1_Behavioral Medicine - Alcohol & Substance Abuse

Question 1 of 82

1

Which of the following has the highest alcohol by volume (ABV) percentage?

Select one of the following:

Beer
Wine
Nyquil
Terpin Hydrate w/ DM

Explanation

Question 2 of 82

1

Which of the following is NOT an opioid?

Select one of the following:

Valium
Ultram
Suboxone
Demerol

Explanation

Question 3 of 82

1

Which of the following is NOT a benzodiazepine?

Select one of the following:

Valium
Ativan
Opana
Klonopin

Explanation

Question 4 of 82

1

Which of the following is NOT a stimulant?

Select one of the following:

dextroamphetamine
dextromethorphan
methylphenidate
modafinil

Explanation

Question 5 of 82

1

Alcohol intoxication disinhibits frontal cortical regulation of behavior.

Select one of the following:

True
False

Explanation

Question 6 of 82

1

Which of the following may occur as a result of Abstinence Syndrome/Withdrawal from ETOH?
(Check all that apply)

Select one or more of the following:

insomnia
anxiety
tremor
hypotension
bradycardia
hallucinations
seizures
delirium

Explanation

Question 7 of 82

1

ETOH is toxic to virtually all bodily tissues.

Select one of the following:

True
False

Explanation

Question 8 of 82

1

The euphoria associated with opioid abuse wanes when physiologic dependence occurs.

Select one of the following:

True
False

Explanation

Question 9 of 82

1

Opioid intoxication may cause...
(Check all that apply)

Select one or more of the following:

euphoria
increased energy
sedation
nausea/vomiting
diarrhea
pupil dilation

Explanation

Question 10 of 82

1

Short-term use of opioids is NOT associated with a hangover effect.

Select one of the following:

True
False

Explanation

Question 11 of 82

1

Which of the following may occur in Abstinence Syndrome/Withdrawal from Opioids? (Check all that apply)

Select one or more of the following:

Flu-like illness: myalgias, headache, fatigue, rhinorrhea, sneezing, hot and cold sweats, N&V, diarrhea, abdominal cramps
Signs of CNS depression: somnolence, ataxia, bradycardia, decreased BP, miosis
involuntary muscle twitches, restless legs syndrome, piloerection, tremor

Explanation

Question 12 of 82

1

Complications of non-lethal overdose on opioids may include all of the following EXCEPT:

Select one of the following:

aspiration
pneumonia
bowel impaction
A & C only
All of the above

Explanation

Question 13 of 82

1

The effects of Sedative-Hypnotic/Anxiolytic intoxication mimic ETOH intoxication in that both may cause: disinhibition of frontal cortical regulation of behavior,
ataxia, slurred speech, memory “blackouts,” sexual dysfunction, loss of consciousness, cardiovascular and respiratory collapse

Select one of the following:

True
False

Explanation

Question 14 of 82

1

sedative-hypnotic/anxiolytic intoxication may manifest as mood changes and irritability.

Select one of the following:

True
False

Explanation

Question 15 of 82

1

Withdrawal from sedative-hypnotics/anxiolytics differs from ETOH withdrawal in that: it may last for weeks and has a higher incidence of seizures.

Select one of the following:

True
False

Explanation

Question 16 of 82

1

Which of the following symptoms may be the result of acute stimulant intoxication:

Select one of the following:

Hypersomnolence
Delusions
Auditory/Visual Hallucinations
Only B & C
All of the above

Explanation

Question 17 of 82

1

Which of the following may be the result of stimulant withdrawal?
(Check all that apply)

Select one or more of the following:

Severe depression with elevated risk of suicide
Anorexia and decreased food intake
Severe fatigue
Severe hypersomnolence

Explanation

Question 18 of 82

1

Medical complications associated with stimulant abuse may include:

Select one of the following:

tachycardia
myocardial infarction
CVA
malnourishment
All of the above

Explanation

Question 19 of 82

1

The short half-life of cocaine (48 min) coupled with its intensive levels of intoxication helps drive the severe cravings and compulsiveness associated with its use.

