Deck 40: Alcohol, Tobacco and Other Drug Use

Question 1

Refers to the acute action of psychoactive substances on the central nervous system.

A) Tolerance
B) Intoxication
C) Dependence
D) Withdrawal

Answer 1

Intoxication

Question 2

This is an ATOD presentation wherein a person may have become physically tolerant to a drug or alcohol, but is not psychologically dependent on ATOD.

A) Tolerance
B) Intoxication
C) Regular excessive use
D) Dependence

Answer 2

Regular excessive use

Question 3

Which among the following is a presentation of alcohol intoxication?

A) Incoherent speech
B) Difficulty breathing
C) Cyanosis
D) Hyperreflexia

Answer 3

Incoherent speech

Question 4

Presence of headache, irritability, drowsiness and fatigue are withdrawal signs of which of the following drugs?

A) Nicotine
B) Caffeine
C) Heroin
D) Marijuana

Question 5

What initial action is required in caring for an intoxicated patient who cannot open their eyes to simple stimuli?

A) Conduct a blood alcohol concentration test
B) Conduct a Glassgow Coma Scale (GCS) assessment
C) Check vital signs and record them
D) Notify medical officer immediately

Question 6

How does alcohol consumption affect the level of thiamine in the body?

A) It decreases the absorption of thiamine from the GI tract
B) It changes the structure of thiamine
C) It decreases the absorption of thiamine from the GI tract and It changes the structure of thiamine
D) None are correct

Question 7

The most serious complication of alcohol withdrawal syndrome in which the onset is 2-6 days after the last drink.

A) Seizures
B) Delirium tremens
C) Confusion
D) Hallucination

Question 8

What should the initial management be for opioid overdose?

A) Establish airway and oxygenation immediately
B) Administer narcotic antagonist drug immediately
C) Start an intravenous fluid immediately
D) Place patient in a recovery position

Question 9

Which among the following is NOT a symptom of opiod withdrawal?

A) Tremor
B) Restlessness
C) Muscle twitching
D) Hypotension

Question 10

The phase of psychostimulant cessation in wich the acute symptoms are gradually diminishing.

A) Crash
B) Withdrawal
C) Prolonged withdrawal
D) Dependence

Question 11

In Australia the highest morbidity and mortality rates relating to substance abuse results from abuse of:

A) Alcohol
B) Heroin and other narcotics
C) Tobacco
D) Methamphetamine

Question 12

You respond to a suburban residential address for a 30-year-old male who is reportedly intoxicated. On arrival you are shown to a male person who is in an altered level of consciousness with slurred speech, pinpoint pupils, bi-lateral ptosis and drowsy. His heart rate is 110 regular; BP 145/75; respiration rate 8; SpO2 89% on room air and his BSL is 5.3 mmol/L. His friends state that he has consumed a couple of standard drinks over the past 2 hours and that he has taken some other drugs, but they aren't sure what they are. Based on the patient's clinical presentation, the most likely cause of his presentation is an overdose of:

A) Stimulant medication such as amphetamine or methamphetamine
B) Alcohol and other sedatives such as a benzodiazepines
C) Narcotic
D) Marijuana

Question 13

In relation to question 2 above, the most appropriate intervention for this patient would be:

A) Administer oxygen therapy via a face mask to correct hypoxia; administer 0.8-2.0 mg naloxone intramuscular; transport to hospital for further assessment and observation
B) Administer oxygen therapy via a face mask to correct hypoxia; administer 0.8-2.0 mg naloxone intramuscular; if the patient improves leave him at home in the care of his friends
C) Administer oxygen therapy via a face mask to correct hypoxia and transport patient to hospital for further assessment and observation
D) Ventilate the patient with a bag-valve-mask and 100% oxygen; administer 0.8-2.0 mg naloxone intravenously and if the patient improves give him the choice of remaining at home or being transported to hospital

Question 14

At 0200 hours you are dispatched to the police watch house to assess a 25-year-old male in an altered conscious state. On your arrival the arresting police officer advises that they arrested the patient for disorderly conduct and that they think that he is just drunk and want him assessed. There is no history or evidence of any other drug use other than alcohol, according to the police. On your examination the patient has a GCS of 11 (E2,V3, M6); is slurring words; is incontinent of urine; is unable to stand or walk without assistance; vomiting. His vital signs are heart rate 120 reg; BP 105/65; respiration rate 10; SpO2 97% room air; BGL 5.1 mmol/L; temp 35.9?0°C (tymp); pupils 5 mm reactive L=R. There is no evidence of trauma.Based on the patient's clinical presentation, his blood alcohol concentration is likely to be:

A) 0.05-0.08 g% (risky state)
B) 0.08-0.15 g% (dangerous state)
C) 0.15-0.30 g% (stupor)
D) >0.30 g% (at risk for death)

Question 15

You are dispatched to a 53-year-old female for agitation and confusion. On arrival at the patient's residence her partner informs you that the patient is an alcoholic. However, he hasn't has a drink for the past 3 days. On assessment of the patient she is agitated and restless with uncontrolled shaking of her hands. Her vital signs are:
Heart rate: 134 regular Blood pressure: 165/95 Skin: flushed, warm, sweaty Resp rate: 28 non-retractive SpO2: 95% room air
Temp 37.9?0°C (tymp)
GCS: 14
BSL: 2.9 mmol/L
Delirium tremens is the most serious complication of alcohol withdrawal and is a medical emergency. Typically how many days after the last drink do delirium tremens manifest?

A) 1-2 days
B) 2-3 days
C) 2-4 days
D) 2-5 days

Question 16

In relation to question 5 above, the most appropriate management of the patient would include (transport time to ED is approximately 60 mins):

A) Infusion of isotonic crystalloid to correct dehydration; administration of an intravenous benzodiazepine to manage agitation and autonomic instability; administration of intravenous 10% glucose (150 mL) to correct hypoglycaemia and transport to the emergency department
B) No specific treatment is required pre-hospital other than transport to an emergency department
C) Administration of intravenous 10% glucose (150 mL) to correct hypoglycaemia and transport to the emergency department
D) Infusion of isotonic crystalloid to correct dehydration; administration of an intravenous benzodiazepine to manage agitation and autonomic instability and transport to an emergency department

Question 17

In relation to question 6 above, administration of parental glucose to the alcoholic patient may precipitate:

A) Hyperglycaemia
B) Wernicke's encephalopathy
C) Seizures
D) Hyponatraemia

Question 18

You are dispatched to a 40-year-old male complaining of chest pain. On arrival at the residence you are met at the door by the patient, who appears distressed and in pain and is sweaty. After seating the patient he tells you that he experienced the onset of a heavy central chest pain radiating down his left arm about 30 minutes after using cocaine. He describes associated shortness of breath, palpitations and sweating. He states that he uses cocaine once or twice a week and has done for the past 5 years. He denies any other alcohol or drug use, any significant past medical history, current medications or allergies. His vital signs are:
A. Heart rate: 124 irregular Blood pressure: 145/90 Skin: pale, warm, sweaty Resp rate: 20 non-retractive SpO2: 98% room air
B. Temp: 37.2°C (tymp)
C. ECG: Sinus tachycardia with occasional PVSs; ST segment elevation in leads 1, aVL,V3,V4,V5 and V6
The most appropriate management of the patient in question 8 above is:

A) Management of his STEMI with aspirin, glyceryl trinitrate, narcotic analgesia and institution of an appropriate re-perfusion strategy such a pPCI or thrombolysis
B) Manage the patient with an intravenous benzodiazepine such as midazolam as his symptoms are most likely due to the effects of cocaine and will resolve once his tachycardia and hypertension are managed
C) Manage his STEMI with glyceryl trinitrate, narcotic analgesia and transport to a hospital capable of performing pPCI. Aspirin and other antiplatelets, anticoagulants and fibrinolytic agents are contra-indicated due to the increased risk of intracerebral haemorrhage in this patient
D) Manage with glyceryl trinitrate only as the ST segment elevation is most likely due to spasm of the coronary arteries secondary to cocaine use and this will most likely resolve the spasm

Question 19

A popular party drug that causes CNS depression, euphoria, respiratory depression, bradycardia and seizures with street names including 'liquid E' and 'grievous bodily harm' is:

A) Ecstasy
B) Phencyclidine
C) Chloral hydrate
D) Gamma-hydroxybutyrate (GHB)