Vital signs: HR 110, BP 145/95,
temperature 37.8°C. Which medication is most
appropriate for symptom management and
prevention of seizure progression?
A) Haloperidol
B) Lorazepam
C) Carbamazepine
D) Baclofen
Correct answer: B
Rationale: Benzodiazepines (lorazepam) are first-line
for alcohol withdrawal to prevent seizure and
delirium tremens by enhancing GABAergic tone.
They reduce autonomic instability and craving.
,2. A 28-year-old female with opioid use disorder is
maintained on buprenorphine/naloxone 8/2 mg daily.
She becomes pregnant (6 weeks gestation). Which is
the most appropriate management?
A) Taper buprenorphine to zero over 4 weeks
B) Continue buprenorphine/naloxone at current dose
C) Switch to methadone
D) Switch to naltrexone
Correct answer: C
Rationale: Methadone is the preferred treatment for
opioid use disorder in pregnancy due to extensive
safety data. Buprenorphine is also acceptable but the
combination product (with naloxone) is less studied;
many experts switch to methadone or buprenorphine
monoproduct.
3. A 45-year-old male with cocaine use disorder
presents with chest pain 30 minutes after using crack
cocaine. ECG shows ST-segment elevation in leads
V2-V4. Which is the most appropriate immediate
treatment?
A) Aspirin and nitroglycerin
B) Lorazepam and haloperidol
C) Propranolol
,D) Sodium bicarbonate
Correct answer: A
Rationale: Cocaine-associated myocardial infarction
is treated with aspirin and nitroglycerin. Beta-
blockers are contraindicated due to unopposed
alpha-adrenergic vasoconstriction. Benzodiazepines
are adjunctive for agitation.
4. A 22-year-old male with cannabis use disorder
reports daily use since age 15. He wants to quit but
cannot sleep without cannabis. Which medication has
the strongest evidence for cannabis withdrawal?
A) Dronabinol
B) Naltrexone
C) Fluoxetine
D) Gabapentin
Correct answer: A
Rationale: Dronabinol (synthetic THC) reduces
cannabis withdrawal symptoms including insomnia,
irritability, and decreased appetite. Gabapentin has
some evidence but dronabinol is more specific.
5. A 38-year-old female with alcohol use disorder has
a gamma-glutamyl transferase (GGT) of 250 U/L and
, AST 120/ALT 90. She drinks 10 beers daily. Which
laboratory finding suggests alcoholic hepatitis rather
than simple steatosis?
A) AST:ALT ratio >1.5
B) Elevated GGT
C) Macrocytic anemia
D) Elevated bilirubin
Correct answer: A
Rationale: AST:ALT ratio >1.5 (often >2) is
characteristic of alcoholic liver disease, particularly
alcoholic hepatitis. Simple steatosis may have normal
AST/ALT or mild elevation with ratio <1.
6. A 29-year-old male with opioid use disorder on
methadone 80 mg daily has a QTc interval of 480 ms.
Which is the most appropriate next step?
A) Reduce methadone to 60 mg
B) Switch to buprenorphine
C) Check electrolytes and repeat ECG
D) Add verapamil
Correct answer: C
Rationale: Methadone-associated QTc prolongation
requires electrolyte check (K+, Mg2+), repeat ECG,
CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF PSYCHIATRY &
NEUROLOGY | COMPLETE EXAM Q&A WITH
RATIONALES
1. A 34-year-old male with alcohol use disorder
reports craving, anxiety, and insomnia for 3 days
after his last drink. Vital signs: HR 110, BP 145/95,
temperature 37.8°C. Which medication is most
appropriate for symptom management and
prevention of seizure progression?
A) Haloperidol
B) Lorazepam
C) Carbamazepine
D) Baclofen
Correct answer: B
Rationale: Benzodiazepines (lorazepam) are first-line
for alcohol withdrawal to prevent seizure and
delirium tremens by enhancing GABAergic tone.
They reduce autonomic instability and craving.
,2. A 28-year-old female with opioid use disorder is
maintained on buprenorphine/naloxone 8/2 mg daily.
She becomes pregnant (6 weeks gestation). Which is
the most appropriate management?
A) Taper buprenorphine to zero over 4 weeks
B) Continue buprenorphine/naloxone at current dose
C) Switch to methadone
D) Switch to naltrexone
Correct answer: C
Rationale: Methadone is the preferred treatment for
opioid use disorder in pregnancy due to extensive
safety data. Buprenorphine is also acceptable but the
combination product (with naloxone) is less studied;
many experts switch to methadone or buprenorphine
monoproduct.
3. A 45-year-old male with cocaine use disorder
presents with chest pain 30 minutes after using crack
cocaine. ECG shows ST-segment elevation in leads
V2-V4. Which is the most appropriate immediate
treatment?
A) Aspirin and nitroglycerin
B) Lorazepam and haloperidol
C) Propranolol
,D) Sodium bicarbonate
Correct answer: A
Rationale: Cocaine-associated myocardial infarction
is treated with aspirin and nitroglycerin. Beta-
blockers are contraindicated due to unopposed
alpha-adrenergic vasoconstriction. Benzodiazepines
are adjunctive for agitation.
4. A 22-year-old male with cannabis use disorder
reports daily use since age 15. He wants to quit but
cannot sleep without cannabis. Which medication has
the strongest evidence for cannabis withdrawal?
A) Dronabinol
B) Naltrexone
C) Fluoxetine
D) Gabapentin
Correct answer: A
Rationale: Dronabinol (synthetic THC) reduces
cannabis withdrawal symptoms including insomnia,
irritability, and decreased appetite. Gabapentin has
some evidence but dronabinol is more specific.
5. A 38-year-old female with alcohol use disorder has
a gamma-glutamyl transferase (GGT) of 250 U/L and
, AST 120/ALT 90. She drinks 10 beers daily. Which
laboratory finding suggests alcoholic hepatitis rather
than simple steatosis?
A) AST:ALT ratio >1.5
B) Elevated GGT
C) Macrocytic anemia
D) Elevated bilirubin
Correct answer: A
Rationale: AST:ALT ratio >1.5 (often >2) is
characteristic of alcoholic liver disease, particularly
alcoholic hepatitis. Simple steatosis may have normal
AST/ALT or mild elevation with ratio <1.
6. A 29-year-old male with opioid use disorder on
methadone 80 mg daily has a QTc interval of 480 ms.
Which is the most appropriate next step?
A) Reduce methadone to 60 mg
B) Switch to buprenorphine
C) Check electrolytes and repeat ECG
D) Add verapamil
Correct answer: C
Rationale: Methadone-associated QTc prolongation
requires electrolyte check (K+, Mg2+), repeat ECG,