Select one of the following:

True
False

Explanation

Question 20 of 82

1

Which of the following time estimates of addictive progression - from start to end-stage - is/are accurate?
(Check all that apply)

Select one or more of the following:

Alcohol 10-40 years
Heroin 20-40 years
Cocaine 5-10 years

Explanation

Question 21 of 82

1

While commonly known to cause relaxation and euphoria, marijuana may conversely cause stimulation, agitation, and dysphoria in others.

Select one of the following:

True
False

Explanation

Question 22 of 82

1

In young, chronic users (no pun intended), marijuana may arrest cognitive development and cause memory impairments.

Select one of the following:

True
False

Explanation

Question 23 of 82

1

Binge drinking is defined by:

Select one of the following:

5+ drinks/occasion x 1 in past 30 days
5+ drinks/occasion more than once in past 30 days
10+ drinks/occasion x 1 past 30 days
10+ drinks/occasion more than once in past 30 days
None of the above

Explanation

Question 24 of 82

1

Nearly 1 in 4 persons, ages 12 and older, in the U.S. met criteria for "binge drinking" in a 2013 national survey.

Select one of the following:

True
False

Explanation

Question 25 of 82

1

About what percent of substance use disorders are estimated to go untreated each year in the U.S.?

Select one of the following:

30%
50%
60%
90%

Explanation

Question 26 of 82

1

At-risk drinking for men and women ages 65+ years old is considered to be:

Select one of the following:

More than 2 drinks in a day (or more than 6 per week)
More than 3 drinks in a day (or more than 7 in a week)
More than 4 drinks in a day (or more than 10 a week)
More than 5 drinks in a day (or more than 12 a week)

Explanation

Question 27 of 82

1

At-risk drinking for men under 65+ years old is considered to be:

Select one of the following:

More than 2 drink in a day (or more than 5 drinks in a week)
More than 3 drinks in a day (or more than 10 in a week)
More than 4 drinks in a day (or more than 14 in a week)
More than 5 drinks in a day (or more than 20 in a week)

Explanation

Question 28 of 82

1

Broadly speaking, the DSM-IV defines substance abuse as: recurrent or continued substance use despite adverse effects.

Select one of the following:

True
False

Explanation

Question 29 of 82

1

Which of the following are characteristic of substance dependence? (Check all that apply)

Select one or more of the following:

loss of control of use (i.e. compulsive use)
tolerance (i.e. increased tolerance with decreased effect)
withdrawal (or active avoidance of withdrawal)
use to avoid negative effects rather than obtain positive ones
(i.e. no euphoria; just trying to avoid being sick)

Explanation

Question 30 of 82

1

The DSM-V groups criteria for substance use disorders into broad categories which include: (Check all that apply)

Select one or more of the following:

Impaired contol
Risky use
Social impairment
Pharmacological criteria

Explanation

Question 31 of 82

1

The DSM-V lists 11 criteria for classifying the severity of substance use disorders (SUD); which of the following does NOT accurately represent one of those classifications?

Select one of the following:

Mild SUD: 1-3 criteria met
Moderate SUD 4-5 criteria met
Severe SUD: 6+ criteria met

Explanation

Question 32 of 82

1

Physiological dependence and addiction are synonymous.

Select one of the following:

True
False

Explanation

Question 33 of 82

1

Physiological dependence may occur with non-problematic administration of a drug as it is intended to be used for the alleviation of symptoms.

Select one of the following:

True
False

Explanation

Question 34 of 82

1

SBIRT is an effective, evidence-based, and reimbursable method for dealing with substance use disorders in the context of an office visit.

SBIRT stands for:

Select one of the following:

Selective Behavioral Intervention and Relapse Test
Substances, Behaviors, Interventions, Reactions, and Treatments
Screening Brief Intervention and Referral to Treatment
Self-directed Behavioral Interviewing and Rehabilitative Teaching
Support-Based Interventions, Relapse-prevention, and Treatment

Explanation

Question 35 of 82

1

Which of the following accurately describe their purpose and function in the SBIRT method: (Check all that apply)

Select one or more of the following:

Screening: quickly assess use and severity of alcohol, illicit drug, and prescription drug abuse.
Brief Intervention: a 3-5 minute motivational and awareness-raising intervention given to risky or problematic substance users.
Referral to Treatment: referrals to specialty care for pts with substance use disorders.

