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  • Question 1 - What is the weekly unit intake of a patient who consumes 3 litres...

    Correct

    • What is the weekly unit intake of a patient who consumes 3 litres of 12% ABV wine per day?

      Your Answer: 252

      Explanation:

      The weekly total is 252 units.

      Alcohol Conversion

      When converting alcohol volume to units, use the equation: Alcohol (units) = Alcohol volume (litres) x Alcohol by volume. For example, if you have 2 liters of cider with 6% alcohol, it is equal to 12 units. Remember to always use this equation to accurately convert alcohol volume to units.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      4.4
      Seconds
  • Question 2 - Which statement about acamprosate is accurate? ...

    Correct

    • Which statement about acamprosate is accurate?

      Your Answer: It is an NMDA glutamate receptor antagonist

      Explanation:

      Anticonvulsants are not recommended for relapse prevention in alcohol dependence. While some studies have shown potential benefits for certain anticonvulsants, such as carbamazepine and valproate, the evidence is not strong enough to support their routine use. Additionally, these drugs can have significant side effects, including liver toxicity and blood disorders, and require careful monitoring. Therefore, they are not recommended by NICE for this indication.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      7.8
      Seconds
  • Question 3 - Regarding symptoms of withdrawal associated with prolonged alcohol consumption, which of the following...

    Incorrect

    • Regarding symptoms of withdrawal associated with prolonged alcohol consumption, which of the following statements is accurate?

      Your Answer: Withdrawal reflects enhanced neurotransmission in type A gamma-aminobutyric acid pathways

      Correct Answer: Carbamazepine is as effective as benzodiazepines in the acute treatment of the symptoms of alcohol withdrawal

      Explanation:

      A study has found that starting with a dose of 800 mg of Carbamazepine per day is just as effective as using Oxazepam for treating acute alcohol withdrawal. However, Phenytoin has been shown to be ineffective in treating seizures related to alcohol withdrawal. The symptoms of alcohol withdrawal are caused by a decrease in neurotransmission through type A gamma-aminobutyric pathways and an increase in neurotransmission through N-methyl-D-aspartate pathways. For more information, refer to the article Management of Drug and Alcohol Withdrawal by Kosten TR and O’Connor PG in the New England Journal of Medicine.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      52.9
      Seconds
  • Question 4 - Which of the following is not a symptom of niacin deficiency? ...

    Correct

    • Which of the following is not a symptom of niacin deficiency?

      Your Answer: Constipation

      Explanation:

      Pellagra (niacin deficiency) is associated with diarrhea instead of constipation.

      Pellagra: A Vitamin B3 Deficiency Disease

      Pellagra is a disease caused by a lack of vitamin B3 (niacin) in the body. The name pellagra comes from the Italian words pelle agra, which means rough of sour skin. This disease is common in developing countries where corn is a major food source, of during prolonged disasters like famine of war. In developed countries, pellagra is rare because many foods are fortified with niacin. However, alcoholism is a common cause of pellagra in developed countries. Alcohol dependence can worsen pellagra by causing malnutrition, gastrointestinal problems, and B vitamin deficiencies. It can also inhibit the conversion of tryptophan to niacin and promote the accumulation of 5-ALA and porphyrins.

      Pellagra affects a wide range of organs and tissues in the body, so its symptoms can vary. The classic symptoms of pellagra are known as the three Ds: diarrhea, dermatitis, and dementia. Niacin deficiency can cause dementia, depression, mania, and psychosis, which is called pellagra psychosis. The most noticeable symptom of pellagra is dermatitis, which is a hyperpigmented rash that appears on sun-exposed areas of the skin. This rash is usually symmetrical and bilateral, and it is often described as Casal’s necklace when it appears on the neck.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 5 - What drug is classified as a schedule 3 controlled substance? ...

    Incorrect

    • What drug is classified as a schedule 3 controlled substance?

      Your Answer: Zolpidem

      Correct Answer: Temazepam

      Explanation:

      Temazepam falls under the category of drugs classified as schedule 3.

      Drug Misuse (Law and Scheduling)

      The Misuse of Drugs Act (1971) regulates the possession and supply of drugs, classifying them into three categories: A, B, and C. The maximum penalty for possession varies depending on the class of drug, with Class A drugs carrying a maximum sentence of 7 years.

      The Misuse of Drugs Regulations 2001 further categorizes controlled drugs into five schedules. Schedule 1 drugs are considered to have no therapeutic value and cannot be lawfully possessed of prescribed, while Schedule 2 drugs are available for medical use but require a controlled drug prescription. Schedule 3, 4, and 5 drugs have varying levels of restrictions and requirements.

      It is important to note that a single drug can have multiple scheduling statuses, depending on factors such as strength and route of administration. For example, morphine and codeine can be either Schedule 2 of Schedule 5.

