Diagnose Me Please
52 y/o M presents today for annual physical exam for which he has no complaints. On PE, you note several abnormal findings including hand tremor, palmar erythema and diaphoresis. When asked about drinking patient states that he has been trying to quit for months but proud to say he has not drank in the past 16 hrs. He believes he can "do it this time" and states that he had been drinking 1/5th whiskey at night and 2-3 beers every morning to take the edge off. Whats his most likely diagnosis?
A) ETOH intoxication
B) MDD
C) ETOH dependence/withdrawal
D) Wernicke- Korsakoff
C) ETOH dependence/withdrawal
What medication is used during a BZD overdose?
A) Naltrexone
B) Clonidine
C) Flumazenil
D) Acamprosate
C) Flumazenil
22 y/o F brought into ED by friends with intractable vomiting after they attended a frat party. Friends state they weren't around her the whole time but in a different room. Patient can barely speak between the vomiting bouts. Vitals: HR-98 R-15 BP-128/86
Patient appears flush in the face with slurred speech. No aggression or irritability noted. While walking to the bathroom, you note instability and inability to walk straight to the restroom despite short distance. What did they use?
A) PCP
B) Opioids
C) MDMA
D) ETOHD) ETOH
42 y/o M comes to your outpatient clinic for a refill of his Prozac. He tells you that he has off and on episodes of depression that has been going on since HS. Patient also notes that he is a recovering alcoholic that started in his early 20s but has been sober for 12 years now. He is currently experiencing anhedonia, depressed mood, trouble getting out of bed, lack of motivation and insomnia for the past 3 weeks. Whats his primary dx?
A) MDD
B) AUD
C) Substance induced mood disorder
D) Dysthymia/PDD
A) MDD
38 y/o M comes to your outpatient clinic today after spending a week in detox and wants to get started on Naltrexone for his ETOH cravings. What lab do you check before starting Naltrexone?
A) CBC
B) Lipids
C) LFTs
D) Thyroid Panel
C) LFTs
27 y/o M presents to the ER with severe abdominal cramping for the past 18 hrs along with N/V/D. Patient denies any sick contacts and any questionable food choices. PE you note he has a runny nose, runny eyes and diaphoresis. Labs come back normal as well as a normal abdominal xray. What do you suspect he may have?
A) Gastroenteritis
B) Food poisoning
C) COVID
D) Opioid withdrawal
D) Opioid withdrawal
Patient is a 52 y/o M who presents today to your outpatient office looking to help his AUD. He is currently in a halfway house and doing well/staying compliant with UDS/IOP. Patient states that he does still have cravings to drink and needs help with that. What can you give him?
A) Trazodone
B) Vistaril
C) Naltrexone
D) Suboxone
C) Naltrexone
35 y/o M is brought to your outpatient clinic to psych evaluation. He describes some issues he is having with his depression but mid conversation seems to be nodding out some. When you ask about his drug use, he immediately denies and starts picking his skin. When asked about any other current concerns, he notes some sleep changes (excessive or non-existent), constipation and some bad mood swings. Only thing noted on PE are constricted pupils and open sores on B arms and face. What could he have been using?
A) ETOH
B) Opioids
C) Amphetamines
D) LSD
B) Opioids
28 y/o F comes into your office saying she has severe anxiety. Anxiety comes and goes. Has been going on for the past 6 months. Also has palpitations and SOB as well when this occurs. Patient started grad school 9 months ago and states that she is doing well overall but worried about getting a B. When further questioned, pt admits to using amphetamines to do well in school. Off and on use for the past 6 months for exams and late night studying. Whats her dx?
A) GAD
B) Social anxiety d/oD) Substance-induced mood d/o
D) Substance-induced mood disorder
You have a 29 y/o F OBOT patient in your office who have been giving monthly Suboxone scripts to when the nurse comes in with her + Amphetamine - Bup UDS. She denies any other drug use and confirms taking her Bup daily. What do you do?
A) Write full 30 day script and rescreen next month
B) Hold Script and run confirmatory testing (mean while the patient runs out)
C) Order confirmatory testing but only write 1 weeks worth at current dose
D) Write this months script but cut dose in half
C) Order confirmatory testing and write 1 weeks worth
42 y/o F comes to your outpatient psychiatric office stating that "she just cannot get everything she needs done at home". Patient states that she has issues with focus, concentration and getting tasks completed. Denies any true struggles in school as a child or young adult. Patient states that several friends are taking something for this and that she has tried some before. "It really helps but I don't want to keep taking theirs". What is the most likely diagnosis?
A) ADHD
B) Amphetamine abuse
C) GAD
D) OCD
B) Amphetamine abuse
29 y/o M comes to ED via ambulance after becoming beligerent at a party and "wanting to fight everyone". He is currently restrained, aggressive and very uncooperative. You are able to get him to do a UDS... + for PCP. What can you give him?
A) Low potency antipsychotic
B) BZD
C) SSRI
D) Naloxone
B) BZD
41 y/o M patient is brought into the ED after walking in traffic. He states he was just "listening to the symphony of colors". Felt "very good and that everything was going to be okay". He denies any PMHx or psychiatric hx. Not currently on any medications.
On PE, you do note some mild tachycardia and HTN. Temp is noted at 100 degrees F and patient appears to be sweating som. Pupils are moderately dilated (mydriasis). Otherwise unremarkable exam. What did he use?
A) LSD
B) Opiates
C) Heroin
D) SSRIs
A) LSD
35 y/o F brought to you in the ED by her friends who state that for the past several weeks she has been up all hrs of the night rearranging their apartment, bought a whole new wardrobe and has been bragging about sleeping with 3 different guys. She states that they are "just jealous" and she shouldn't even be there. Denies illicit drug use but states that she does drink ETOH and that has increased the last several weeks. Mood seems elevated and patient seems to have some pressured speech. Otherwise MSE is unremarkable. Whats her dx?
A) AUD
B) Histrionic PD
C) Bipolar I d/o
D) Substance-induced mood disorder
C) Bipolar I d/o
31 y/o tests + for both Bup and Cocaine on confirmatory testing. He is currently on 8 mg Suboxone from you. What do you do?
A) Decrease suboxone for a period of time and increase therapy sessions
B) Increase Suboxone dose and decrease therapy
C) Increase therapy and increase Suboxone dose
D) Kick him out of the program
While teaching IOP, you notice that a 32 y/o F is "nodding out" while you are speaking. She appears very drowsy but does wake up when shaken. When approaching her about it, you notice that she has miosis and breathing is shallow and slow. Patient appears confused and very slow to respond to your questions. If you were to do a UDS on her, what would it show?
A) ETOH
B) PCP
C) COCAINE
D) HEROIN
D) Heroin
Patient is a currently pregnant 28 y/o F with a hx of OUD and has been recently using Subutex off the street because she no longer wants to use but knows she will go into withdrawals if she stops. Currently using 16 mg out on the street or more if she can find it. What is gold standard for this patient?
A) Subutex
B) Suboxone
C) Methadone
D) Clonidine
C) Methadone
55 y/o F comes to your office for fatigue after "crashing" for 2 whole days. She states that she literally slept 2 days straight and now feels horrible. Having a lot of muscle aches and joint pain. Also notes depressed and down mood. The only thing that is going well is her appetite. Feels like she is eating everything in the fridge. On PE, you note that she appears emaciated with very dry skin, brittle hair and that her teeth are showing signs of decay and damage. What has she been using?
A) Marijuana
B) Opioids
C) Methamphetamines
D) ETOH
C) Methamphetamines
48 y/o M comes in to see you because his employer says he has to. Patient has been talking to himself at work and has been getting into fights. He states that they "are talking behind my back". When management investigated, everyone stated that nothing was said and it was completely quiet in the room. When discussing previous employers, you note this isn't a new issue. Employer did do a UDS and it was + for THC. Patient states that he uses off and on because it helps quiet his mind. What is his dx?
A) Schizophrenia
B) Schizoaffective
C) Substance-induced mood disorder
D) PTSD
A) Schizophrenia
Severely agitated 38 y/o M comes to the ED in restraints and continues to become aggressive with the nursing staff. You suspect PCP intoxication. What do you give him?
A) Low potency antipsyhotic
B) BZD
C) Clonidine
D) Vistaril
B) BZD
23 y/o PA student is brought to ED after kicking his roommate. Student insists that he be discharged to study for his upcoming exam... becoming very angry and aggressive. He states he has been hardcore studying for this weeks test. Roommate states he has not been sleeping or eating the last few days. No PMHx or psych hx. Exam: BP- 140/92 and HR-105 bpm. Dilated pupils, sweaty with mild hand tremor bilaterally. AAO x 3 but uncooperative. Most likely dx is:
A) Amphetamine intoxication
B) PCP intoxication
C) Cocaine intoxication
D) Hyperthyroidism
A) Amphetamine intoxication
52 y/o F brought to ED by police after stumbling into traffic walking down the street. You smell ETOH. Very poor historian. After getting her settled down, what would you give her first?
A) Naltrexone
B) Thiamine
C) Glucose
D) BZD
B) Thiamine
16 y/o M presents to ED today with his parents. Parents state that he has been having bad headaches off and on with N/V. They also note some paranoia about people following him from school "but doesn't last long". They brought him in quickly today because it does seem to come and go quickly.
On PE, O2 sat is slightly low at 92. Having some mm weakness and hyporeflexia in LE. Having some mildly slurred speech. Normal PE otherwise. What was he using?
A) Amphetamines
B) Opioids
C) Glue or other inhalant
D) PCP
C) Glue or other inhalant
56 y/o M comes in today to see you in outpatient psych because his PCP recently started him on an SSRI but he started having "bad side effects". When asked he notes bright colorful sounds. Its "like I am out of my body and experiencing it like a movie". He states that he is proud to say that he has been clean for 10+ years. What do you think is going on?
A) SSRI SE
B) Lying about current substance use
C) LSD flashbacks
D) Schizophrenia
C) LSD flashbacks
You test a patients LFTs before starting naltrexone and they have moderate liver dysfunction but normal renal function. What can you give them for AUD?
A) Naltrexone
B) Vivitrol
C) Antabuse
D) Acamprosate
D) Acamprosate