Question 4: A 15 year old boy is brought by the police to the emergency room. He had been arguing and fighting with one of his neighbors. He reports dizziness, trouble concentrating and visual hallucinations. His conjunctivae are red and there is a red rash around his mouth. His breath has an odd odor, and he has an upper extremity tremor. His Mini-mental State score is 20/30. Of the following, the most likely diagnosis is intoxication with:

Question 38: Which of the following clinical signs are most likely in a patient who drinks an alcoholic beverage while taking disulfiram?

Question 50: When a patient requests a scheduled II opioid for chronic nonmalignant pain, which of the following should be considered prior to initiating the controlled substance?

Question 27: A 50 y/o male is admitted to your detox unit for alcohol withdrawal. He has a history of heavy drinking for many years. As part of your admission laboratory work, you order a comprehensive metabolic profile and CBC. You might expect to see all of the following except:

Question 23: Many neurotransmitters are involved in the development of drug dependence, both in the acute reinforcing effects of drugs and in the recruitment of the brain stress system. All of the following neurotransmitters have been identified as being involved in the acute reinforcing effects of drugs EXCEPT:

Question 15: The primary receptor site of action of cocaine is:

Question 22: A young man is brought to the emergency room by his friends, who report that the patient was at a fraternity party and was “partying” with other partygoers, when he started “acting weird,” saying he wanted to kill himself. His roommate recalled that the patient has been increasingly depressed since he was injured in a car accident a week ago, especially in the past few days. The patient binges on alcohol occasionally and has been taking “some pain meds” since his accident but does not use other substances. He quit smoking “cold turkey” 2-3 days ago. He has no known history of a mood disorder. On examination, the young man has slurred speech and an ataxic gait. He has nystagmus bilaterally, and his pupils are constricted. When you gently start examining the leg that was injured, he yells, “What are you doing?! Trying to kill me?!” and whimpers in pain. In addition to alcohol intoxication, which of the following are other conditions in your differential diagnosis?

Question 20: The hallucinogen methylenedioxymethamphetamine (MDMA, Ecstasy) is related to what class of drugs?

Question 26:  A 53 year old male presents to the ED complaining of confusion and agitation. His vitals are a BP of 148/100, HR of 120, a RR of 12 and a temperature of 101 F. His history is positive for an alcohol use disorder of 25 years and he states that he decided to give it up “cold turkey” 3 days ago. Which one of the following is the most appropriate next step?

Question 49:A prescriber needs to be particularly careful about prescribing opioids since a study by Shah and his colleagues on opioid-naïve, cancer-free adults was published indicating: