Substance Use Disorders — MCQs

Substance Use Disorders Indian Medical PG Practice Questions and MCQs

Question 401: The term 'Cold Turkey' is used to denote which of the following cessation methods?

A. Abrupt cessation of substance use (Correct Answer)
B. Consumption of a substance
C. Gradual withdrawal of substance use
D. A place to withdraw from a substance in a group

Explanation: ***Correct Option A: Abrupt cessation of substance use*** - "Cold Turkey" refers to the sudden and complete stopping of an addictive substance, contrasting with a gradual reduction. - This method often leads to intense and rapid onset of **withdrawal symptoms**, which are likened to the goosebumps and pallor resembling a plucked turkey. *Incorrect Option B: Consumption of a substance* - This option refers to the act of using a substance, which is the opposite of cessation. - The term "cold turkey" specifically describes a method of stopping, not consuming. *Incorrect Option C: Gradual withdrawal of substance use* - Gradual withdrawal involves slowly reducing the dose of a substance over time to minimize withdrawal symptoms. - This is a planned and controlled process, unlike the abrupt and sudden nature of "cold turkey." *Incorrect Option D: A place to withdraw from a substance in a group* - This describes a facility or support group for withdrawal but does not define the *method* of cessation. - The term "cold turkey" is about the *manner* of stopping, not the location or social context.

Question 402: All are true of opioid withdrawal, except:

A. Hallucinations (Correct Answer)
B. Nausea
C. Piloerection
D. Yawning

Explanation: ***Hallucinations*** - **Hallucinations** are not a typical symptom of uncomplicated opioid withdrawal. While severe delirium or co-occurring psychiatric conditions might involve them, they are generally absent in opioid cessation alone. - Opioid withdrawal is characterized by physical symptoms, and psychotic features like hallucinations are more common in withdrawal from substances such as alcohol or benzodiazepines. *Nausea* - **Nausea** and vomiting are very common gastrointestinal symptoms experienced during opioid withdrawal due to widespread opioid receptor effects in the gut and brainstem. - The abrupt cessation of opioid agonists leads to an overactivity of systems previously suppressed by the drug, resulting in GI distress. *Piloerection* - **Piloerection**, or "goosebumps," is a classic sign of opioid withdrawal, often referred to as "cold turkey" because of the resemblance to plucked poultry skin. - This symptom results from dysregulation of the autonomic nervous system as the body attempts to adapt to the absence of opioids. *Yawning* - **Yawning** is a very common early and persistent symptom of opioid withdrawal, thought to be related to changes in neurotransmitter levels in the brain, particularly those regulating arousal and sleep-wake cycles. - Excessive yawning is a characteristic sign often observed within hours of the last opioid dose, accompanying other autonomic symptoms.

Question 403: What is the first-line treatment for acute alcohol withdrawal?

A. Diazepam (Correct Answer)
B. Bupropion
C. Disulfiram
D. Acamprosate

Explanation: ***Diazepam*** - **Benzodiazepines** like diazepam are the first-line treatment for acute alcohol withdrawal due to their ability to **potentiate GABAergic inhibition**, thereby counteracting the excitatory CNS state. - They effectively reduce symptoms such as **tremors**, **agitation**, and prevent severe complications like **seizures** and **delirium tremens**. *Bupropion* - **Bupropion** is an antidepressant that works as a **norepinephrine-dopamine reuptake inhibitor** and is used for depression and smoking cessation. - It is **contraindicated** in alcohol withdrawal due to its potential to **lower the seizure threshold**, which is already elevated in withdrawal. *Disulfiram* - **Disulfiram** is used as an **aversion therapy** for alcohol use disorder by blocking acetaldehyde dehydrogenase, leading to unpleasant symptoms if alcohol is consumed. - It is **not used** for the treatment of **acute withdrawal symptoms** and should only be initiated once the patient is fully detoxified. *Acamprosate* - **Acamprosate** is used for the **maintenance of abstinence** in alcohol-dependent individuals by modulating glutamatergic activity. - It does **not treat acute withdrawal symptoms** but rather helps reduce cravings and relapse rates in the post-detoxification phase.

Question 404: Which substance is most commonly associated with experiencing a 'bad trip'?

A. Cocaine
B. Cannabis
C. LSD (Correct Answer)
D. Heroin

Explanation: ***LSD*** - **Lysergic acid diethylamide (LSD)** is a potent **hallucinogen** known for causing profound alterations in perception, mood, and cognitive processes. - The subjective experience can be highly dose-dependent and influenced by the user's mindset and environment (**set and setting**), making **"bad trips"** with intense anxiety, paranoia, and terrifying hallucinations relatively common. *Cocaine* - **Cocaine** is a **stimulant** that primarily causes euphoria, increased energy, and alertness, but can lead to anxiety, paranoia, and psychosis at high doses or with chronic use. - While unpleasant psychological effects can occur, they are generally not categorized as a "bad trip" in the same hallucinatory sense as with LSD. *Cannabis* - **Cannabis** can induce feelings of relaxation and altered perception, but in some individuals, especially with high doses or edibles, it can trigger **anxiety**, **paranoia**, and occasionally **acute psychosis**. - Although these experiences can be very distressing, they typically lack the profound dissociative and hallucinatory intensity associated with an LSD "bad trip." *Heroin* - **Heroin** is an **opioid** that primarily produces euphoria, pain relief, and sedation. - Its main risks include **respiratory depression**, overdose, and withdrawal symptoms, rather than the perceptual and psychological disturbances characterized as a "bad trip."

