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 HiYield Paper B

 Addiction Psychiatry

 MCQs Addictions Part 1

HiYield Paper B
Started on Tuesday, 31 May 2016, 7:06 AM

State Finished

Completed on Tuesday, 31 May 2016, 7:08 AM

Time taken 2 mins 14 secs

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Question 1
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HiY Addictions 001
The current prevalence of heroin use in the UK is
Select one:
10%
5%
3%
1%

20%
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The current prevalence of heroin use in the UK is around 1% (male-to-female ratio of 2:1), with most
treatment seekers being in their 20s.
The correct answer is: 1%

Question 2
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HiY Addictions 002
What percentage of patients taking benzodiazepines for nearly a year develop dependence
syndrome?
Select one:
80%
40%
15%
60%

20%
Check

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Your answer is incorrect.
Rate of dependence varies with duration of use - 15% of those using 1-5 months of prescribed
benzodiazepines develop dependence compared to nearly 40% of those using it for nearly a year
(De lasCuevas, 2003)
The correct answer is: 40%

Question 3
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HiY Addictions 003
How much of heroin does a typical heroin dependent user consume on a day?
Select one:
10-20 g per day
0.25-2.0 g per day
0.1-0.2 g per day
2.0-4.0 g per day

5.0-10.0 g per day

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Illicit heroin is sold as a brown or white powder in 'bags' or 'wraps', costing £50- £100 (median value
£80 in the UK as of 2014) per gram, with a typical dependent user taking 0.25- 2.0 g per day. It is
most commonly consumed by smoking (chasing) but is also taken orally, occasionally snorted, and
parenterally by IV, IM, or subcutaneous routes. Street supplies are of variable purity (25-50% by
volume); an occasional pure batch may be associated with a series of deaths and overdose due to
higher potency. Retrieved from: Oxford Handbook of Psychiatry; 538
The correct answer is: 0.25-2.0 g per day

Question 4
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HiY Addictions 004
Ice is the street name for a particularly strong and pure form of
Select one:
Amphetamine
Cocaine
Cannabis
Phencyclidine

Heroin
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Your answer is incorrect.
Many synthetic forms of amphetamines are now available. Methamphetamine is a potent form that
can be inhaled, smoked, or injected intravenously. Ice (crystal meth) is a particularly strong purer
form - smoked or injected. Oral IV and snorting possible; called whiz or speed
The correct answer is: Amphetamine

Question 5
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HiY Addictions 005
Which of the following is an acute effect caused by LSD (Lysergic acid diethylamide)?
Select one:
persistent psychosis
post hallucinogenic perceptual disorder
flash backs
persistent anxiety

bad trips
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Your answer is incorrect.
Acute harmful effects of LSD include "behaviours related to toxicity (i.e. harm related to acting on
beliefs such as having the ability to fly) and 'bad trips' (i.e. dissociation, fear of incipient madness,
frightening perceptions). There is no risk of overdose, and physiological dependence and
withdrawals do not generally occur". Chronic harmful effects include flashbacks even many years
after consumption, post-hallucinogenic perceptual disorder, persistent psychosis, and persistent
anxiety/depressive symptoms. Retrieved from: Oxford Handbook of Psychiatry; 544
The correct answer is: bad trips

Question 6
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HiY Addictions 006
Which of the following is a preferred maintenance treatment after opioid detoxification?
Select one:
Lofexidine
Oral morphine
Buprenorphine
Naloxone

LAAM
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Your answer is incorrect.
Buprenorphine is considered to be a safe option to treat opioid dependence with a very low potential
for abuse, especially when used in combination with naloxone in a sublingual preparation
(Suboxone).
The correct answer is: Buprenorphine
Question 7
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HiY Addictions 007
Suboxone is a drug that contains
Select one:
Buprenorphine and Naloxone
Buprenorphine and methadone
Buprenorphine and Naltrexone
Methadone and Naloxone

Methadone and Naltrexone

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Your answer is incorrect.
Suboxone contains buprenorphine as well as the opioid antagonist naloxone to deter the abuse of
prescribed buprenorphine via intravenous injection of the crushed tablets. Controlled trials suggest
that buprenorphine and naloxone mixed at a 4:1 ratio in suboxone produces unpleasant withdrawal
symptoms if taken intravenously by opioid users, but has no such effect when taken sublingually.
However, the suboxone formulation still has potential to produce an opioid agonist "high" if injected
by non-dependent persons. Suboxone has been approved by the European regulatory body for
prescribed medications.
The correct answer is: Buprenorphine and Naloxone

Question 8
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HiY Addictions 008
Which drug has no evidence base for treating opioid withdrawal symptoms?
Select one:
Buprenorphine
Clonidine
Methadone
Chlordiazepoxide

Lofexidine
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Your answer is incorrect.
There is a substantial evidence base for three main types of pharmacotherapy: 1. Methadone 2.
Buprenorphine and 3. a2 adrenergic agonists (e.g. clonidine and Lofexidine). All three groups of
medications are shown to be effective in reducing withdrawal symptoms. The choice of agent may
be guided by the patient's preference, desired duration of treatment, adverse effects and withdrawal
severity.
The correct answer is: Chlordiazepoxide

Question 9
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HiY Addictions 009
Mr. Z is a gentleman with a history of using illicit drugs in the past. He is observed to have a nasal
septal perforation. Which of the following is the most likely offending drug?
Select one:
Cannabis
LSD
Heroin
Amphetamines

Cocaine
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Your answer is incorrect.
Cocaine is an alkaloid derived from the shrub Erythroxylon coca. It is a powerful positive reinforcer -
strong dependence producer. It is a Potent dopamine reuptake blockade. It can be Injected, smoked
or snorted. It may cause nasal septal perforation due to local anaesthetic effect with repeated
trauma, and vasoconstriction and ischemic necrosis.
The correct answer is: Cocaine

Question 10
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HiY Addictions 010
'Crack' is a pure form of which of the following street drugs?
Select one:
Amphetamines
LSD
Heroin
Cocaine

Cannabis
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Your answer is incorrect.
Street cocaine can be freebased (released free from the base e.g. sodium bicarbonate which is
mixed with it) to produce purer form called crack - acts as rapidly as IV when inhaled..
The correct answer is: Cocaine

Question 11
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HiY Addictions 011
Tolerance does not develop to one of the following features of opiate use
Select one:
Pupillary dilatation
Sedation
Constipation
Euphoria

Analgesic effect
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Your answer is incorrect.
While tolerance to nausea, vomiting, sedation, euphoria and respiratory depression occur rapidly,
there is a minimal development of tolerance to constipation and miosis.
The correct answer is: Constipation