Explanation

Question 36 of 82

1

Which of the following are NOT considered to be "Standard Drinks" per current U.S. guidelines? (Check all that apply)

Select one or more of the following:

12 oz. PBR
12-16 oz. Four Loko
5 oz. Franzia
1.5 oz. Maker's Mark

Explanation

Question 37 of 82

1

This man is an alcoholic.

Select one of the following:

True
False

Explanation

Question 38 of 82

1

The CAGE questionnaire is a screening tool for ETOH abuse/dependence. Which of the following is/are NOT accurately representing the acronym?

Select one or more of the following:

C: have you ever felt you should Cut down on your use of ETOH?
A: do you ever get Annoyed by others criticizing your ETOH use?
G: have you ever felt bad or Guilty because of your drinking?
E: do you find that you drink Every day/night that you are able to do so?

Explanation

Question 39 of 82

1

CAGE-AID is the same CAGE screening questions used for ETOH use, except it's "Adapted to Include Drugs" (AID).

Select one of the following:

True
False

Explanation

Question 40 of 82

1

The key to the Brief Intervention in the SBIRT, includes all of the following EXCEPT:

Select one or more of the following:

Raise the subject
Provide feedback
Enhance motivation
Negotiate a plan
Contract for safety

Explanation

Question 41 of 82

1

A patient in the "Pre-Contemplation" stage has no current intention of changing his or her behavior.

Select one of the following:

True
False

Explanation

Question 42 of 82

1

In the stages of change outlined by motivational interviewing, what comes after Contemplation (aware a problem exists; no commitment to action):

Select one of the following:

Preparation (intent upon taking action)
Action (active modification of behavior)
Maintenance (sustained change - new behavior replaces old)
Relapse (fall back into old patterns of behavior)

Explanation

Question 43 of 82

1

Using the "readiness ruler" motivational strategy, one might address a patient by asking him or her:

Select one of the following:

"Are you ready to quit?"
"On a scale of 1-10 how ready are you to quit or cut down? And why?"
"Who is the ruler of your readiness to quit?"
"Are you willing to take any measure it takes to quit?"

Explanation

Question 44 of 82

1

Using the motivational strategy of "decisional balance", what questions might you ask the patient: (Check all that apply)

Select one or more of the following:

What do you like about drinking? What are the pros/positive aspects of drinking?
What would you dislike about not drinking – disadvantages?
What do you dislike about drinking? What are the cons/disadvantages?
What would you like about not drinking? What are the benefits of not drinking?

Explanation

Question 45 of 82

1

What are the elements of a good plan, based on the SBIRT model? (Choose all that apply)

Select one or more of the following:

It reduces harm and/or provides an important learning experience
It matches the patient’s level of readiness to change
It is concrete, specific, measureable, and realistic
It ensures the patient will not use/abuse substances before the next appointment
Patient agrees to it and is able to repeat it back to you

Explanation

Question 46 of 82

1

Patients with substance use disorders and/or those who need additional assistance with problematic use often require referrals to specialty care.

Select one of the following:

True
False

Explanation

Question 47 of 82

1

Which of the following are important factors to consider when making a referral for treatment?

Select one of the following:

Past treatment history, what worked, what didn't, and why.
Inpatient vs. outpatient
Insurance/ability to pay
Patient's worries regarding treatment
All of the above are important

Explanation

Question 48 of 82

1

When making a referral for treatment, you should reassure the patient that you won’t abandon them, regardless of how treatment turns out.

Select one of the following:

True
False

Explanation

Question 49 of 82

1

The largest promise of the SBIRT approach lies in which patient population?

Select one of the following:

At-risk pts w/out current SUD
Chronic risk pts w/ recurrent SUD
Medical pts w/ co-morbid SUD
Dual-diagnosis pts w/ mental illness & SUD

Explanation

Question 50 of 82

1

Controlling for environmental influences, everyone is born with the same risk of developing SUDs.

Select one of the following:

True
False

Explanation

Question 51 of 82

1

What's your Holmes Stress Scale right now?

Select one of the following:

261
300+
You do NOT want to know...
Mental math stresses me out.
AHHHHHHHHHHHHHHHHHHH!

Explanation

Question 52 of 82

1

Protective factors increase resiliency.