Question 405: Key symptom in alcohol withdrawal syndrome is:

A. Sleep disturbance
B. Visual hallucinations
C. Tremors (Correct Answer)
D. Delirium

Explanation: ***Tremors*** - Tremors are one of the **earliest and most common symptoms** of alcohol withdrawal, often appearing within 6-12 hours after the last drink. - They are a classic manifestation of **autonomic hyperactivity** due to the sudden cessation of chronic alcohol's depressant effects. *Sleep disturbance* - While **insomnia and disturbed sleep** are very common in alcohol withdrawal, they are generally less specific and often accompany other symptoms. - Sleep disturbances are a consequence of the overall nervous system dysregulation, not typically the single "key" defining symptom in isolation. *Visual hallucinations* - **Visual hallucinations** can occur in alcohol withdrawal, particularly in more severe forms like **alcoholic hallucinosis**, often appearing 12-24 hours after cessation. - However, they are not as ubiquitous or as early-onset as tremors, making tremors a more fundamental "key" symptom. *Delirium* - **Delirium (Delirium Tremens)** is the most severe and life-threatening form of alcohol withdrawal, characterized by confusion, disorientation, agitation, and profound autonomic instability. - It usually develops later (48-96 hours after cessation) and is an extreme manifestation, whereas tremors are a more universal and initial sign across milder to severe withdrawal.

Question 406: Which of the following statements about alcoholic dependence syndrome is false?

A. CAGE questionnaire is used for screening
B. Withdrawal symptoms
C. No tolerance (Correct Answer)
D. Physical dependence

Explanation: ***No tolerance*** - This statement is **false** because **tolerance** to alcohol is a common and defining feature of **alcoholic dependence syndrome**. Individuals with alcohol dependence often need to consume increasingly larger amounts of alcohol to achieve the desired effect. - The development of tolerance is a neuroadaptive response to chronic alcohol exposure, where the brain adjusts to the presence of alcohol, leading to diminished effects over time. *Withdrawal symptoms* - This statement is **true**. **Withdrawal symptoms** are a hallmark of alcoholic dependence syndrome, occurring when alcohol consumption is reduced or stopped after prolonged heavy use. - These symptoms can range from tremors and anxiety to seizures and delirium tremens, indicating the body's physical adaptation to alcohol. *CAGE questionnaire is used for screening* - This statement is **true**. The **CAGE questionnaire** is a widely used and effective screening tool for identifying potential alcohol problems, including dependence. - The acronym CAGE stands for "Cut down," "Annoyed," "Guilty," and "Eye-opener," referring to questions about controlling drinking, being annoyed by criticism of drinking, feeling guilty about drinking, and needing a morning drink. *Physical dependence* - This statement is **true**. **Physical dependence** is a core component of alcoholic dependence syndrome, characterized by the body's adaptation to chronic alcohol exposure. - This adaptation leads to the development of withdrawal symptoms when alcohol intake is reduced or ceased, clearly demonstrating a physical reliance on the substance.

Question 407: What is the most common illicit drug that causes dependence?

A. Cannabis (Correct Answer)
B. Cocaine
C. Heroin
D. Amphetamine

Explanation: ***Cannabis*** - **Cannabis** is the most widely used illicit drug globally, and despite common misconceptions, it can certainly lead to **cannabis use disorder** characterized by dependence. - The high prevalence of its use contributes to it being the illicit drug that most commonly causes clinical dependence, as a larger user base means more individuals will develop problematic use patterns. *Cocaine* - While cocaine is known for its **highly addictive potential** and rapid development of dependence, its overall prevalence of use is lower than cannabis. - The intense psychological dependence associated with cocaine can lead to severe withdrawal symptoms and compulsive drug-seeking behavior. *Heroin* - **Heroin**, an opioid, is highly addictive, causing both **physical and psychological dependence** very quickly due to its potent effects on the brain's reward system. - However, its illicit use is less widespread compared to cannabis, making it responsible for fewer overall cases of dependence. *Amphetamine* - **Amphetamines** also have a high potential for **psychological dependence**, leading to compulsive use and significant withdrawal symptoms upon cessation. - Like cocaine and heroin, the overall number of people who use amphetamines illicitly is significantly lower than those who use cannabis.

Question 408: A 55-year-old chronic alcoholic male, presented with irrelevant talks, tremor and sweating. He had his last drink 3 days back. What is the probable diagnosis?