      Overall, the Misuse of Drugs Act and Regulations aim to regulate and control the use of drugs in the UK, with the goal of reducing drug misuse and related harm.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      6
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  • Question 6 - A 25-year-old woman comes to you with concerns about 'hearing voices'. These voices...

    Correct

    • A 25-year-old woman comes to you with concerns about 'hearing voices'. These voices are external and sound like her mother speaking directly to her. The content of the voices is not threatening. The woman is oriented and appears alert. She reports no prior psychiatric history in herself of her family. She speaks calmly and is not agitated. She has been drinking heavily for the past two years but denies any illicit drug use. She recently ended a long-term relationship and has been struggling to find stable employment.
      What is the most likely diagnosis?

      Your Answer: Alcoholic hallucinosis

      Explanation:

      Probable alcoholic hallucinosis is indicated when non-persecutory second person auditory hallucinations are present in an individual who chronically abuses alcohol. Antipsychotics are effective in treating these hallucinations, but only if the individual abstains from alcohol.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      56.6
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  • Question 7 - In which psychological therapy is the concept of 'rolling with resistance' utilized? ...

    Correct

    • In which psychological therapy is the concept of 'rolling with resistance' utilized?

      Your Answer: Motivational interviewing

      Explanation:

      Motivational Interviewing: A Model for Resolving Ambivalence and Facilitating Change

      Motivational interviewing (MI) is an evidence-based method used for people with substance misuse problems. It was introduced by William Miller in 1983, based on his experience with alcoholics. MI focuses on exploring and resolving ambivalence and centres on the motivational process that facilitates change. It is based on three key elements: collaboration, evocation, and autonomy.

      There are four principles of MI: expressing empathy, supporting self-efficacy, rolling with resistance, and developing discrepancy. MI involves the use of micro-counseling skills called OARS, which stands for open-ended questions, affirmations, reflections, and summaries.

      Change talk is defined as statements by the client that reveal consideration of, motivation for, of commitment to change. In MI, the therapist aims to guide the client to expression of change talk. Types of change talk can be remembered by the mnemonic DARN-CAT, which stands for desire, ability, reason, need, commitment, activation, and taking steps.

      Overall, MI is a model for resolving ambivalence and facilitating change that emphasizes collaboration, evocation, and autonomy. It is a useful tool for therapists working with clients with substance misuse problems.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      3.8
      Seconds
  • Question 8 - A 25-year-old male presents with chest pain, confusion, and agitation that started shortly...

    Correct

    • A 25-year-old male presents with chest pain, confusion, and agitation that started shortly after using a recreational substance. Upon examination, he has a fever of 38.3°C and a blood pressure of 188/102 mmHg. Which recreational drug is the most probable cause of his symptoms?

      Your Answer: Cocaine

      Explanation:

      The young male is exhibiting confusion and agitation, which is likely due to drug abuse, specifically cocaine. Cocaine can cause sweating, fever, and high blood pressure through its effects on the central nervous system and adrenergic receptors. Additionally, it may lead to the constriction of coronary and cerebral arteries, potentially resulting in heart attacks of strokes.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      40.9
      Seconds
  • Question 9 - Which of the options below is not utilized as a means of opioid...

    Correct

    • Which of the options below is not utilized as a means of opioid detoxification?

      Your Answer: Ephedrine

      Explanation:

      Medications utilized for opioid detoxification comprise of Methadone, Buprenorphine, and Lofexidine.

      Opioid Maintenance Therapy and Detoxification

      Withdrawal symptoms can occur after as little as 5 days of regular opioid use. Short-acting opioids like heroin have acute withdrawal symptoms that peak in 32-72 hours and last for 3-5 days. Longer-acting opioids like methadone have acute symptoms that peak at day 4-6 and last for 10 days. Buprenorphine withdrawal lasts up to 10 days and includes symptoms like myalgia, anxiety, and increased drug craving.

      Opioids affect the brain through opioid receptors, with the µ receptor being the main target for opioids. Dopaminergic cells in the ventral tegmental area produce dopamine, which is released into the nucleus accumbens upon stimulation of µ receptors, producing euphoria and reward. With repeat opioid exposure, µ receptors become less responsive, causing dysphoria and drug craving.

      Methadone and buprenorphine are maintenance-oriented treatments for opioid dependence. Methadone is a full agonist targeting µ receptors, while buprenorphine is a partial agonist targeting µ receptors and a partial k agonist of functional antagonist. Naloxone and naltrexone are antagonists targeting all opioid receptors.

      Methadone is preferred over buprenorphine for detoxification, and ultra-rapid detoxification should not be offered. Lofexidine may be considered for mild of uncertain dependence. Clonidine and dihydrocodeine should not be used routinely in opioid detoxification. The duration of detoxification should be up to 4 weeks in an inpatient setting and up to 12 weeks in a community setting.

      Pregnant women dependent on opioids should use opioid maintenance treatment rather than attempt detoxification. Methadone is preferred over buprenorphine, and transfer to buprenorphine during pregnancy is not advised. Detoxification should only be considered if appropriate for the women’s wishes, circumstances, and ability to cope. Methadone or buprenorphine treatment is not a contraindication to breastfeeding.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      12.5
      Seconds
  • Question 10 - Which principle is not recognized in motivational interviewing? ...

    Correct

    • Which principle is not recognized in motivational interviewing?

      Your Answer: Therapeutic neutrality

      Explanation:

      Motivational Interviewing: A Model for Resolving Ambivalence and Facilitating Change

      Motivational interviewing (MI) is an evidence-based method used for people with substance misuse problems. It was introduced by William Miller in 1983, based on his experience with alcoholics. MI focuses on exploring and resolving ambivalence and centres on the motivational process that facilitates change. It is based on three key elements: collaboration, evocation, and autonomy.

      There are four principles of MI: expressing empathy, supporting self-efficacy, rolling with resistance, and developing discrepancy. MI involves the use of micro-counseling skills called OARS, which stands for open-ended questions, affirmations, reflections, and summaries.

      Change talk is defined as statements by the client that reveal consideration of, motivation for, of commitment to change. In MI, the therapist aims to guide the client to expression of change talk. Types of change talk can be remembered by the mnemonic DARN-CAT, which stands for desire, ability, reason, need, commitment, activation, and taking steps.

      Overall, MI is a model for resolving ambivalence and facilitating change that emphasizes collaboration, evocation, and autonomy. It is a useful tool for therapists working with clients with substance misuse problems.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      5.8
      Seconds
  • Question 11 - A father is concerned that his 16-year-old daughter's marijuana consumption may lead to...

    Correct

    • A father is concerned that his 16-year-old daughter's marijuana consumption may lead to the development of schizophrenia. How would you explain to him the difference in the risk of schizophrenia between cannabis use and non-use?

      Your Answer: There is a 2-4 fold increase in the risk of schizophrenia attributable to cannabis

      Explanation:

      Schizophrenia and Cannabis Use

      The relationship between cannabis use and the risk of developing schizophrenia is a topic of ongoing debate. However, research suggests that cannabis use may increase the risk of later schizophrenia of schizophreniform disorder by two-fold (Arseneault, 2004). The risk of developing schizophrenia appears to be higher in individuals who start using cannabis at a younger age. For instance, regular cannabis smokers at the age of 15 are 4.5 times more likely to develop schizophrenia at the age of 26, compared to those who did not report regular use until age 18 (Murray, 2004).

      A systematic review published in the Lancet in 2007 found that the lifetime risk of developing psychosis increased by 40% in individuals who had ever used cannabis (Moore, 2007). Another meta-analysis reported that the age at onset of psychosis was 2.70 years younger in cannabis users than in non-users (Large, 2011). These findings suggest that cannabis use may have a significant impact on the development of schizophrenia and related disorders.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      21.7
      Seconds
  • Question 12 - What combination of substances is included in Suboxone? ...

    Correct

    • What combination of substances is included in Suboxone?

      Your Answer: Naloxone and buprenorphine

      Explanation:

      Suboxone vs. Subutex: What’s the Difference?

      Suboxone and Subutex are both medications used to treat opioid addiction. However, there are some key differences between the two.

      Suboxone is a combination of buprenorphine and naloxone. The naloxone is added to prevent people from injecting the medication, as this was a common problem with pure buprenorphine tablets. If someone tries to inject Suboxone, the naloxone will cause intense withdrawal symptoms. However, if the tablet is swallowed as directed, the naloxone is not absorbed by the gut and does not cause any problems.

      Subutex, on the other hand, contains only buprenorphine and does not include naloxone. This means that it may be more likely to be abused by injection, as there is no deterrent to prevent people from doing so.

      Overall, both Suboxone and Subutex can be effective treatments for opioid addiction, but Suboxone may be a safer choice due to the addition of naloxone.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      15.6
      Seconds
  • Question 13 - A 45-year-old woman presents to the local Emergency department with double vision.
    She has...

    Correct

    • A 45-year-old woman presents to the local Emergency department with double vision.
      She has been consuming more than 20 units of alcohol daily for several years. She appears unkempt, emaciated and malnourished. Her blood alcohol level is negative and she claims to have stopped drinking five days ago. She has been experiencing vomiting multiple times a day for the past three days.
      The Emergency department physician seeks your expert opinion. You observe signs of lateral rectus palsy, ataxia and nystagmus.
      What is the most probable location of the lesion in the women's nervous system?

      Your Answer: Mammillary bodies

      Explanation:

      This case presents a man who exhibits the classic triad of symptoms associated with Wernicke’s encephalopathy, including ophthalmoplegia, ataxia, and confusion. The underlying lesion is located in the Mammillary bodies and around the third ventricle and aqueduct. This condition is typically caused by a deficiency in thiamine (vitamin B-1), which can be triggered in individuals who are malnourished and dependent on alcohol due to prolonged vomiting. Korsakoff’s amnesic syndrome is a later manifestation of this condition, characterized by memory loss and confabulation.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      20.9
      Seconds
  • Question 14 - In which brain region is a lesion most commonly observed on an MRI...