Select one of the following:

True
False

Explanation

Question 53 of 82

1

What is the most common cause of secondary HTN?

Select one of the following:

ETOH
Cocaine
TOB
PA school

Explanation

Question 54 of 82

1

Name that SUD! PE: pt w/ RUQ or mid-gastric pain, HTN and/or tachycarida, and a slight tremor.

Select one of the following:

ETOH
Opiods
Sedative/hypnotics/anxiolytics
Stimulants
Marijuana

Explanation

Question 55 of 82

1

Name that SUD! PE: mydriasis, malnutrition/weight loss, tachycarida, and poor hygiene.

Select one of the following:

ETOH
Opioids
Sedative-hypnotic/anxiolytic
Stimulant
Marijunana

Explanation

Question 56 of 82

1

Name that SUD! PE: pt w/ flu-like sxs, nodding off during exam, murmur of SBE.

Select one of the following:

ETOH
Opioids
Sedative-hypnotic/anxiolytics
Stimulants
Marijuana

Explanation

Question 57 of 82

1

Name that SUD! Labs: pt w/ elevated MCV, LFTs (especially GGT), and glucose

Select one of the following:

ETOH
Opioids
Stimulants
Sedative-hypnotic/anxiolytics
Marijuana

Explanation

Question 58 of 82

1

Name that SUD! Labs: pt w/ elevated LFTs due to HCV, seropostive for STDs.

Select one of the following:

ETOH
Opioids
Stimulants
Sedative-hypnotic/anxiolytics
Marijuana

Explanation

Question 59 of 82

1

While abstinence is recommended, a pt w/ mild to moderate SUD may be able to return to "normal" use.

Select one of the following:

True
False

Explanation

Question 60 of 82

1

Abstinence is necessary for pts for pt's w/ a hx of moderate to severe ETOH, sedative hypnotic/anxiolytic, and stimulant SUDs; however, abstinence is rarely an effective strategy for pts w/ a hx of opioid SUD.

Select one of the following:

True
False

Explanation

Question 61 of 82

1

Which of the following may be indications for inpatient substance abuse tx?

Select one of the following:

medical complications (e.g. h/o seizures in withdrawal)
unstable living environment
risk of loss of job, marriage, etc.
All of the above

Explanation

Question 62 of 82

1

While abstinence is worth a try if the patient is motivated; less than 10% remain abstinent and in recovery from opioid SUDs.

Select one of the following:

True
False

Explanation

Question 63 of 82

1

What is the treatment of choice for opioid SUDs if long-term abstinence is not achieved?

Select one of the following:

Specialized long-term inpatient care (e.g. residential treatment)
Narcotics Anonymous (NA)
Cognitive Behavioral Therapy (CBT)
Medication Assisted Treatment (MAT)

Explanation

Question 64 of 82

1

Medication Assisted Treatment (MAT) for Opioid Dependence includes which of the following medications? (Check all that apply)

Select one or more of the following:

Methadone
Buprenorphine (e.g. Suboxone, Subutex, Zubsolv, Bunavail)
Naltrexone (ReVia, Vivitrol)
Modafinil (Provigil)
Acamprosate (Campral)

Explanation

Question 65 of 82

1

Which of the following are benefits of methadone tx for opioid dependence?
(Check all that apply)

Select one or more of the following:

Long-acting full agonist opioid (T½  24 hours)
Blockade (“pseudo-blockade”): No effect if use opioids
Relatively inexpensive
Easily available by Rx
Relatively few drug-drug interactions

Explanation

Question 66 of 82

1

Which of the following are disadvantages of methadone tx for opioid dependence?
(Check all that apply)

Select one or more of the following:

Incomplete relief of withdrawal or craving
Potential for sedation if dose too high, or if taken with benzodiazepine
Potential for lethal overdose
Must be discontinued when opioid analgesics needed
Relatively Expensive

Explanation

Question 67 of 82

1

Which of the following are advantages of buprenorphine tx for opioid dependence?
(Check all that apply)

Select one or more of the following:

No potential for overdose even at extremely high doses, due to “ceiling effect” (unless a large dose is combined with a large dose of benzodiazepine)
No sedation
Easily available by Rx
Relatively inexpensive
Very few drug-drug interactions

Explanation

Question 68 of 82

1

Which of the following are disadvantages of buprenorphine tx for opioid dependence?
(Check all that apply)

Select one or more of the following:

Occasional treatment failures
Multiple drug-drug interactions
Must visit clinic for daily dose
Very expensive if patient does not have insurance ($250-800 mo)
incomplete relief of withdrawal or craving (rare)

Explanation

Question 69 of 82

1

Methadone is the strongly and unanimously recommended treatment of choice for pregnant women to reduce risk of complications

Select one of the following:

True
False

Explanation

Question 70 of 82

1

Since the Drug Abuse Treatment Act of 2000 (DATA 2000), PAs can now Rx Buprenorphine for Office-Based Opioid Treatment (OBOT).

Select one of the following:

True
False

Explanation

Question 71 of 82

1

Suboxone, a sublingual film and combination of buprenorphine and naloxone, is specifically formulated to prevent abuse and associated overdose.

Select one of the following:

True
False

Explanation

Question 72 of 82

1

Buprenorphine, sublingual tablets without naloxone, is available, primarily for pregnant women and rare patients who have sensitivity to naloxone.

Select one of the following:

True
False

Explanation

Question 73 of 82

1

Naltrexone benefits in MAT for Opioid Dependence
(Check all that apply)

Select one or more of the following:

Long-acting pure opioid antagonist (PO T½ = 4h for parent drug (13h for active metabolite)
once a day PO dosing
Preferentially displaces opioids at receptors, blocking all opioid effects (i.e. if patient uses opioids, they have no effect)
available as monthly IM injection
Generally good compliance rates

Explanation

Question 74 of 82

1

Naltrexone disadvantages in MAT for Opioid Dependence (Check all that apply)

Select one or more of the following:

Need to monitor LFTs due to hepatic toxicity (rare)
Notoriously poor compliance with PO tabs
Must be discontinued when opioid analgesics needed (e.g., surgery; compare to buprenorphine)
IM injections are extremely expensive ($800-1200mo) if not covered by insurance
Unreliable mechanism of action; can result in accidental OD

Explanation

Question 75 of 82

1

Naltrexone advantages in MAT for ETOH Dependence (Check all that apply)

Select one or more of the following:

Impedes activation of endorphins and enkephalins (endogenous opioid reward system) by alcohol
Reduces craving for alcohol
Causes sickness in pts that use ETOH to disincentivize relapse
Reduces euphoria if alcohol is consumed
Better compliance rate with PO dosing than when using for opioid dependence (even better efficacy w/ IM injections)

Explanation

Question 76 of 82

1

This drug (used in MAT for ETOH dependence) interrupts the metabolism of ethanol, resulting in accumulation of acetaldehyde that causes acute illness with potential sxs of nausea, vomiting, hypotension, facial flushing, tachycardia and palpitations, anxiety, chest pain, SOB, headache.

Select one of the following:

naltrexone
disulfiram
acamprosate
modafinil

Explanation

Question 77 of 82

1

Studies have shown disulfiram (antabuse) to be no better than placebo in the tx of ETOH dependence.

Select one of the following:

True
False

Explanation

Question 78 of 82

1

For some people, drinking alcohol causes an increase in glutamate and corresponding decrease in GABA in the CNS, which is associated with feeling anxious, restless, ill-at-ease. This drug enhances GABA and modulates glutamate, thereby restoring a healthy balance in CNS.

Select one of the following:

naltrexone
disulfiram
modafinil
acamprosate
buprenorphine

Explanation

Question 79 of 82

1

Which of the following are used in MAT for Cocaine Dependence? (Check all that apply)

Select one or more of the following:

disulfiram
modafinil
baclofen
naltrexone
buprenorphine

Explanation

Question 80 of 82

1

Addiction is a chronic, relapsing and remitting, illness, and like other chronic diseases (e.g. diabetes, HTN), there is no cure - only effective treatment.

Select one of the following:

True
False

Explanation

Question 81 of 82

1

Relapse is a normal, expected part of the recovery process.

