Laura is a 24 year-old female who came to the emergency room this evening with severe nausea, vomiting, diarrhea, tremors, hot and cold flushes, sweating, and goosebumps. In the physical examination, you found an anxious, watery eyed patient, who was yawning and restless. She reports that she has been using oxycodone, methadone regularly and marijuana occasionally. Last night she had two beers, her regular daily intake. Today she went to an outpatient clinic for the treatment of her opioid disorder and was started on naloxone 50 mg once daily. Which of the following medications is the reason for her emergency room visit this evening?
Ayaan is a 24 year-old female who has been diagnosed with alcohol dependence. She would like to get started on an opioid antagonist to treat her alcoholism. Of the following, which is an opioid antagonist approved for adjunctive treatment of alcohol dependence?
One of your patients has been struggling to get control over his alcohol use. He would like to have some information about pharmacologic and nonpharmacologic options for the treatment of alcohol use disorder. You recommended participation in Alcoholics Anonymous. Regarding Alcoholics Anonymous (AA), which of the following statements is true?
A 67 year-male came to your office for refills on his medications. His current medical disorders include hypertension and gastroesophageal reflux disorder. He drinks 10 – 14 alcoholic drinks per week. Of the following, which is a medical consequence of alcohol use in older adults?
A 32 year-old man comes to your office because he needs a refill on his allopurinol. As you go over his social history and alcohol use, he informs you that he drinks up to 16 drinks a week. He has tried to cut it down to 5 drinks per week but he could not. His wife is not happy with his drinking and it caused ‘some disturbance’ in their relationship. Which of the following is the most likely diagnosis in this patient regarding his alcohol use?
John is a 9 year-old boy admitted to the hospital for the treatment of a complicated ear infection. He protested while a phlebotomist tried to insert an intravenous catheter into his vein. He complained that the whole experience is ‘painful and stressful’ and the taste of the hospital food is ‘just unbearable’. Next morning, his mother notices he wetted his bed. John’s bedwetting stopped when he was 5 years-old and now it returned during his hospital stay. This is an example of which of the following defense mechanisms?
You’re excited to see your first patient for the day. When you opened the door of the exam room, you found a 30 year-old attractive female who was already smiling at you even before you greeted her. She wore flashy, revealing clothing with the front of her blouse unbuttoned to expose her breasts. You asked her politely, ‘So, how can I help you today?’ She replied, ‘I need some help with my headaches’. You asked, ‘What triggers your headaches?’ She replied, ‘Well, I am having lots of loneliness in my life. All the good men are taken’ and looked seductively at your wedding ring and touched you on the forearm. One of your medical assistants entered the exam room to pick up a blood pressure cuff. You looked at the medical assistant but the patient did not want to lose your attention even for a moment. “Why are you craving to be the center of attention?” You asked the patient in your mind, though you did not put it in your words to the patient. “So, what do you do for fun, Dr.James?” She asked you. ‘Seriously? You are calling me by my first name in the first few minutes of our meeting?’ You said to yourself. She reports that she is so bored in this town and would like to move to a new place. She reports a history of multiple broken relationships and suicide attempts. Suddenly she becomes tearful after bursts of laughter just a few moments ago. You told her that you are not planning to prescribe any medications today and you think she would be better off going to counseling. She replies, ‘I hate counseling. But if you are going to be my counselor, I would do it a million times.’ You tried to convince her that you don’t do counseling. She becomes tearful and says, ‘Please don’t say no. You are the only one I can trust in this practice.’ Which of the following is the most likely diagnosis in this patient?
A male patient comes to your office because he needs an urgent prescription for alprazolam. He shouts at your staff for keeping him too long in the waiting room even though he arrived late for his appointment. He called himself Jack Snyder even though his driver’s license shows a different name. Your office staff reports that he has a very ‘negative vibe around him’. Finally, when you meet him in the room, he states, ‘Doc, I respect you. But listen, if I don’t get some xanax today, I might seriously harm someone in this office or outside.I took buprenorphine from a friend. It’s crap. It’s not helping me to calm down’. As you explore his history, he informs you that during his school years, teachers warned him to respect the rights of other students, to control his impulsive behavior, and to take the safety of others seriously. He has a history of arrests for shoplifting and imprisonments for violent behavior and possession of drug paraphernalia. He has a family history of alcoholism, drug abuse, imprisonments and hysteria. During his school years, he was diagnosed with conduct disorder. When you inform him that he needs another follow up, he shouts, ‘I am in between jobs. I don’t have money to pay for these visits. I still owe a lot of money to a lot of people. My girlfriend left me last week’. In the physical and mental health examination, you notice an aggressive individual with a manipulative attitude, low frustration tolerance, high propensity for anger, poor impulse control and poor judgment. His orientation and cognition appear normal. He has no delusions or hallucinations. He has a tattoo on his right deltoid which indicates a gang affiliation. To diagnose this individual with antisocial personality disorder, he must have been at least
A 22 year-old male comes to your office because he needs an urgent prescription for alprazolam. He shouts at your staff for keeping him too long in the waiting room even though he arrived late for his appointment. He called himself Jack Snyder even though his driver’s license shows a different name. Your office staff reports that he has a very ‘negative vibe around him’. Finally, when you meet him in the room, he states, ‘Doc, I respect you. But listen, if I don’t get some xanax today, I might seriously harm someone in this office or outside.I took buprenorphine from a friend. It’s crap. It’s not helping me to calm down’. As you explore his history, he informs you that during his school years, teachers warned him to respect the rights of other students, to control his impulsive behavior, and to take the safety of others seriously. He has a history of arrests for shoplifting and imprisonments for violent behavior and possession of drug paraphernalia. He has a family history of alcoholism, drug abuse, imprisonments and hysteria. During his school years, he was diagnosed with conduct disorder. When you inform him that he needs another follow up, he shouts, ‘I am in between jobs. I don’t have money to pay for these visits. I still owe a lot of money to a lot of people. My girlfriend left me last week’. In the physical and mental health examination, you notice an aggressive individual with a manipulative attitude, low frustration tolerance, high propensity for anger, poor impulse control and poor judgment. His orientation and cognition appear normal. He has no delusions or hallucinations. He has a tattoo on his right deltoid which indicates a gang affiliation. Which of the following is the most common feature of this disorder?