    Correct

    • In which brain region is a lesion most commonly observed on an MRI of a patient with Wernicke's encephalopathy?

      Your Answer: Mammillary bodies

      Explanation:

      Wernicke’s Encephalopathy: Symptoms, Causes, and Treatment

      Wernicke’s encephalopathy is a serious condition that is characterized by confusion, ophthalmoplegia, and ataxia. However, the complete triad is only present in 10% of cases, which often leads to underdiagnosis. The condition results from prolonged thiamine deficiency, which is commonly seen in people with alcohol dependency, but can also occur in other conditions such as anorexia nervosa, malignancy, and AIDS.

      The onset of Wernicke’s encephalopathy is usually abrupt, but it may develop over several days to weeks. The lesions occur in a symmetrical distribution in structures surrounding the third ventricle, aqueduct, and fourth ventricle. The mammillary bodies are involved in up to 80% of cases, and atrophy of these structures is specific for Wernicke’s encephalopathy.

      Treatment involves intravenous thiamine, as oral forms of B1 are poorly absorbed. IV glucose should be avoided when thiamine deficiency is suspected as it can precipitate of exacerbate Wernicke’s. With treatment, ophthalmoplegia and confusion usually resolve within days, but the ataxia, neuropathy, and nystagmus may be prolonged of permanent.

      Untreated cases of Wernicke’s encephalopathy can lead to Korsakoff’s syndrome, which is characterized by memory impairment associated with confabulation. The mortality rate associated with Wernicke’s encephalopathy is 10-20%, making early diagnosis and treatment crucial.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      33.4
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  • Question 15 - Which of the following symptoms is uncommon in cases of alcohol withdrawal? ...

    Incorrect

    • Which of the following symptoms is uncommon in cases of alcohol withdrawal?

      Your Answer: Irritability

      Correct Answer: Persistent hallucinations

      Explanation:

      It is uncommon for individuals experiencing alcohol withdrawal to have transient hallucinations, as they are not a typical symptom.

      Alcohol withdrawal is characterized by overactivity of the autonomic nervous system, resulting in symptoms such as agitation, tremors, sweating, nausea, vomiting, fever, and tachycardia. These symptoms typically begin 3-12 hours after drinking stops, peak between 24-48 hours, and can last up to 14 days. Withdrawal seizures may occur before blood alcohol levels reach zero, and a small percentage of people may experience delirium tremens (DT), which can be fatal if left untreated. Risk factors for DT include abnormal liver function, old age, severity of withdrawal symptoms, concurrent medical illness, heavy alcohol use, self-detox, previous history of DT, low potassium, low magnesium, and thiamine deficiency.

      Pharmacologically assisted detox is often necessary for those who regularly consume more than 15 units of alcohol per day, and inpatient detox may be needed for those who regularly consume more than 30 units per day. The Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA-Ar) can be used to assess the severity of withdrawal symptoms and guide treatment decisions. Benzodiazepines are the mainstay of treatment, as chronic alcohol exposure results in decreased overall brain excitability and compensatory decrease of GABA-A neuroreceptor response to GABA. Chlordiazepoxide is a good first-line agent, while oxazepam, temazepam, and lorazepam are useful in patients with liver disease. Clomethiazole is effective but carries a high risk of respiratory depression and is not recommended. Thiamine should be offered to prevent Wernicke’s encephalopathy, and long-acting benzodiazepines can be used as prophylaxis for withdrawal seizures. Haloperidol is the treatment of choice if an antipsychotic is required.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      29.8
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  • Question 16 - What is a true statement about disulfiram? ...

    Correct

    • What is a true statement about disulfiram?

      Your Answer: It is contraindicated in those with psychosis

      Explanation:

      Anticonvulsants are not recommended for relapse prevention in alcohol dependence. While some studies have shown potential benefits for certain anticonvulsants, such as carbamazepine and valproate, the evidence is not strong enough to support their routine use. Additionally, these drugs can have significant side effects, including liver toxicity and blood disorders, and require careful monitoring. Therefore, they are not recommended by NICE for this indication.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      13.6
      Seconds
  • Question 17 - A woman with schizophrenia and alcohol misuse is admitted to hospital following a...

    Correct

    • A woman with schizophrenia and alcohol misuse is admitted to hospital following a fall. On day three of the admission she becomes confused and agitated. Which of the following should not be prescribed?

      Your Answer: IV glucose

      Explanation:

      It is possible that the man is experiencing alcohol withdrawal, which often causes fluid imbalances that need to be addressed. However, administering intravenous glucose is not recommended as it could lead to Wernicke’s encephalopathy. While beta blockers have been found to be helpful in treating alcohol withdrawal, this is not a widely used method. A resource for further information on this topic is the article Alcohol Withdrawal Syndrome by Bayard M. in the March 15, 2004 issue of American Family Physician.

      Alcohol withdrawal is characterized by overactivity of the autonomic nervous system, resulting in symptoms such as agitation, tremors, sweating, nausea, vomiting, fever, and tachycardia. These symptoms typically begin 3-12 hours after drinking stops, peak between 24-48 hours, and can last up to 14 days. Withdrawal seizures may occur before blood alcohol levels reach zero, and a small percentage of people may experience delirium tremens (DT), which can be fatal if left untreated. Risk factors for DT include abnormal liver function, old age, severity of withdrawal symptoms, concurrent medical illness, heavy alcohol use, self-detox, previous history of DT, low potassium, low magnesium, and thiamine deficiency.

      Pharmacologically assisted detox is often necessary for those who regularly consume more than 15 units of alcohol per day, and inpatient detox may be needed for those who regularly consume more than 30 units per day. The Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA-Ar) can be used to assess the severity of withdrawal symptoms and guide treatment decisions. Benzodiazepines are the mainstay of treatment, as chronic alcohol exposure results in decreased overall brain excitability and compensatory decrease of GABA-A neuroreceptor response to GABA. Chlordiazepoxide is a good first-line agent, while oxazepam, temazepam, and lorazepam are useful in patients with liver disease. Clomethiazole is effective but carries a high risk of respiratory depression and is not recommended. Thiamine should be offered to prevent Wernicke’s encephalopathy, and long-acting benzodiazepines can be used as prophylaxis for withdrawal seizures. Haloperidol is the treatment of choice if an antipsychotic is required.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      30.6
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  • Question 18 - A young adult woman is brought to the emergency department after experiencing a...

    Correct

    • A young adult woman is brought to the emergency department after experiencing a seizure at a nightclub. Upon your arrival, she has regained consciousness but is exhibiting signs of paranoia and teeth grinding. A nurse discovered a packet of white powder in her coat pocket, which you notice has a distinct fishy odor similar to stale urine. What substance do you suspect she may have ingested?

      Your Answer: Mephedrone

      Explanation:

      New Psychoactive Substances, previously known as ‘legal highs’, are synthetic compounds designed to mimic the effects of traditional illicit drugs. They became popular due to their ability to avoid legislative control, but the introduction of the Psychoactive Substances Act 2016 changed this. There is no standard for clinical classification, but some common legal highs include Mephedrone, Piperazines, GBL, Synthetic cannabinoids, and Benzofuran compounds. These substances have effects similar to ecstasy, amphetamines, and cannabis, and are classified as either Class B of Class C drugs in the UK.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      23.3
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  • Question 19 - What is the condition that involves the gradual loss of myelin in the...

    Correct

    • What is the condition that involves the gradual loss of myelin in the corpus callosum and is commonly linked to alcohol abuse?

      Your Answer: Marchiafava-Bignami disease

      Explanation:

      Marchiafava-Bignami Disease: A Rare Disorder Associated with Alcoholism and Malnutrition

      Marchiafava-Bignami disease is a rare condition that is commonly observed in individuals with alcoholism and malnutrition. The disease is characterized by the progressive demyelination and subsequent necrosis of the corpus callosum, which can lead to a range of nonspecific clinical symptoms such as motor of cognitive disturbances. The course of the disease can be either acute of chronic, and patients may experience dementia, spasticity, dysarthria, and an inability to walk. The outcome of the disease is unpredictable, with some patients lapsing into a coma and dying, while others may survive for many years in a demented state, of even recover.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      9.1
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  • Question 20 - What is a true statement about quitting smoking? ...

    Incorrect

    • What is a true statement about quitting smoking?

      Your Answer: treatment with bupropion should be started the same day that the person stops smoking

      Correct Answer: The recommended course of treatment with varenicline is 12 weeks

      Explanation:

      Smoking cessation can be achieved through various methods, including nicotine replacement therapy (NRT), bupropion, and varenicline. NRT is available in different forms, including patches, gum, lozenges, inhalators, and nasal spray. Combination treatment with NRT has been found to be more effective than a single product of placebo. Bupropion is a selective inhibitor of dopamine and noradrenaline reuptake and is presumed to work directly on the brain pathways involved in addiction and withdrawal. It is recommended to start bupropion while still smoking and to discontinue after 7-9 weeks. Varenicline is a partial nicotinic receptor agonist that reduces the rewarding and reinforcing effects of smoking. It is recommended to start varenicline while still smoking and to continue for 12 weeks. Nausea is the most common adverse effect of varenicline, and depression has been reported in some users. Bupropion and varenicline should be avoided in certain populations, including those with a history of bipolar disorder, epilepsy, and pregnancy of breastfeeding.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      17
      Seconds
  • Question 21 - What is a true statement about drug screening tests? ...

    Correct

    • What is a true statement about drug screening tests?

      Your Answer: Standard urine drug tests for amphetamine may detect MDMA

      Explanation:

      It is unlikely for passive inhalation of cannabis and crack to result in a positive drug test, unless the individual has been exposed to heavy and prolonged smoke in a highly contaminated environment.

      Drug Screening

      Drug testing can be conducted through various methods, but urinalysis is the most common. Urine drug tests can be either screening of confirmatory. Screening tests use enzymatic immunoassays to detect drug metabolites of classes of drug metabolites in the urine. However, these tests have limitations, such as false positives due to cross-reactivity. Therefore, any positive test should be confirmed through gas chromatography of mass spectrometry.

      People may try to manipulate drug testing procedures by adulterating the sample. Normal urine parameters, such as temperature, specific gravity, and pH, can assist in detecting adulterated samples. Adulterants include household items like vinegar, detergent, and ammonia, as well as commercially available products. Diluted urine may also yield false negatives.

      Detection times vary from person to person, and the approximate drug detection time in urine can be found in a table provided by Nelson (2016). False positives can occur due to cross-reactivity, as illustrated by Moeller (2017). Clinicians should be aware of the limitations of urine drug tests and the potential for manipulation.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      16
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  • Question 22 - To aid in preventing relapse in individuals with alcohol dependency, NICE recommends the...

    Incorrect

    • To aid in preventing relapse in individuals with alcohol dependency, NICE recommends the following.

      Your Answer: Topiramate

      Correct Answer: Nalmefene

      Explanation:

      Anticonvulsants are not recommended for relapse prevention in alcohol dependence. While some studies have shown potential benefits for certain anticonvulsants, such as carbamazepine and valproate, the evidence is not strong enough to support their routine use. Additionally, these drugs can have significant side effects, including liver toxicity and blood disorders, and require careful monitoring. Therefore, they are not recommended by NICE for this indication.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      17.8
      Seconds
  • Question 23 - According to Maudsley Guidelines, what is the recommended maximum length of time for...

    Incorrect

    • According to Maudsley Guidelines, what is the recommended maximum length of time for prescribing benzodiazepines for anxiety?

      Your Answer: 6 weeks

      Correct Answer: 4 weeks

      Explanation:

      Benzodiazepines and Addiction

      Benzodiazepines are known to be addictive and should only be prescribed as a hypnotic or anxiolytic for a maximum of 4 weeks. Withdrawal symptoms can be physical of psychological, including stiffness, weakness, GI disturbance, paraesthesia, flu-like symptoms, visual disturbance, anxiety, insomnia, nightmares, depersonalisation, decreased memory and concentration, delusions, and hallucinations. Patients who wish to withdraw from short-acting benzodiazepines should first be converted to diazepam, which has a longer half-life and produces less severe withdrawal. The table provides approximate equivalent doses for different benzodiazepines. These guidelines are from the Maudsley Guidelines 10th Edition.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 24 - What is the active ingredient in subutex? ...

    Correct

    • What is the active ingredient in subutex?

      Your Answer: Buprenorphine

      Explanation:

      Suboxone vs. Subutex: What’s the Difference?

      Suboxone and Subutex are both medications used to treat opioid addiction. However, there are some key differences between the two.

      Suboxone is a combination of buprenorphine and naloxone. The naloxone is added to prevent people from injecting the medication, as this was a common problem with pure buprenorphine tablets. If someone tries to inject Suboxone, the naloxone will cause intense withdrawal symptoms. However, if the tablet is swallowed as directed, the naloxone is not absorbed by the gut and does not cause any problems.

      Subutex, on the other hand, contains only buprenorphine and does not include naloxone. This means that it may be more likely to be abused by injection, as there is no deterrent to prevent people from doing so.

      Overall, both Suboxone and Subutex can be effective treatments for opioid addiction, but Suboxone may be a safer choice due to the addition of naloxone.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      3.2
      Seconds
  • Question 25 - A 30 year old man presents to his primary care physician with complaints...

    Incorrect

    • A 30 year old man presents to his primary care physician with complaints of insomnia, anxiety, tremors, and confusion. He is an avid bodybuilder and reports that he had been taking a supplement to enhance his muscle growth. He explains that he had been using a clear liquid provided by a friend. What is the most likely cause of his symptoms?

      Your Answer: Benzofuran compounds

      Correct Answer: Gamma Butyrolactone

      Explanation:

      The indications are in line with the effects of discontinuing GBL use, which is frequently utilized by individuals in the bodybuilding community due to its perceived ability to aid in muscle growth.

      New Psychoactive Substances, previously known as ‘legal highs’, are synthetic compounds designed to mimic the effects of traditional illicit drugs. They became popular due to their ability to avoid legislative control, but the introduction of the Psychoactive Substances Act 2016 changed this. There is no standard for clinical classification, but some common legal highs include Mephedrone, Piperazines, GBL, Synthetic cannabinoids, and Benzofuran compounds. These substances have effects similar to ecstasy, amphetamines, and cannabis, and are classified as either Class B of Class C drugs in the UK.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 26 - A teenager presents to A&E in a state of distress and you are...

    Correct

    • A teenager presents to A&E in a state of distress and you are told by his friend that he is withdrawing from 'speed'. Which of the following is least likely to be present?

      Your Answer: Reduced appetite

      Explanation:

      Withdrawal from amphetamine, commonly referred to as speed, usually leads to an increase in appetite rather than a decrease.

      Illicit drugs, also known as illegal drugs, are substances that are prohibited by law and can have harmful effects on the body and mind. Some of the most commonly used illicit drugs in the UK include opioids, amphetamines, cocaine, MDMA (ecstasy), cannabis, and hallucinogens.

      Opioids, such as heroin, are highly addictive and can cause euphoria, drowsiness, constipation, and respiratory depression. Withdrawal symptoms may include piloerection, insomnia, restlessness, dilated pupils, yawning, sweating, and abdominal cramps.

      Amphetamines and cocaine are stimulants that can increase energy, cause insomnia, hyperactivity, euphoria, and paranoia. Withdrawal symptoms may include hypersomnia, hyperphagia, depression, irritability, agitation, vivid dreams, and increased appetite.

      MDMA, also known as ecstasy, can cause increased energy, sweating, jaw clenching, euphoria, enhanced sociability, and increased response to touch. Withdrawal symptoms may include depression, insomnia, depersonalisation, and derealisation.

      Cannabis, also known as marijuana of weed, can cause relaxation, intensified sensory experience, paranoia, anxiety, and injected conjunctiva. Withdrawal symptoms may include insomnia, reduced appetite, and irritability.

      Hallucinogens, such as LSD, can cause perceptual changes, pupillary dilation, tachycardia, sweating, palpitations, tremors, and incoordination. There is no recognised withdrawal syndrome for hallucinogens.

      Ketamine, also known as Vitamin K, Super K, Special K, of donkey dust, can cause euphoria, dissociation, ataxia, and hallucinations. There is no recognised withdrawal syndrome for ketamine.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 27 - What is a true statement about Wernicke's encephalopathy? ...

    Incorrect

    • What is a true statement about Wernicke's encephalopathy?

      Your Answer: of those treated, 20% go on to develop Korsakoff's syndrome

      Correct Answer: It has an associated mortality of 10-20% if untreated

      Explanation:

      Wernicke’s Encephalopathy: Symptoms, Causes, and Treatment

      Wernicke’s encephalopathy is a serious condition that is characterized by confusion, ophthalmoplegia, and ataxia. However, the complete triad is only present in 10% of cases, which often leads to underdiagnosis. The condition results from prolonged thiamine deficiency, which is commonly seen in people with alcohol dependency, but can also occur in other conditions such as anorexia nervosa, malignancy, and AIDS.

      The onset of Wernicke’s encephalopathy is usually abrupt, but it may develop over several days to weeks. The lesions occur in a symmetrical distribution in structures surrounding the third ventricle, aqueduct, and fourth ventricle. The mammillary bodies are involved in up to 80% of cases, and atrophy of these structures is specific for Wernicke’s encephalopathy.

      Treatment involves intravenous thiamine, as oral forms of B1 are poorly absorbed. IV glucose should be avoided when thiamine deficiency is suspected as it can precipitate of exacerbate Wernicke’s. With treatment, ophthalmoplegia and confusion usually resolve within days, but the ataxia, neuropathy, and nystagmus may be prolonged of permanent.

      Untreated cases of Wernicke’s encephalopathy can lead to Korsakoff’s syndrome, which is characterized by memory impairment associated with confabulation. The mortality rate associated with Wernicke’s encephalopathy is 10-20%, making early diagnosis and treatment crucial.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
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  • Question 28 - A woman reporting vivid dreams, increased sleep and an increased appetite, is most...

    Incorrect

    • A woman reporting vivid dreams, increased sleep and an increased appetite, is most likely to be experiencing which of the following?

      Your Answer: Amphetamine intoxication

      Correct Answer: Cocaine withdrawal

      Explanation:

      Illicit drugs, also known as illegal drugs, are substances that are prohibited by law and can have harmful effects on the body and mind. Some of the most commonly used illicit drugs in the UK include opioids, amphetamines, cocaine, MDMA (ecstasy), cannabis, and hallucinogens.

      Opioids, such as heroin, are highly addictive and can cause euphoria, drowsiness, constipation, and respiratory depression. Withdrawal symptoms may include piloerection, insomnia, restlessness, dilated pupils, yawning, sweating, and abdominal cramps.

      Amphetamines and cocaine are stimulants that can increase energy, cause insomnia, hyperactivity, euphoria, and paranoia. Withdrawal symptoms may include hypersomnia, hyperphagia, depression, irritability, agitation, vivid dreams, and increased appetite.

      MDMA, also known as ecstasy, can cause increased energy, sweating, jaw clenching, euphoria, enhanced sociability, and increased response to touch. Withdrawal symptoms may include depression, insomnia, depersonalisation, and derealisation.

      Cannabis, also known as marijuana of weed, can cause relaxation, intensified sensory experience, paranoia, anxiety, and injected conjunctiva. Withdrawal symptoms may include insomnia, reduced appetite, and irritability.

      Hallucinogens, such as LSD, can cause perceptual changes, pupillary dilation, tachycardia, sweating, palpitations, tremors, and incoordination. There is no recognised withdrawal syndrome for hallucinogens.

      Ketamine, also known as Vitamin K, Super K, Special K, of donkey dust, can cause euphoria, dissociation, ataxia, and hallucinations. There is no recognised withdrawal syndrome for ketamine.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      34.3
      Seconds
  • Question 29 - A middle-aged woman addicted to alcohol visits her GP. Her GP advises her...

    Correct

    • A middle-aged woman addicted to alcohol visits her GP. Her GP advises her to stop drinking and the woman replies that she enjoys drinking as it helps her forget about her problems. She does, however, acknowledge that her drinking has caused problems in her relationships and at work. According to the stages of change model, which stage is she currently at?

      Your Answer: Contemplation

      Explanation:

      The individual is currently in the contemplative stage, which is marked by conflicting thoughts and emotions and a sense of ambivalence towards their cannabis use. This indicates that they are experiencing a duality of perspectives. In contrast, someone in the pre-contemplative stage would not possess such a nuanced understanding of their behavior.

      Stages of Change Model

      Prochaska and DiClemente’s Stages of Change Model identifies five stages that individuals go through when making a change. The first stage is pre-contemplation, where the individual is not considering change. There are different types of precontemplators, including those who lack knowledge about the problem, those who are afraid of losing control, those who feel hopeless, and those who rationalize their behavior.

      The second stage is contemplation, where the individual is ambivalent about change and is sitting on the fence. The third stage is preparation, where the individual has some experience with change and is trying to change, testing the waters. The fourth stage is action, where the individual has started to introduce change, and the behavior is defined as action during the first six months of change.

      The final stage is maintenance, where the individual is involved in ongoing efforts to maintain change. Action becomes maintenance once six months have elapsed. Understanding these stages can help individuals and professionals in supporting behavior change.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      35.5
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  • Question 30 - A middle-aged man presents to the emergency department with complaints of painful urination....

    Correct

    • A middle-aged man presents to the emergency department with complaints of painful urination. A dipstick test confirms the presence of blood in his urine. He reports using an illegal substance for several months but is unable to recall its name. What is the most probable cause of his urinary symptoms?

      Your Answer: Ketamine

      Explanation:

      According to a study published in the Urology journal in May 2007, there have been instances where prolonged use of ketamine has resulted in ulcerative cystitis. This condition is considered a new clinical entity and has been documented in case reports.

      Illicit drugs, also known as illegal drugs, are substances that are prohibited by law and can have harmful effects on the body and mind. Some of the most commonly used illicit drugs in the UK include opioids, amphetamines, cocaine, MDMA (ecstasy), cannabis, and hallucinogens.

      Opioids, such as heroin, are highly addictive and can cause euphoria, drowsiness, constipation, and respiratory depression. Withdrawal symptoms may include piloerection, insomnia, restlessness, dilated pupils, yawning, sweating, and abdominal cramps.

      Amphetamines and cocaine are stimulants that can increase energy, cause insomnia, hyperactivity, euphoria, and paranoia. Withdrawal symptoms may include hypersomnia, hyperphagia, depression, irritability, agitation, vivid dreams, and increased appetite.

      MDMA, also known as ecstasy, can cause increased energy, sweating, jaw clenching, euphoria, enhanced sociability, and increased response to touch. Withdrawal symptoms may include depression, insomnia, depersonalisation, and derealisation.

      Cannabis, also known as marijuana of weed, can cause relaxation, intensified sensory experience, paranoia, anxiety, and injected conjunctiva. Withdrawal symptoms may include insomnia, reduced appetite, and irritability.

      Hallucinogens, such as LSD, can cause perceptual changes, pupillary dilation, tachycardia, sweating, palpitations, tremors, and incoordination. There is no recognised withdrawal syndrome for hallucinogens.

      Ketamine, also known as Vitamin K, Super K, Special K, of donkey dust, can cause euphoria, dissociation, ataxia, and hallucinations. There is no recognised withdrawal syndrome for ketamine.

    • This question is part of the following fields:

      • Substance Misuse/Addictions
      10.3
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Substance Misuse/Addictions (21/30) 70%
Passmed