Select one of the following:

True
False

Explanation

Question 82 of 82

1

Recovery from SUDs is:

Select one of the following:

usually a single event in time during treatment in which a pt finally makes a conscious effort to fully and completely abstain from use
a process where, over time, a person has shorter, less frequent episodes, and longer periods of sobriety in between
not possible, because addiction is a lifelong disease
unlikely to occur in the vast majority of all SUDs
up to the addict, who must inevitably hit "rock bottom" before turning away from substance use/abuse

	Created by campbellpa2017 over 8 years ago

	Copied by campbellpa2017 over 8 years ago

Alcohol & Substance Abuse

1_Behavioral Medicine - Alcohol & Substance Abuse

Question 1 of 82

Which of the following has the highest alcohol by volume (ABV) percentage?

Select one of the following:

Explanation

Question 2 of 82

Which of the following is NOT an opioid?

Select one of the following:

Explanation

Question 3 of 82

Which of the following is NOT a benzodiazepine?

Select one of the following:

Explanation

Question 4 of 82

Which of the following is NOT a stimulant?

Select one of the following:

Explanation

Question 5 of 82

Alcohol intoxication disinhibits frontal cortical regulation of behavior.

Select one of the following:

Explanation

Question 6 of 82

Which of the following may occur as a result of Abstinence Syndrome/Withdrawal from ETOH? (Check all that apply)

Select one or more of the following:

Explanation

Question 7 of 82

ETOH is toxic to virtually all bodily tissues.

Select one of the following:

Explanation

Question 8 of 82

The euphoria associated with opioid abuse wanes when physiologic dependence occurs.

Select one of the following:

Explanation

Question 9 of 82

Opioid intoxication may cause... (Check all that apply)

Select one or more of the following:

Explanation

Question 10 of 82

Short-term use of opioids is NOT associated with a hangover effect.

Select one of the following:

Explanation

Question 11 of 82

Which of the following may occur in Abstinence Syndrome/Withdrawal from Opioids? (Check all that apply)

Select one or more of the following:

Explanation

Question 12 of 82

Complications of non-lethal overdose on opioids may include all of the following EXCEPT:

Select one of the following:

Explanation

Question 13 of 82

The effects of Sedative-Hypnotic/Anxiolytic intoxication mimic ETOH intoxication in that both may cause: disinhibition of frontal cortical regulation of behavior, ataxia, slurred speech, memory “blackouts,” sexual dysfunction, loss of consciousness, cardiovascular and respiratory collapse

Select one of the following:

Explanation

Question 14 of 82

sedative-hypnotic/anxiolytic intoxication may manifest as mood changes and irritability.

Select one of the following:

Explanation

Question 15 of 82

Withdrawal from sedative-hypnotics/anxiolytics differs from ETOH withdrawal in that: it may last for weeks and has a higher incidence of seizures.

Select one of the following:

Explanation

Question 16 of 82

Which of the following symptoms may be the result of acute stimulant intoxication:

Select one of the following:

Explanation

Question 17 of 82

Which of the following may be the result of stimulant withdrawal? (Check all that apply)

Select one or more of the following:

Explanation

Question 18 of 82

Medical complications associated with stimulant abuse may include:

Select one of the following:

Explanation

Question 19 of 82

The short half-life of cocaine (48 min) coupled with its intensive levels of intoxication helps drive the severe cravings and compulsiveness associated with its use.

Select one of the following:

Explanation

Question 20 of 82

Which of the following time estimates of addictive progression - from start to end-stage - is/are accurate? (Check all that apply)

Which of the following may occur as a result of Abstinence Syndrome/Withdrawal from ETOH?
(Check all that apply)

Opioid intoxication may cause...
(Check all that apply)

The effects of Sedative-Hypnotic/Anxiolytic intoxication mimic ETOH intoxication in that both may cause: disinhibition of frontal cortical regulation of behavior,
ataxia, slurred speech, memory “blackouts,” sexual dysfunction, loss of consciousness, cardiovascular and respiratory collapse

Which of the following may be the result of stimulant withdrawal?
(Check all that apply)

Which of the following time estimates of addictive progression - from start to end-stage - is/are accurate?
(Check all that apply)

SBIRT is an effective, evidence-based, and reimbursable method for dealing with substance use disorders in the context of an office visit.

SBIRT stands for: