Psychiatry Question Bank – 53 Multiple Choice Questions on "Psychoactive Substance use Disorders"

53 Multiple Choice Questions (MCQs) with Answers on “Psychiatric History and Examination” for Psychiatry Post Graduate Students:

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1. Confabulation means:

A. Conversation with an imaginary person

B. Misinterpretation of stimuli

C. Perception in the absence of stimuli

D. Making up stories to fill up gaps in memory

Confabulation—uses imaginary events in the early phase of the illness.

Chronic alcoholism causes

Wernicke’s – Korsakoff’s syndrome

Wernicke’s encephalopathy is the acute phase of delirium preceding the amnesic syndrome, while Korsakoff’s syndrome is the chronic phase of amnesic syndrome.

Treatment for chronic alcoholism causing Wernicke’s encephalopathy – thiamine (high doses) Prognosis is often poor in Korsakoff’s syndrome.

2. The active substance in hashish is:

A. Morphine

B. LSD

C. Mescaline

D. Tetrahydrocannabinol

3. Physical withdrawal symptoms are absent in patients

A. Alcohol

B. Cannabis

C. Opium

D. Pethidine

Complications of cannabis include:

1. Transient/short lasting psychiatric disorders.

2. Amotivational syndrome (lethargy, apathy, loss of interest, amnesia, reduced drive and ambition)

3. Hemp inanity – “Run amok”

4. Memory impairment, worsening / relapse of psychosis or mood disorder

5. Reversible inhibition of spermatogenesis.

4. Tactile hallucinations are seen with:

A. Alcohol

B. Heroin

C. Cocaine

D. Fortwin-phenergan combination

Cocaine-street name “crack” combination with opiates called – “speedball” acute intoxicatory state. Mydriasis, tachycardia, Ht, ↑ sweating, nausea and vomiting, hypo manic picture with impaired judgment and socio-occupational functioning.

Withdrawal Syndrome:

Mild physical but very strong psychological dependence +.

5. All the following are features of opioid withdrawal, except:

A. Diarrhea

B. Lacrimation

C. Rhinorrhea

D. Miosis

Opioid withdrawal causes mydriatic effect.

6. Morbid jealousy is seen with the use of:

A. Alcohol

B. Opium

C. Cannabis

D. Amphetamine

Is a form of delusional conjugal paranoiamen are more commonly involved. Onset is often sudden.

7. The drug of choice in delirium tremens is:

A. Diazepam

B. Phenytoin

C. Chlordiazepoxide

D. Morphine

The drugs of choice are benzodiazepines: Chlordiazepoxide (80-200 mg/day) or diazepam (40- 80 mg/day).

8. Treatment is NOT required for withdrawal symptoms of:

A. Cannabis

B. Alcohol

C. Amphetamine

D. LSD

No withdrawal syndrome has been described with LSD use

Flash back phenomena – occurs sometimes within weeks to months after the first experience.

9. All the following are the features of alcohol withdrawal except:

A. Hyper somnolence

B. Epileptic seizure

C. Restlessness

D. Hallucination

10. Symptomatic treatment is not required in withdrawal of:

A. Cannabis

B. Morphine

C. Alcohol

D. Cocaine

11. All the following drugs have abuse liability, except:

A. Buprenorphine

B. Alprazolam

C. Fluoxetine

D. Dextropropoxyphene

12. Disulfiram acts by:

A. Inhibiting alcohol dehydrogenase

B. Inhibiting aldehyde dehydrogenase

C. Both of the above

D. None of the above

14. An alcoholic is brought to the emergency OPD with the complaint of irrelevant talking. He had stopped using alcohol three days back. On examination he is found to be disoriented to time, place, and person. He also has visual hallucinations and illusions. There is no history of head injury. The most likely diagnosis is:

A. Dementia praecox

B. Delirium tremens

C. Schizophrenia

D. Korsakoff’s psychosis

15. A 40-year-old man presents to casualty with history of regu­lar and heavy use of alcohol for 10 years and morning drinking for 1 year. The last alcohol intense was 3 days back. There is no history of head injury or seizures. On examination, there is no icterus, sign of hepatic encepha­lopathy, or focal neurological sign. The patient has course tremors, visual hallucinations, and has disorientation to time. Which of the following is the best medicine to be prescribed for such a patient?

A. Diazepam

B. Haloperidol

C. Imipramine

D. Naltrexone

This patient is in delirium tremens.

16. A 39-year-old carpenter has taken two bottles of liquor from the local shop. After about an hour he develops confusion, vomiting, and blurring of vision. He has been brought to the emergency outpatient department. He should be given:

A. Naloxone

B. Diazepam

C. Flumazenit

D. Ethyl alcohol

It is a case of methyl alcohol poisoning, where in the. metabolism could be replaced by using ethyl alcohol immediately.

17. A 34-year-old rickshaw puller has been using heroic for the past 10 yrs. One evening his family members found him unconscious. He was brought to the causality. On examination he has tachycardia, shallow breathing, con­stricted pupils, his blood pressure was 100/70 mm of Hg. He had brisk bilateral deep tendon reflexes. The plan­tar reflexes were flexor on both sides. Which of the fol­lowing is the best treatment for him?

A. Buprenorphine

B. Flumazenil

C. Methadone

D. Naloxone

20 to 50 mg/ day of methadone is given to the patient to shift him from “hard” drugs, thus decreasing the IV use.

18. The basic determinant of treatment in drug addicts is:

A. Vitamin B-complex therapy

B. High intelligence

C. Motivation

D. Behaviour therapy

19. The characteristic feature of Alcoholic blackout includes:

A. Amnesia (for events during alcohol drinking)

B. Event of no significance

C. Malingering

D. All the of the above

20. Visual hallucinations are seen in:

A. Phobia

B. Alcoholism

C. Mania

D. Depression

21. Korsakoff’s syndrome is seen in:

A. Uremia

B. Alcoholism

C. Lead poisoning

D. All of the above

22. Which of the following is true regarding methadone?

A. Has better compliance

B. Has no addition liability

C. Useful for maintenance therapy

D. Useful for long term therapy

Methadone maintenance is a very popular method. 20 to 50 mg/d of methadone is given to the pt to shift him from hard drugs.

23. Which of the following drug is used in reducing the se­verity of morphine withdrawal syndrome?

A. Apomorphine

B. Methadone

C. Naloxone

D. None

24. Drug dependence occurs due to:

A. One having curiosity about use of drugs

B. Sudden withdrawal symptoms

C. Development of tolerance

D. All of the above

25. Drug of choice in alcohol withdrawal syndrome is:

A. Diazepam

B. Naloxone

C. Clonidine

D. Carbamazepine

Drug of choice for alcohol withdrawal are benzo­diazepines. Chlordiazepoxide 80 to 200 mg/day or diazepams 40 to 80 mg/d are most frequently used.

26. One of the following is associated with “Punch drunken­ness”:

A. Boxing

B. Fortwin addiction

C. Intravenous alcohol

D. Methyl alcohol toxicity

27. “Bad trips” are characteristically associated with the addition of:

A. Cannabis

B. Cocaine

C. Morphine

D. LSD

Acute LSD intoxication sometimes presents with an acute panic reaction, known as a bad trip in which the individual experience a loss of control over his self. Recovery usually occurs within 8 to 12 hr of the last dose. Rarely, the intoxication is severe enough to produce an acute psychotic episode resembling schizophreniform psychosis.

Flashback occurs in LSD and cannabis where there is a spontaneous recurrence of the LSD use experience in a drug free state.

28. Which of the following is not a useful action of morphine and Pethidine?

A. Antiemetic

B. Antitussive

C. Analgesic

D. Addictive

29. Amphetamine (Dexedrine) is used in:

A. Narcolepsy

B. Psychosis

C. Anxiety disorders

D. Obsessive-compulsive neurosis

30. Sexual infidelity is commonly associated with:

A. Morbid jealousy

B. Fear

C. Manic depressive psychosis

D. Anxiety neurosis

31. Amotivational syndrome is seen in:

A. LSD

B. Amphetamine

C. Cannabis

D. Cocaine

32. Which of the following is not seen in Korsakoff’s syn­drome?

A. Clear consciousness

B. Inability to learn new things

C. Hallucinations

D. Confabulation

It is due to thiamine deficiency

Lesions are seen in manually bodies and bilateral dorso-medial nucleus of thalamus.

33. Amphetamine psychosis is not characterized by:

A. Mania

B. Tactile hallucinations

C. Clear sensorium

D. Loosing of associations and paranoia. Amphetamine produces a psychosis which closely resembles paranoid schizophrenia.

34. Cannabis has not been used for the following medicinal purpose:

A. Nausea

B. Epilepsy

C. Tics

D. Glaucoma

Therapeutic user of cannabis – nausea caused by cancer chemotherapy, bronchial asthma, epilepsy, glaucoma, dystonia.

35. Naloxone is an antidote for all except:

A. Pethidine

B. Pentazocine

C. Buprenorphine

D. Diphenoxylate

As buprenorphine is a mixed against – antagonist.

36. Delirium tremens (DT) is precipitated by:

A. Shock after sever injury

B. Sudden excess of alcohol uptake

C. Acute withdrawal of alcohol

D. All of the above

Remember- 5 per cent of alcoholics get DT. Recovery is seen by 1 week.

37. Amnesic reaction and delirium are seen with:

A. Alcohol

B. Opiates

C. Cannabis

D. Amphetamines

Amnesic syndrome—Korsakoff’s described it and it is named after him

It is due to damage to mamillary body and dorsal and medial thalamic nucleus.

38. The characteristic features of Korsakoff’s psychosis are:

A. Loss of recent memory and impaired learning

B. Hallucinations

C. Delusions

D. Convulsion

Korsakoff’s syndrome has impaired recent memory and new learning ability remote memory is intact. It is due to thiamine deficiency caused by chronic alcohol use.

39. Morbid jealousy is seen with:

A. Alcoholism

B. LSD addiction

C. Schizophrenia

D. Dementia

Morbid jealousy is occurrence of delusion of infidelity seen in alcoholism also termed Othello syndrome.

40. Wernicke’s encephalopathy occurs due to deficiency of:

A. Thiamine

B. Cyanocobalamin

C. Riboflavin

D. Pyridoxine

41. Alcohol withdrawal is treated with:

A. Oxazepam

B. Disulfiram

C. Amitryptiline

D. Chlordiazepoxide

Chlordiazepoxide and diazepam are most frequently used.

42. Which of the following is the direct evidence of alcohol addiction?

A. Withdrawal symptoms

B. Memory disturbance

C. Confabulation

D. Cirrhosis

Definite evidence of addition of a substance – withdrawal symptoms.

Other Features:

Desire

Loss of control

Tolerance

Salience

Harmful use

43. In delirium tremens, not seen is:

A. Agitation

B. Depression

C. Perceptual disturbances

D. Disorientation in time

Features of DT—Altered sensorium – Autonomic – Perceptual disturbance.

44. Mandrax is a combination of a hypnotic and:

A. Antihistaminic

B. Analgesic

C. Antipyretic

D. None of the above

45. Magnan phenomenon occurs in addition with:

A. Cannabis

B. Cocaine

C. Morphine

D. Alcohol

46. The drug of choice for delirium tremens:

A. Diazepam

B. Phenobarbitone

C. Disulfiram

D. Chloral hydrate

Patients with delirium tremens need hospitalization.

47. Non-addicting drug useful for suppressing symptoms of opioid withdrawal is:

A. Clonidine

B. Cyclazocine

C. LAAM

D. Methadone

Clonidine, LAAM and Methadone are used in opioid withdrawal. LAAM and Methadone have addictions potential.

48. All of following are features of alcohol withdrawal syndrome, except:

A. Hallucination

B. Delusion

C. Drowsiness

D. Obsession.

Simple withdrawal – Tremors, nausea, vomiting, hangover, irritability, insomnia, anxiety severe with­drawal – delirium tremens, alcoholic hallucinosis.

49. All of the following are features of morphine withdrawal,

A. Piloerection

B. Insomnia

C. Constipation

D. Increased nasal secretion

Symptoms of morphine withdrawal will include lacrimation, rhinorrhea, sweating, diarrhea, tachycardia, mild hypertension, insomnia, muscle cramps, raised body temperature.

50. Opiate withdrawal is linked with:

A. Chlorpromazine

B. Nalorphine

C. Methadone

D. Pethidine

51. Drug abuse of which substance shows symptoms similar to Schizophrenia:

A. LSD

B. Heroin

C. Amphetamine

D. Cannabis

52. The drug of choice in alcohol withdrawal is:

A. Haloperidol

B. Lithium

C. Benzodiazepine

D. Chlordiazepoxide

Diazepam can also be used

53. All the following are drugs used in heroin withdrawal except:

A. Haloperidol

B. Buprenorphine

C. Clonidine

D. Dextropropoxyphene

54. By which of the following is alcohol dependence best indicated:

A. Black outs

B. Withdrawal symptoms

C. Early morning drinking

D. Physical complaints

55. A 60-year-old female alcoholic who is a heavy drinker hears voice of people discussing their intention to kill her. She also has decreased sleep and feels sael. The diagnosis is:

A. Psychotic features with depression

B. Wernicke-korsakoff

C. Delirium tremens

D. Alcoholic hallucinosis

Alcohol hallucinosis occurs in 2 per cent of alcoholics. Hallucinations occur in clear consciousness. The conditions have to be differentiated from delirium tremens.

56. A 42-year-old chronic alcoholic meets with an accident and suddenly stops drinking. He presents with tremor, immaturity, poor attention span, andan inability to iden­tify his family members 24 hours later. The diagnosis is:

A. Wernicke’s encephalography

B. Delirium tremens

C. Alcohol intoxication

D. Acute psychosis

Features of Delirium tremens:

It occurs within 2 to 4 days of abstinence

Clouding of consciousness

Poor attention span

Visual and auditory hallucinations

Moved autonomies disturbance

Psychomotor agitation and ataxia

Insomnia

Dehydration with electrolyte unbalance.

57. A person drinking alcohol says that he is doing so to overcome family problems. The defense mechanism involved is:

A. Rationalization

B. Denial

C. Projection

D. Minimalization

Answer

1.D 2.D 3.B 4.C 5.D 6.A 7.A 8.D 9.A 10.A 11.C 12.B 13.A 14.B 15.A 16.D 17.C 18.C 19.A 20.B 21.D 22.C 23.B 24.B 25.A 26.A 27.D 28.A 29.A 30.A 31.C 32.C 33.A 34.C 35.C 36.D 37.A 38.A 39.A 40.A 41.D 42.A 43.B 44.A 45.B 46.A 47.A 48.D 49.C 50.C 51.C 52.D 53.A 54.B 55.D 56.B 57.A