Question 12
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HiY Addictions 012
The intervention with most consistent evidence base among all psychosocial interventions for
cocaine users is
Select one:
Vocational training
Contingency management
Problem solving therapy
Motivational enhancement

Residential rehab housing

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Your answer is incorrect.
Contingency management refers to interventions in which clients receive tangible, positive
reinforcers for objective evidence of behaviour change. Patients may receive a voucher,
exchangeable for retail goods and services, or a prize draw lottery whenever they submit a drug
negative urine specimen. Higgins et al. (2003) found that using a contingency management involving
vouchers alone or with an intensive behaviour therapy (community reinforcement approach (CRA))
was effective in maintaining cocaine abstinence.
The correct answer is: Contingency management

Question 13
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HiY Addictions 013
The common side effects of benzodiazepines include which of the following?
Select one:
Dizziness
Gastrointestinal upset
Disinhibition
Headache

Blurred vision
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Your answer is incorrect.
The most common side effects of benzodiazepines are drowsiness and dizziness
The correct answer is: Dizziness

Question 14
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HiY Addictions 014
Which one of the following is a specific benzodiazepine antagonist used in accident and emergency
departments to reverse the effects of the benzodiazepines?
Select one:
Flumazenil
Naloxone
Naltrexone
Saline infusion

Apomorphine
Check

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Your answer is incorrect.
Flumazenil is a specific benzodiazepine antagonist used in A&E/ICU to reverse the effects of the
benzodiazepines.
The correct answer is: Flumazenil

Question 15
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HiY Addictions 015
Which benzodiazepine has been particularly implicated in cases of 'date rape'?
Select one:
Flunitrazepam
Clonazepam
Diazepam
Lorazepam

Temazepam
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Your answer is incorrect.
Flunitrazepam: A short-acting potent benzodiazepine used particularly in dance settings for
intoxicant and weak aphrodisiac effects. It results in impaired judgement and anterograde amnesia.
It is tasteless as a solution, and has been implicated in cases of 'date rape'. Ref: Oxford handbook of
psychiatry; 540
The correct answer is: Flunitrazepam

Question 16
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HiY Addictions 016
According to ICD10 diagnostic coding, which term is used to denote the state where alcohol causes
actual physical or mental damage, but the drinker has no dependence pattern yet?
Select one:
Demotivation
Harmful use
Compulsion
Abuse

Reinstatement
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Your answer is incorrect.
ICD10 has a diagnostic code for 'harmful use' where actual damage is caused to the drinker
physically or mentally, but he/she has no dependence pattern (yet). DSM IV had a concept of 'abuse'
which refers to maladaptive use 1. despite problems in social, occupational, physical and
psychological domains 2. in hazardous situations 3. At least one month, recurring over a longer
period usually. 4. But not dependent on alcohol. DSM-5 has introduced the concept of a 'spectrum'
of alcohol use disorder that captures the entire range from harmful use to dependence. DSM-5
definition of Alcohol Use Disorder is rather too lenient, as it describes a substantial portion of the
general population to have the disorder. In a recent epidemiological study that used DSM-5 criteria
for alcohol use disorder [AUD], twelve-month and lifetime prevalences of AUD were 13.9% and
29.1% respectively. (Grant et al., 2015) [http://archpsyc.jamanetwork.com/article.aspx?
articleID=2300494])
The correct answer is: Harmful use

Question 17
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HiY Addictions 017
The most commonly used opioid in the UK is
Select one:
Heroin
Pethidine
Morphine
Codeine

Methadone
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Your answer is incorrect.
Heroin is the most commonly used opioid and it is most commonly smoked (called chasing) or
injected IV/IM though it can be snorted or taken orally too. Street drug is almost always adulterated
and impure; accidental injection of pure form may result in death due to toxicity. Once only use is
quite rare - generally people progress from recreational exposure to dependent pattern mostly.
The correct answer is: Heroin

Question 18
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HiY Addictions 018
Which of the following drugs is no longer used as patients developed prolonged QT intervals
associated with fatal torsades de pointes?
Select one:
Methadone
Clonidine
LAAM
Buprenorphine

Suboxone
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Your answer is incorrect.
Levo-alpha-acetylmethadol (LAAM) is a long-acting derivative of methadone. It suppresses
withdrawal for 48 to 72 hours and has the advantage of requiring less frequent clinic visits than
methadone. It is no longer used as patients developed prolonged QT intervals associated with fatal
torsades de pointes.
The correct answer is: LAAM

Question 19
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HiY Addictions 019
Which of the following is an alpha-2 adrenergic agonist, licensed for the management of symptoms
of opioid withdrawal?
Select one:
Buprenorphine
Naltrexone
Naloxone
Acamprosate

Lofexidine
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Your answer is incorrect.
Lofexidine is an alpha-2 adrenergic agonist, licensed for the management of symptoms of opioid
withdrawal. It can counteract the adrenergic hyperactivity associated with opioid withdrawal,
demonstrated by characteristic signs and symptoms such as tachycardia, sweating, runny nose,
shivering and goose bumps. Detoxification is much faster than with methadone or Buprenorphine,
typically lasting 5-7 days and up to a maximum of 10 days.
The correct answer is: Lofexidine

Question 20
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HiY Addictions 020
Mr.Z has presented to A and E with a history of ingesting an illicit drug. He believes that he can fly.
Which of the following could be the most likely offending drug?
Select one:
Cannabis
Heroin
Ecstasy
LSD

Speed
Check

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Your answer is incorrect.
LSD: Acute harmful effects are behavioural toxicity (i.e. harm related to acting on beliefs such as
having the ability to fly) and 'bad trips' (i.e. dissociation, fear of incipient madness, frightening
perceptions). Ref: Oxford handbook of psychiatry; 544
The correct answer is: LSD

Question 21
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HiY Addictions 021
Which one among the following drugs is recommended by NICE guidance as the first choice
treatment for opioid dependence?
Select one:
Methadone
Buprenorphine
Acamprosate
Naloxone

Naltrexone
Check

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Your answer is incorrect.
The 2007 NICE Guidance on the management of opioid dependence recommends oral methadone
or buprenorphine as the preferred pharmacotherapeutic options for opioid dependence. The decision
on which to use should be based on the patient's preference. In cases where both methadone and
buprenorphine appear equally suitable, the NICE Guidance advises prescribing methadone as first
choice. Ref: NICE clinical guideline 52; July 2007
The correct answer is: Methadone

Question 22
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HiY Addictions 022
Which of the following is due to the chronic harmful effect of cocaine?
Select one:
Impaired judgement
Arrhythmias
Intense anxiety
Hypertension

Necrosis of nasal septum

Check
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Your answer is incorrect.
Acute harmful effects include arrhythmias, intense anxiety, hypertension, CVA, acute impulsivity,
and impaired judgement. Chronic harmful effects include necrosis of nasal septum, foetal damage
(crack babies), panic and anxiety disorders, persecutory delusions, and psychosis. It is not
associated with classical dependence, but a minority of users will consume in a regular 'compulsive'
pattern. Retrieved from: Oxford Handbook of Psychiatry; 542
The correct answer is: Necrosis of nasal septum

Question 23
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HiY Addictions 023
The term cold turkey is commonly used to refer to
Select one:
Cannabis withdrawal
Amphetamine withdrawal
Alcohol withdrawal
Cocaine withdrawal

Opiate withdrawal
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Your answer is incorrect.
The term cold turkey is often used to refer to opioid withdrawal state. Opioid withdrawal is rarely fatal
in a healthy adult. Morphine and heroin withdrawal syndrome begins 6 to 8 hours after the last dose,
peaks in 2 days and reduces in a week usually. The features include; dysphoric mood, nausea or
vomiting, muscle aches, lacrimation or rhinorrhea, pupillary dilation, piloerection (goose flesh), or
sweating, diarrhoea, yawning, fever and insomnia. Note that insomnia, bradycardia, temperature
dysregulation, and a craving for opioids can persist for months after an episode of withdrawal,
necessitating maintenance methadone in number of patients
The correct answer is: Opiate withdrawal

Question 24
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HiY Addictions 024
Which of the following drugs and their street names are incorrectly matched?
Select one:
Heroin- brown
LSD- acid
Speed-amphetamines
Phencyclidine- dope

Freebase cocaine-crack
Check

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Your answer is incorrect.
The street drug name 'crack' refers to the freebase cocaine. Ref: Oxford handbook; 536
The correct answer is: Phencyclidine- dope

Question 25
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HiY Addictions 025
The common cause of death in benzodiazepine overdose is usually due to
Select one:
Liver failure
Respiratory depression
Myoglobinuria
Renal failure
Myocardial infarct
Check

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Your answer is incorrect.
In contrast to barbiturates, the benzodiazepines have a larger margin of safety in overdoses. The
ratio of lethal dose to effective dose is about 200 to 1 or higher. When benzodiazepines are taken in
overdose with alcohol or other antidepressants this can be more serious. In such cases death is
usually due to respiratory depression.
The correct answer is: Respiratory depression

Question 26
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HiY Addictions 026
A pregnant woman who is currently using heroin wants to undergo opioid detoxification. Which of the
following is the best period to undertake opioid detoxification in a pregnant woman?
Select one:
Second trimester
Third trimester
As soon as possible in any trimester
First trimester

Should not be attempted when pregnant

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Your answer is incorrect.
Opioid detoxification is typically avoided in the first trimester due to an association of spontaneous
abortion with withdrawal.40 It is also avoided during the third trimester due to the association with
fetal stress and preterm labor. In a carefully controlled second trimester detoxification regimen
restricted to inpatient perinatal units, the outpatient methadone dose was decreased by about 1 mg
per day in some studies, with a dose reduction in outpatient settings of 5 mg every 2 weeks (though
neither of these numbers should be used as clinical guidelines, as these doses were generalized
from relatively small study populations)
The correct answer is: Second trimester

Question 27
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HiY Addictions 027
Which of the following is a common side effect of clonidine?
Select one:
Dysphoria
Sedation
Diarrhoea
Hypersalivation

Hypertension
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Your answer is incorrect.
Clonidine causes excessive sleepiness.
The correct answer is: Sedation

Question 28
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HiY Addictions 028
With respect to naltrexone use in opioid dependence, which of the following is true?
Select one:
Naltrexone implants have better evidence base as adjuvants in relapse prevention
Dysphoria, depression and insomnia are not known side effects of naltrexone
It can be initiated irrespective of the amount of current opioid use
Naltrexone is superior to methadone in relapse prevention among opioid users

The evidence for the use of naltrexone for relapse prevention in opioid users is inconclusive
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Your answer is incorrect.
Following successful withdrawal from opioids, naltrexone may be administered on a chronic basis to
block any future effects of opioids. Naltrexone appears to have some limited benefit in helping
formerly opioid-dependent individuals to remain abstinent, although the quality of the evidence is
relatively poor and heterogeneous.
The correct answer is: The evidence for the use of naltrexone for relapse prevention in opioid users
is inconclusive

Question 29
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HiY Addictions 029
In an average user, LSD can be detected in urine for up to
Select one:
3 days
7 days
1 day
10 days

LSD cannot be detected in urine

Check

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Your answer is incorrect.
Since the half-life of LSD is only a few hours, only a very small amount of LSD remains even at the
end of the trip, and this is excreted in the urine.
The correct answer is: 1 day
Question 30
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HiY Addictions 030
The risk of seizures associated with bupropion use is estimated as
Select one:
1 in 100
1 in 5000
1 in 10
1 in 1000

1 in 500
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Your answer is incorrect.
The risk of seizures associated with the anti-smoking agent bupropion is 1 in 1000. Bupropion is
contraindicated in patients with a history of seizures, eating disorders, CNS tumour, pregnancy,
breastfeeding or those experiencing acute benzodiazepine or alcohol withdrawal. Ref: Maudlsey
Prescribing guidelines; 10th edition; 323
The correct answer is: 1 in 1000

Question 31
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HiY Addictions 031
Untreated heroin withdrawal symptoms typically reach their peak within how many hours after the
last dose?
Select one:
12-24 hours
24-36 hours
32-72 hours
6-12 hours

72-120 hours
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Your answer is incorrect.
Untreated heroin withdrawal symptoms typically reach their peak within 32-72 hours after the last
dose and symptoms will have subsided substantially after five days. Untreated methadone
withdrawal symptoms typically reach their peak within 4-6 days after the last dose and symptoms do
not subside substantially for 10-12 days. Ref: Department of health; drug misuse and dependence
guidelines on clinical management; Norwich; DOH 1999
The correct answer is: 32-72 hours

Question 32
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HiY Addictions 032
Mr. X has been consuming a high dose of cannabis for a long time. How long will it be present in his
urine?
Select one:
3 days
10 days
24 hours
7 days

4 weeks
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Your answer is incorrect.
Cannabis- (Urine drug screen) Occasional use - up to 3 days. High daily use for long time - up to 4
weeks.
The correct answer is: 4 weeks

Question 33
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HiY Addictions 033
For cessation of smoking, nicotine replacement treatment should be used for a period of
Select one:
18-22 weeks
4-8 weeks
2-4 weeks
8-12 weeks

1-2 weeks
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Your answer is incorrect.
All nicotine replacement treatment should be used for about 8-12 weeks but may be continued
beyond this time if needed to prevent relapse. They can also be used in combination if required,
usually the patch plus a faster acting oral NRT for relief of situational urges to smoke. Ref: Maudlsey
Prescribing guidelines; 10th edition; 322
The correct answer is: 8-12 weeks

Question 34
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HiY Addictions 034
Which class of drugs are commonly abused by athletes and bodybuilders seeking competitive
advantage?
Select one:
hallucinogens
volatile solvents
opiods
anabolic steroids

benzodiazepines
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Your answer is incorrect.
Anabolic steroids: These prescription-only medicines (e.g. nandrolone and stanozolol) can be
abused by athletes and bodybuilders seeking competitive advantage or, more rarely, for their
euphoriant effects alone. They produce increased muscle mass and strength, with increased training
time and reduced recovery time as well as euphoriant effects and a sense of increased energy
levels. Ref: Oxford handbook of psychiatry; 547
The correct answer is: anabolic steroids

Question 35
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HiY Addictions 035
Roid Rage is an acute emotional instability associated with the use of
Select one:
benzodiazepines
hallucinogens
corticotrophin
stimulants

anabolic steroids
Check
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Your answer is incorrect.
Use of anabolic steroids is associated with physical health problems including hypertension,
hypogonadism, gynaecomastia, amenorrhoea, liver damage, impotence, and male pattern baldness;
and with mental health problems including acute emotional instability (sometimes known as roid
rage), increased aggressiveness, persecutory/grandiose delusions, depressive illness, and chronic
fatigue. Ref: Oxford handbook of psychiatry; 547
The correct answer is: anabolic steroids

Question 36
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HiY Addictions 036
Kinaesthetic hallucinations are reported in cases with
Select one:
Alcohol withdrawal
Benzodiazepine withdrawal
Cannabis withdrawal
Amphetamine withdrawal

Cocaine withdrawal
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Your answer is incorrect.
Symptoms of Benzodiazepine withdrawal include autonomic hyperactivity, increased tremor,
insomnia, nausea or vomiting, transient visual, tactile, or auditory hallucinations or illusions,
psychomotor agitation. anxiety (most prominent), with grand mal seizures and kinaesthetic
hallucinations reported in a few patients.
The correct answer is: Benzodiazepine withdrawal

Question 37
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HiY Addictions 037
Which atypical antidepressant has been advocated by NICE for smoking cessation?
Select one:
Maprotiline
Nefazadone
Trazadone
Bupropion

Nomifensin
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Your answer is incorrect.
Bupropion is an atypical antidepressant with dopaminergic and noradrenergic actions and has been
advocated by NICE for smoking cessation. A systematic review of 19 randomised controlled trials of
bupropion revealed a doubling of smoking cessation as compared to the placebo control. Ref:
Maudlsey Prescribing guidelines; 10th edition; 322
The correct answer is: Bupropion

Question 38
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HiY Addictions 038
Which of the following statements about caffeine is incorrect?
Select one:
Caffeine acts as an antagonist of the adenosine receptors
Caffeine is a methylxanthine
Caffeine does not readily cross the blood-brain barrier.
The half-life of caffeine in the human body is 3 - 10 hours

Caffeine at high doses can affect dopamine and noradrenergic neurons

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Caffeine readily crosses the blood-brain barrier. Caffeine in the nontolerant individuals may reduce
GABAergic activity in cerebral cortex and striaturn; but tolerance to caffeine brings back the
GABAergic activity to the normal level. Single cup that has low to moderate doses of caffeine (i.e.,
20 to 200 mg) produces alertness. 300 to 800 mg produces unpleasant anxiety and nervousness.
Caffeine results in global cerebral vasoconstriction and decrease in cerebral blood flow; this may not
occur in those over 65yrs. Tolerance does not develop to these vasoconstrictive effects; blood flow
shows a rebound increase after withdrawal
The correct answer is: Caffeine does not readily cross the blood-brain barrier.

Question 39
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HiY Addictions 039
Which of the following drugs is associated with an amotivational syndrome?
Select one:
Opioids
Mushrooms
Cannabis
Ketamine

MDMA
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A controversial amotivational syndrome has been associated with long-term heavy use of cannabis.
Patients show loss of motivation to persist in a task that requires prolonged attention or effort. They
may appear apathetic and anergic and may be gaining weight.
The correct answer is: Cannabis
Question 40
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HiY Addictions 040
A 53-year-old gentleman has a long-standing history of illicit drug use and has been recently
diagnosed with lung cancer. Which of the following agents is potentially associated with carcinoma
of lung?
Select one:
LSD
Heroin
Cocaine
Cannabis

Speed
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Your answer is incorrect.
Cannabis is normally smoked with tobacco. In addition, benzyprene, a carcinogen, is present in the
tar of both tobacco and cannabis cigarettes.Therefore, most of the health risks associated with
nicotine smoking also apply to cannabis smoking. The tendency of cannabis smokers to inhale
deeply and to retain the smoke in the lungs for as long as possible will exacerbate this risk. Acute
harmful effects of cannabis include mild paranoia, panic attacks, and accidents associated with
delayed reaction time. There are no reports of fatal overdose. Chronic harmful effects include
dysthymia, anxiety/depressive illnesses, the disputed amotivational syndrome (possibly representing
a combination of chronic intoxication in a heavy user and a long half-life). Ref: Oxford handbook of
psychiatry; 515
The correct answer is: Cannabis

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Flashback phenomenon is commonly reported after ingesting which of the following substances?
Select one:
Psychotropic medication
Nicotine
Hallucinogen
Psychostimulant

Cocaine
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Long after ingesting a hallucinogen like LSD, a person can experience a flashback of hallucinogenic
symptoms. This syndrome is diagnosed as hallucinogen persisting perception disorder in DSM-5.
This reexperiencing of perceptual symptoms following cessation of hallucinogen use is characterised
by seeing geometric hallucinations, false perceptions of movement in the peripheral visual fields,
flashes or intensified colours, trails of images of moving objects, positive afterimages, halos around
objects, macropsia, and micropsia. This is also called flashback phenomenon. The following can
trigger a flashback: Emotional stress, Sensory deprivation, Use of another psychoactive substance,
such as alcohol or marijuana.
The correct answer is: Hallucinogen

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Mr. Z presented to the A and E with rashes around his nose and mouth and an unusual breath
odour. On examination, he shows signs of ocular and oropharyngeal irritation. What class of
substances on consumption produces this presentation?
Select one:
Hallucinogens
Alcohol
Opioids
Stimulants

Inhalants
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A recent inhalant user may have rashes around nose and mouth; unusual breath odours, the residue
of the inhalant substances on body or clothes; and can show signs of ocular and oropharyngeal
irritation. Inhalants are often used by adolescents. No dependence syndrome described; no
withdrawals noted as per DSM. Signs of intoxication include dizziness, nystagmus, Incoordination,
slurred speech, unsteady gait, lethargy, depressed reflexes, psychomotor retardation, tremor,
generalized muscle weakness, blurred vision or diplopia, stupor or coma, euphoria. The effects
appear within 5 minutes of inhalation of vapours and can last for 30 minutes to several hours.
Inhalants generally act as a CNS depressants; the concentrations of many inhalant substances in
blood are increased when used in combination with alcohol.
The correct answer is: Inhalants

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Smoking does not induce the metabolism of
Select one:
Fluvoxamine
Haloperidol
Lithium
Olanzapine

Clozapine
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Lithium is renally cleared without undergoing any hepatic metabolism.
The correct answer is: Lithium
Question 44
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Bad trip is the most common adverse effect of;
Select one:
Cocaine
LSD
Cannabis
Amphetamines

Heroin
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Bad trip is the most common adverse effect of LSD and related substances. It resembles the acute
panic reaction but sometimes more severe. A bad trip can occasionally produce true psychotic
symptoms. The bad trip generally ends when the immediate effects of the hallucinogen wear off, but
its course is variable.
The correct answer is: LSD

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Which of the following drugs have shared amphetamine-like stimulant effect and LSD-like
hallucinogen effect simultaneously?
Select one:
Cocaine
MDMA
Methylphenidate
Psilocybin

Angel dust
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MDMA is a substituted amphetamine. It produces subjective effects resembling those of
amphetamine and LSD (lysergic acid diethylamide). So it is partially hallucinogenic and partially
stimulant.
The correct answer is: MDMA

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The drug that is not licensed in UK for smoking cessation is
Select one:
Methamphetamine
Nicotine patches
Nicotine inhalers
Varenicline Tartrate

Bupropion prolonged release tablets

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The three main treatments licensed in UK for smoking cessation are nicotine replacement therapy
(NRT); the antidepressant Bupropion prolonged release tablets and Varenicline Tartrate. NRT and
Bupropion have been investigated in a large number of well conducted RCTs and Varenicline
Tartrate in 4 similar trials. Ref: Maudlsey Prescribing guidelines; 10th edition; 321
The correct answer is: Methamphetamine

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Which of the following unsafe practices of injecting opioid is associated with Candida
endophthalmitis?
Select one:
Rotating injection sites
Using sterile water to inject
Sharing needles
Using lemon juice to reconstitute

Injecting in the direction of blood flow

Check

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Harm reduction advice for opiate users include not using opiates while alone; avoid use in
combination with other drugs; avoid IV route; always inject in the direction of blood flow (in veins, this
is towards heart); rotate injection sites; use new sterile needles and syringes on each occasion using
sterile water - avoid lemon juice which can cause Candida endophthalmitis.
The correct answer is: Using lemon juice to reconstitute

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Which of the following is the main side effect of varenicline?
Select one:
Nausea
Headache
Agitation
Dizziness

Confusion
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Varenicline Tartrate is a partial agonist binding with high affinity to alpha4beta2 nicotinic
acetylcholine receptor. It was launched in UK in Dec 2006 and has been recommended by NICE for
use as part of a programme of behavioural support. Two large scale randomised placebo controlled
trails comparing it directly with Bupropion suggest that it is nearly 80% more effective. The main side
effect is nausea (30%). Depression and Suicidality have also been reported. Ref: Maudlsey
Prescribing guidelines; 10th edition; 324
The correct answer is: Nausea

Question 49
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Caffeine may elevate mood through increasing release of
Select one:
Dopamine
Serotonin
Excitatory amino acids
Acetyl Choline

Noradrenaline
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Caffeine may elevate mood through increasing release of noradrenaline (norepinephrine). The
practice of self-medication with caffeine to improve mood is common in the general population.
Excessive consumption may precipitate mania. Ref: Achor MB et al. Diet aids, mania and affective
illness, Am J Psychiatry 1981; 138;392
The correct answer is: Noradrenaline

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Mrs. Z has a history of abusing illicit drugs. She became pregnant and has now given birth to a boy.
He was fine for first 24 hours after birth. However, he is now irritable with frequent yawning,
sneezing, loose stools and fever. Tremors and jittery movements, along with high-pitched cry were
observed. Which of the following drugs when used by mothers during pregnancy can present with
these withdrawal symptoms in the neonates?
Select one:
Alcohol
Nicotine
Cocaine
Cannabis

Opioids
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Neonatal opioid withdrawal syndrome usually begins 24-48 hours after birth, depending on the time
of last dose. However, signs may not appear in some infants until 3-4 days after birth.
Hyperirritability, gastrointestinal dysfunction, respiratory distress, and vague autonomic symptoms
(e.g., yawning, sneezing, mottling, fever). Tremors and jittery movements, high-pitched cries,
increased muscle tone, and irritability are common. Normal reflexes may be exaggerated. Loose
stools are common, leading to possible electrolyte imbalances and diaper dermatitis. Methadone
withdrawal symptoms typically appear within 48-72 hours but may not start until the infant is aged
three weeks. This is generally milder with buprenorphine withdrawal.
The correct answer is: Opioids
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You are called to A and E to see a young American tourist having taken phencyclidine (PCP). Which
of the following is least likely to be present?
Select one:
Vertical or horizontal nystagmus
Seizures
Numbness or diminished responsiveness to pain
Dysarthria with muscle rigidity

Gait disturbances
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Hallucinogen intoxication generally present with marked anxiety or depression, ideas of reference,
fear of losing one's mind, paranoid ideation, and perceptual changes e.g., subjective intensification
of perceptions, depersonalization, derealization, illusions, hallucinations, synesthesias in a state of
full alertness along with pupillary dilation , tachycardia, sweating, Palpitations, blurring of vision,
Tremors and incoordination. Seizures are very rare.
The correct answer is: Seizures

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Which of the following can reduce the harm associated with injecting opioid?
Select one:
Injecting in the direction of blood flow
Injecting into lymph nodes
Injecting in the peritoneum to avoid clotting
Using vinegar to reconstitute

Seeking out isolated and quiet places to inject

Check

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Using opiates while alone can increase the risk of overdose. To reduce harm, users are encouraged
to avoid use in combination with other drugs; avoid IV route; always inject in the direction of blood
flow (in veins, this is towards heart); rotate injection sites; use new sterile needles and syringes on
each occasion using sterile water.
The correct answer is: Injecting in the direction of blood flow