A. Delirium tremens (Correct Answer)
B. Korsakoff psychosis
C. Post-Acute withdrawal syndrome
D. Discontinuation syndrome

Explanation: ***Delirium tremens*** - The presentation of **irrelevant talks**, **tremor**, and **sweating** in a chronic alcoholic who stopped drinking 3 days prior is highly characteristic of **delirium tremens**. - **Delirium tremens** is a severe form of acute **alcohol withdrawal**, typically occurring 2-4 days after the last drink, and involves extreme agitation, disorientation, hallucinations, and autonomic hyperactivity. *Korsakoff psychosis* - **Korsakoff psychosis** is a chronic neuropsychiatric syndrome associated with **thiamine deficiency**, often seen in chronic alcoholics. - It primarily presents with severe **anterograde and retrograde amnesia**, **confabulation**, and **apathy**, rather than acute, fluctuating consciousness and autonomic instability seen in delirium tremens. *Post-Acute withdrawal syndrome* - **Post-Acute Withdrawal Syndrome (PAWS)** involves persistent, milder symptoms that can last weeks or months after acute withdrawal. - Symptoms are generally less severe and acute than described, often including mood swings, anxiety, sleep disturbances, and cognitive impairment, not the acute delirium and autonomic overactivity presented. *Discontinuation syndrome* - **Discontinuation syndrome** refers to a cluster of symptoms that can occur after stopping or reducing certain medications, particularly antidepressants. - It is not directly related to alcohol withdrawal and typically presents with symptoms like dizziness, nausea, sensory disturbances, and flu-like symptoms.

Question 409: Which of the following is NOT a feature of Korsakoff syndrome?

A. Retrograde amnesia
B. Confabulation
C. Antegrade amnesia
D. Ataxia (Correct Answer)

Explanation: ***Ataxia*** - While **ataxia** is a cardinal feature of **Wernicke encephalopathy** (part of the classic triad: confusion, ataxia, ophthalmoplegia), it is **not a primary defining feature** of **Korsakoff syndrome**. - Korsakoff syndrome is primarily characterized by **severe memory deficits** and **confabulation**. - Although ataxia may persist as a residual sign in some patients with Wernicke-Korsakoff syndrome, it is not considered a core diagnostic criterion for Korsakoff syndrome itself. - Among the given options, ataxia is the feature most appropriately classified as "NOT a feature" of Korsakoff syndrome in the classical sense. *Antegrade amnesia* - This is the **primary and most prominent feature** of Korsakoff syndrome, referring to the **severe inability to form new memories** after the onset of the condition. - Patients cannot retain information for more than a few seconds to minutes. - This profound deficit in new learning is the hallmark of the syndrome. *Retrograde amnesia* - This is also a **key feature**, indicating **impaired recall of memories** from before the onset of the condition. - Typically follows a temporal gradient, with recent memories more affected than remote ones. - The extent varies but can span several years prior to onset. *Confabulation* - This is a **highly characteristic symptom** of Korsakoff syndrome, where patients **unconsciously fabricate memories** to fill gaps in their recall. - These fabricated stories are not intentional lies but rather the brain's attempt to make sense of missing information. - Confabulations are often delivered with conviction but are inconsistent when the patient is asked again later.

Question 410: A patient has been a known alcoholic for the last 20 years. He suddenly develops restlessness, tremors, and agitation. What is the most likely diagnosis?

A. Alcoholic hallucinosis
B. Wernicke's encephalopathy
C. Korsakoff's syndrome
D. Delirium tremens (Correct Answer)

Explanation: ***Delirium tremens*** - This condition is characterized by **restless tremors**, **agitation**, and often hallucinations, occurring in chronic alcoholics after sudden cessation or reduction of alcohol intake. - The symptoms typically appear **48-96 hours** after the last drink and can include severe autonomic hyperactivity such as tachycardia, hypertension, and hyperthermia. *Alcoholic hallucinosis* - This involves vivid auditory, visual, or tactile hallucinations that occur in a **clear sensorium**, typically 12-48 hours after decreased alcohol intake. - Unlike delirium tremens, there is usually **no significant disorientation** or severe autonomic instability. *Wernicke's encephalopathy* - This is an acute neurological condition due to **thiamine deficiency**, common in chronic alcoholics, presenting with the classical triad of **ocular disturbances** (nystagmus, ophthalmoplegia), **ataxia**, and **confusion**. - While confusion can be present, the primary symptoms described (restless tremors, agitation) are not the hallmark features. *Korsakoff's syndrome* - This is a chronic neuropsychiatric disorder that often follows untreated Wernicke's encephalopathy, characterized by **severe memory impairment** (anterograde and retrograde amnesia) and **confabulation**. - It primarily affects memory and learning, rather than acute agitation and tremors.

Practice by Chapter

Neurobiology of Addiction

Practice Questions

Alcohol Use Disorder

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Opioid Use Disorder

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Cannabis Use Disorder

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Stimulant Use Disorders

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Sedative, Hypnotic, and Anxiolytic Use Disorders

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Tobacco Use Disorder

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Hallucinogen-Related Disorders

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Substance Withdrawal Syndromes

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Pharmacotherapy for Substance Use Disorders

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Psychosocial Interventions

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Dual Diagnosis Management

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