A 35-year-old man with a history of heroin use disorder presents to the clinic seeking help for his addiction. He reports strong cravings when he sees places where he previously used heroin. He also describes reduced pleasure from activities he once enjoyed, such as eating and socializing. Neuroimaging studies in individuals with chronic substance abuse often show which of the following neurobiological changes?
A 22-year-old college student reports frequent cocaine use over the past year. He describes an intense “high” but also experiences strong cravings when he sees cocaine paraphernalia or people he used to use drugs with. Which of the following brain regions plays the most significant role in linking environmental cues to drug-seeking behavior?
A 28-year-old man with opioid use disorder presents to the emergency department with withdrawal symptoms. He reports that he no longer feels pleasure from daily activities and struggles with intense cravings. The long-term dysregulation of the dopamine reward system in addiction is best explained by which of the following?
A 22-year-old man is brought to the emergency department by his friends due to bizarre behavior at a music festival. They report that he took a psychedelic drug earlier in the evening. He is experiencing intense visual hallucinations, euphoria, and paranoia, and he appears anxious and agitated. His vital signs reveal an elevated heart rate, increased blood pressure, and hyperthermia. He also reports insomnia and loss of appetite. Which of the following substances is most likely responsible for his symptoms?
Jake, a 17-year-old high school senior, arrives at the clinic for a routine check-up. During the consultation, his mother expresses concerns about his recent behavior. She has noticed a decline in his academic performance and reports that Jake has been staying out late with friends more frequently. When asked about his habits, Jake admits to occasional drinking at parties and social events, but he downplays the amount. He recalls his first experience with alcohol at the age of 15 and states that “everyone at school drinks.” Upon further questioning, Jake admits to drinking about once or twice a week, though he denies daily use or dependence. The physician explains the importance of understanding the prevalence of alcohol use among adolescents and the potential risks of continued use at this stage of life. Based on national data, the conversation shifts to exploring the broader patterns of adolescent substance use in the United States. Which of the following statements correctly reflects the trends and prevalence of alcohol use among adolescents in the United States?
A 25-year-old woman with a history of opioid use disorder has been using increasing doses of heroin over the past year to achieve the same euphoric effect. Which of the following terms best describes this phenomenon?
Ruth is a 42 year-old female who arrives in the emergency room with headache, dizziness, confusion, depression, nausea, and vomiting. Physical examination shows miosis and reduced breath sounds and respiratory rate. Her boyfriend attended a suboxone clinic and shared some pills with her this morning. She took some acetaminophen for headaches but it is not helping. Which of the following medications would help her to recover?
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?
A 42 year-old male presents to the emergency room with severe unrelenting colicky abdominal pain, urinary frequency and pain with urination for the last 3 hours. He denies any chest pain, lightheadedness and palpitations. A plain abdominal radiography showed a 4 mm stone in the right ureter.. His medical history is significant for taking methadone 100 mg a day for opioid dependence. He reports taking methadone for over 14 years with ‘no issues’. His ECG is significant for the QTc interval of 470 ms. His other lab values are given below: Sodium 138 mEq/L Potassium 3.7 mEq/L Chloride 98 mEq/L Bicarbonate 24 mEq/L Calcium 8.9 mg/dl Alanine aminotransferase 34 U/L Aspartate aminotransferase 22 U/L Urinalysis….Positive for blood After 3 hours in the emergency room, the patient spontaneously passed the stone and got tremendous relief. What is the next best step in the management of this patient?