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Following smoking cessation, women and heavy smokers are at greatest risk for which of the
following?
Select one:
Hypercholesterolemia
Hypertension
Weight gain
Diabetes

Renal failure
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Following smoking cessation, smokers report cravings for cigarettes, which can last for a longer
period. The mean weight gain after smoking cessation is approximately 10 lb, and women and heavy
smokers are at greatest risk for large weight gain.
The correct answer is: Weight gain

Question 54
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What percentage of those with alcohol withdrawal experience delirium tremens?
Select one:
1-2%
20%
5%
10%

25%
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In most severe cases of alcohol withdrawal syndrome, delirium tremens may develop - this includes
5% of all cases. Delirium tremens is a toxic confusion state that occurs when alcohol withdrawal
symptoms are severe and it is a life threatening state with mortality of approximately 5%. Disturbed
autonomic functions (pulse, temperature and blood pressure changes on either direction), clouded
consciousness with hallucinations (often Lilliputian) and agitation can occur.
The correct answer is: 5%

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HiY Addictions 055
In Wernicke's encephalopathy the classic triad of ataxia, confusion and ophthalmoplegia is seen in
Select one:
70%
1%
10%
80%

50%
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Wernicke's encephalopathy is an acute condition characterized by the well known triad of 1.
Ophthalmoplegia 2. Ataxia 3. Global confusional state. This classic triad of confusion, ataxia and
nystagmus is only present in 10% of patients and 80% of patients are not diagnosed before post
mortem.
The correct answer is: 10%

Question 56
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HiY Addictions 056
The percentage of men in the UK who drink excessively, above the recommended weekly limits for
sensible drinking, is
Select one:
4%
27%
15%
5%

20%
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27% of men and 15% of women in the UK drink excessively, above the recommended weekly limits
for sensible drinking ONS, 1998). Up to 20% of patients presenting to general practice settings will
be consuming alcohol at harmful or hazardous levels. Nearly 25% of UK household survey 2000
respondents had a hazardous pattern of drinking during the year before interview using the Alcohol
Use Disorder Identification Test (AUDIT score >= 8). The prevalence of hazardous drinking was
higher among men (38%) than women (15%). This prevalence decreased with age. For women,
prevalence was highest in the group aged from 16 to 19 years (32%), whereas for men the peak was
found among those aged 20 to 24 (62%).
The correct answer is: 27%

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What is the lifetime risk of suicide in dependent drinkers?
Select one:
1-2%
4%
10-15%
25%

40%
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Suicide risk is generally quoted as lifetime risk of 10-15% in dependent drinkers. The same risk is
estimated as 3-4% in the lifetime of those with alcohol problems. Risk factors for suicide in alcoholics
include; male sex, divorce, personality disorder, increasing age, other drug use, physical
complications, unemployment, psychiatric disorder and history deliberate self harm Ref: Core
Psychiatry-Pg: 429.
The correct answer is: 10-15%

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What is the minimum duration required to make a diagnosis of alcohol dependence according to
ICD-10 criteria?
Select one:
2 months
3 months
12 months
1 month

6 months
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ICD10 alcohol dependence requires at least 3 out of following list satisfied in last 12 months: 1.
intense desire to drink alcohol 2. difficulty in controlling the onset, termination and the level of
drinking 3. experiencing withdrawal symptoms if alcohol is not taken 4. use of alcohol to relieve from
withdrawal symptoms 5. tolerance as evidenced by the need to escalate dose over time tom achieve
same effect 6. salience - neglecting alternate forms of leisure or pleasure in life 7. Narrowing
personal repertoire of alcohol use.
The correct answer is: 12 months

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Cerebellar degeneration has been reported to occur in about
Select one:
50% of chronic alcoholics
10% of chronic alcoholics
40% of chronic alcoholics
30% of chronic alcoholics

20% of chronic alcoholics

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Degeneration of Purkinje cells in the cerebellar cortex (by 10-35 per cent) resulting in cerebellar
atrophy has been reported to occur in about 40% of chronic alcoholics. Limb ataxia and dysarthria
occur more often than in Wernicke's encephalopathy, whereas nystagmus is rare. Impaired
cerebellar function improves significantly when abstinence is maintained.
The correct answer is: 40% of chronic alcoholics

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Mr Z suffers from alcohol dependence syndrome of moderate severity. He is due to be started on
chlordiazepoxide regime. The typical regime usually lasts for
Select one:
1-2 days
2-3 days
3-5 days
5-7 days

10-14 days
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A typical regimen for alcohol dependence of moderate severity might be 10-20 mg QDS, reducing
gradually over 5-7 days. Longer treatment is rarely helpful or necessary. Severely dependent
patients should get 7 days treatment with the flexibility of 'as required' medication in the first 2 days.
Patients who have a history of head injury, delirium tremens or cognitive impairment may need
lengthier withdrawal regimens lasting for 10 days.
The correct answer is: 5-7 days

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The starting dose of acamprosate in adults weighing 60 kg or more
Select one:
999 mg 3 times daily
333 mg 3 times daily
666 mg 3 times daily
300 mg 3 times daily

100 mg 3 times daily

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The starting dose of acamprosate in adults (18-65 year) weighing 60 kg or more is 666 mg three
times daily. For adults less than 60 kg, the dose should be reduced to 666 mg (morning), 333 mg
(mid-day) and 333 mg (night). Currently, it is recommended to start acamprosate as soon after
detoxification as possible. Late onset of treatment may result in loss of efficacy. The benefits of
acamprosate may continue 1- 2 years even after stopping the drug. Ref: British National formulary;
59: Pg 303.
The correct answer is: 666 mg 3 times daily

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HiY Addictions 062
The symptoms of delirium tremens peak at
Select one:
24-48 hours after the last drink
48-72 hours after the last drink
72-96 hours after the last drink
4-6 hours after the last drink

12-24 hours after the last drink

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The symptoms of delirium tremens peak between 72 and 96 hours after the last drink. The classical
triad of symptoms include clouding of consciousness and confusion, vivid hallucinations affecting
every sensory modality and marked tremor. Other features include paranoid delusions, agitation,
insomnia and features of autonomic hyperactivity that includes sweating, fever, tachycardia and
hypertension. The Prodromal symptoms usually include insomnia, restlessness, fear and confusion.
Ref: The Maudlsey prescribing guidelines- 10th edition (Pg 287)
The correct answer is: 72-96 hours after the last drink

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Which of the following is true about relapse prevention in alcohol dependence?
Select one:
Acamprosate is not licensed for the elderly
If a patient relapses on acamprosate it must be stopped at once
Smoking is contraindicated when taking disulfiram
Acamprosate and disulfiram must not be combined

Naltrexone has no place in treating alcohol dependence

Check
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Acamprosate is not licensed for geriatric use. It can be combined with disulfiram in adults. One
relapse is usually allowed on acamprosate; more than one is an indication for stopping the drug.
Naltrexone has shown efficacy in relapse prevention for alcoholics.
The correct answer is: Acamprosate is not licensed for the elderly

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Which term refers to 'discrete episodes of anterograde amnesia that occur in association with
alcohol intoxication'?
Select one:
Alcoholic dementia
Wernicke's encephalopathy
Korsakoff's syndrome
Alcoholic blackouts

Pathological intoxication
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Alcoholic blackouts: Alcohol-related blackouts are not included in DSM5/ ICD10. Blackouts are
discrete episodes of anterograde amnesia that occur in association with alcohol intoxication. During
a blackout (at the time of intoxication), remote memory is intact but patients experience specific
short-term episodic memory deficit (they can talk about their childhood etc, but cannot remember
what topic the conversation is about or how did they come to where they were) They can even
perform complicated tasks but later will not remember these. The memory gap usually lasts for
hours, rarely a day or more. Alcohol blocks the consolidation of new memories into old memories at
hippocampus.
The correct answer is: Alcoholic blackouts

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A 49-year-old man is heavily dependent on alcohol. Due to various physical problems he was
strongly advised to abstain. Unfortunately since last episode of intoxication he has developed
recurrent voices that frighten him. In spite of 2 months of abstinence these hallucinations continue,
and he now presents with persecutory delusions. Which of the following diagnosis best suits his
presentation?
Select one:
Delirium tremens
Alcoholic hallucinosis
Delusional disorder
Depressive psychosis

Schizophrenia
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The DSM-5 has a diagnostic criteria for substance-induced psychotic disorders (when induced by
alcohol, this is popularly called alcoholic hallucinosis). This category allows the specification of the
onset of symptoms in relation to the course of substance use (e.g. onset during intoxication or
withdrawal). The most common hallucinations are unstructured sounds or voices that may be
characteristically malign, and threatening. The hallucinations usually last less than a week, when
patients believe in the hallucinations though afterwards they may realise the untrue nature.
The correct answer is: Alcoholic hallucinosis

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Which of the following medication is better avoided for alcohol detoxification due to the risk of
respiratory depression?
Select one:
Carbamazepine
Oxazepam
Diazepam
Chlormethiazole

Lorazepam
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Chlormethiazole can be used but better avoided for detoxification from alcohol as there is a higher
risk of respiratory depression with its use in alcoholics when compared to other benzodiazepines.
Concerns due to variable bioavailability, higher addictive potential and potential street value
additionally reduce its usefulness.
The correct answer is: Chlormethiazole

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Choose the one feature that is not described under Edwards and Gross criteria (1976) for alcohol
dependence
Select one:
subjective awareness of compulsion
repeated withdrawals
narrowed repertoire
reinstatement after abstinence

decreased tolerance
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Edwards and Gross criteria (1976) for alcohol dependence: 1. narrowed repertoire 2. salience of
alcohol seeking behaviour 3. increased tolerance 4. repeated withdrawals 5. Drinking to prevent or
relieve withdrawals. 6. subjective awareness of compulsion 7. reinstatement after abstinence
The correct answer is: decreased tolerance

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Characteristic features of delirium tremens include all except
Select one:
Clouded consciousness
Diarrhoea
Hallucinations
Fluctuant blood pressure and pulse

Agitation
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Features of alcohol withdrawal: Usually starts within 12 hours of last drink. Tremor, diaphoresis,
sleeplessness, GI distress and anxiety are prominent. Increased urge and craving for alcohol may
be seen. The severity of symptoms depends on the degree of pre-existent drinking. If unattended
symptoms may peak in 48 hours. In these cases seizures may occur. These are grand-mal seizures
especially common in those who had previous seizures (epilepsy or withdrawal seizures), head
injury and electrolyte imbalance such as hyponatraemia or hypokalaemia. In around 5% patients,
delirium tremens may set in. Here disturbed autonomic functions (pulse, temperature and blood
pressure changes in either direction), clouded consciousness with hallucinations (often Lilliputian)
and agitation can occur.
The correct answer is: Diarrhoea

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Mr. Z was admitted to a medical ward for alcohol withdrawal syndrome and later he developed
seizures. Which drug is most helpful in this situation?
Select one:
Diazepam
Oxazepam
Clonazepam
Phenytoin

Carbamazepine
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A meta-analysis of trials assessing efficacy of drugs preventing alcohol withdrawal seizures has
demonstrated that benzodiazepines particularly long acting preparations such as Diazepam
significantly reduces seizures denovo. Most clinicians prefer to use diazepam for medically assisted
withdrawal in those with a past history of seizures. Phenytoin does not prevent alcohol withdrawal
seizures and is therefore not indicated. Carbamazepine has limited evidence with respect to
preventing DTs and seizures in alcohol withdrawal. Ref: The Maudlsey prescribing guidelines- 10th
edition (Pg 296).
The correct answer is: Diazepam

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Acamprosate appears to act centrally on which of the neurotransmitter systems?
Select one:
Serotonin
Noradrenaline
Dopamine
Acetylcholine

GABA
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Acamprosate is a synthetic taurine analogue, which appears to act centrally on glutamate and GABA
neurotransmitter systems, although the mechanism has not been fully established. It inhibits
glutamatergic NMDA receptor function and balances GABA-glutamate imbalance seen in alcohol
dependence. It is hypothesized to suppress the 'urge to drink' in response to learned cues.
Gastrointestinal disturbance (e.g. nausea, diarrhoea) are the most common side effects reported.
The correct answer is: GABA

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A 46-year-old gentleman has been started on disulfiram for the treatment of alcohol dependence. A
common side effect reported by patients on taking disulfiram is
Select one:
Dystonia
Urinary incontinence
Halitosis
Visual hallucinations

Skin pigmentation
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Halitosis is a common side effect of Disulfiram. Disulfiram can act as a helpful adjunct to alcohol
detoxification therapy and allow the patient's relatives regain confidence in their ability to remain
abstinent. Rare reports of psychotic reactions and hepatotoxicity have been noted. Contraindication:
Impulsivity, psychosis, Suicidality, severe hepatic dysfunction, peripheral neuropathies, cardiac
diseases Ref: Oxford handbook of psychiatry- 522
The correct answer is: Halitosis

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Which of the following medication used for delirium tremens may increase the risk of withdrawal
seizures?
Select one:
Chlormethiazole
Oxazepam
Diazepam
Haloperidol

Carbamazepine
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Of all the above choices, only haloperidol lowers the seizure threshold.
The correct answer is: Haloperidol

Question 73
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HiY Addictions 073
Patients with Wernicke's encephalopathy show gliosis and small haemorrhages especially in which
of the following brain regions?
Select one:
Prefrontal cortex
Amygdala
Golgi bodies
Mamillary bodies

Cerebellar peduncles
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Patients with Wernicke's encephalopathy show gliosis and small haemorrhages in periventricular
and periaqueductal structures especially, the mamillary bodies, hypothalamus, mediodorsal thalamic
nucleus, colliculi, and midbrain tegmentum.
The correct answer is: Mamillary bodies

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MATCH trial is a landmark study evaluating treatment options for alcohol dependence. Which of the
following is an accurate finding from the MATCH trial?
Select one:
Impulsivity is the strongest predictor of long term drinking outcome
Binge drinkers do better with a CBT approach
Matching patients to treatment options does not make a significant impact on outcome
Younger drinkers do better with a motivational approach

At least initially drinkers with high psychiatric morbidity do better with CBT than 12 step programmes
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Project MATCH (Matching alcoholism treatments to client heterogeneity) was a large multisite ( 9
centres) USA based RCT with a total of 1726 clients to test if matching patient characteristics to
specific treatments will improve the overall outcome in alcohol dependence. The psychosocial
treatments explored were Cognitive Behavioural Coping Skills Therapy (CBT), Twelve-Step
Facilitation Therapy (TSF), and Motivational Enhancement Therapy (MET). There was little evidence
for matching improving overall outcome. AA attendance predicted a better long-term outcome,
particularly in those lacking a non-drinking support network. At 1 year, clients low in psychiatric
severity (comorbid mental health issues) had more abstinent days after TSF than after CBT. Neither
treatment was clearly superior for clients with higher levels of psychiatric severity. At 3 years, clients
whose social networks were more supportive of drinking derived greater benefit from TSF treatment
than from MET; those with low support for drinking derived more benefit from MET than TSF. This
may be because those who drink even without encouragement from drinking friends may need
motivational enhancement more than those who drink due to social cues. Readiness-to-change and
self-efficacy emerged as the strongest predictors of long-term drinking outcome.
The correct answer is: Matching patients to treatment options does not make a significant impact on
outcome

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The two interventions compared in UK Alcohol Treatment Trial (UKATT) were
Select one:
CBT vs. medication based management
CBT vs. social behaviour and network therapy
Motivational therapy vs. social behaviour and network therapy
CBT vs. Motivational therapy

Motivational therapy vs. twelve step programme

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UKATT (United Kingdom Alcohol Treatment trial) was a multicentre (7 centres Birmingham, Cardiff,
Leeds), pragmatic effectiveness RCT involving 742 clients with alcohol problems (83% FU rate at
one year). It compared Motivational Enhancement Therapy and Social Behaviour and Network
Therapy in treating alcohol problems. SBNT was carried out over eight sessions each lasting 50 min.
Components were drawn from network therapy, behavioural marital therapy, unilateral family
therapy, social aspects of the community reinforcement approach, relapse prevention and social
skills training. The novel social behaviour and network therapy for alcohol problems did not differ
significantly in effectiveness from the comparator.
The correct answer is: Motivational therapy vs. social behaviour and network therapy

Question 76
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HiY Addictions 076
Which of the following statements concerning neuroimaging in Wernicke's encephalopathy is NOT
true?
Select one:
MRI is better than CT scan for suspected Wernicke' s
MRI may show mamillary body lesions
MRI cannot predict progression to Korsakoff s psychosis
MRI is the most valuable diagnostic tool for Wernicke's

MRI has high sensitivity but poor specificity

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MRI is currently the most valuable diagnostic tool to confirm a diagnosis of Wernicke's
encephalopathy. MRI has a sensitivity of only 53%, but its high specificity of 93% means that it can
be used to confirm a suspected diagnosis (Sechi and amp; Serra 2007, The Lancet Neurology. 6, 5,
442-455).
The correct answer is: MRI has high sensitivity but poor specificity

Question 77
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HiY Addictions 077
An opioid receptor antagonist that is effective in reducing craving for alcohol is
Select one:
Chlordiazepoxide
Diazepam
Acamprosate
Naltrexone

Disulfiram
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Your answer is incorrect.
Naltrexone is an opioid receptor antagonist used for the treatment of alcohol dependence. A
systematic review on Naltrexone treatment concluded that it is effective in reducing craving for
alcohol. However there were a number of limitations. Naltrexone may reduce the pleasurable effects
of alcohol by blocking the effects of opioids released by alcohol; this results in reduced stimulation of
mesolimbic dopamine reward system. Naltrexone has been shown to be superior to placebo in
maintaining abstinence, relapse rates, time to first drink, and reduction in number of drinking days,
reduction in craving and improvement in GGT (liver function). Ref: Srisurapanont et al;. Opiate
antagonist for alcohol dependence, Cochrane database review 2005
The correct answer is: Naltrexone

Question 78
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HiY Addictions 078
The symptom/sign that responds earlier than others when thiamine is replaced in a patient with
Wernicke's encephalopathy is
Select one:
Opthalmoplegia
Ataxia
Confusion
Apathy
Amnesia
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Ophthalmoplegia responds within hours, but cognitive impairment takes longer.
The correct answer is: Opthalmoplegia

Question 79
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HiY Addictions 079
Mr. Y was assessed by the drug and alcohol team and suggested alcohol detoxification. He is a
chronic smoker and has a history of a chronic respiratory disease. Which one of the following is the
most suitable drug for detoxification?
Select one:
Chlordiazepoxide
Clonazepam
Oxazepam
Temazepam

Diazepam
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Your answer is incorrect.
Oxazepam is useful in patients with chronic respiratory disease and it is important to note that the
majority of dependent drinkers are smokers. However, it is important to note that the risk of alcohol
withdrawal seizures may be higher with Oxazepam
The correct answer is: Oxazepam

Question 80
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HiY Addictions 080
Which of the following is an important adjunctive treatment for the prophylaxis and treatment of
Wernicke-Korsakoff syndrome?
Select one:
Parenteral thyroid replacement
Parenteral mineral replacement
Parenteral albumin replacement
Parenteral aldehyde replacement

Parenteral vitamin replacement

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Your answer is incorrect.
Parenteral vitamin replacement is an important adjunctive treatment for the prophylaxis and or
treatment of Wernicke-Korsakoff syndrome and other vitamin related neuropsychiatric conditions
The correct answer is: Parenteral vitamin replacement
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