Thursday, 15 November 2012

Usmle Step 1 MCQ's # 4

Title: Usmle Step 1 MCQ's # 4
Subject: Behavioral Science

Q NO 4: A 49-year-old patient is evaluated for suicidal ideation after he is found laying on train tracks by police. The man is disheveled and malodorous and states that he has “reached the end” and would rather die. He admits to depressed mood, anhedonia, poor energy and appetite; he feels miserable and regrets what he has done with his life and wants to put an end to it. He states he has felt this way since age 26, alter he was discharged from the military. The man indicates that his life was “great” until he increased his drinking, which caused a divorce at age 30. He has had two arrests for driving under the influence. He was in jail for 6 months alter he had an accident while drunk that resulted in public property damage. He remembers that he initially felt sick in jail, with sweating, vomiting, shaking, and he experienced a seizure. He then improved alter a few days and felt better during the rest of his imprisonment without any depression. Which of the following criteria most strongly suggests alcohol abuse?

A. Desire to cut down
B. Recurrent drunk driving
C. Seizure alter withdrawal
D. Suicidal ideation
E. Tolerance

The correct answer is B. The DSM criteria for alcohol abuse are recurrent use resulting in failure to fulfill obligations, recurrent use in hazardous situations, recurrent legal problems related to use, and continued use despite negative consequences.
A persistent desire or unsuccessful efforts to cut down (choice A) is also a symptom of dependence.
Seizures (choice C) are a symptom of severe withdrawal in chronic alcoholics. When the patient develops withdrawal symptoms and tolerance, requiring larger amount to achieve the desired effect, he or she has met the criteria for dependence.
Suicidal ideation (choice D) in this patient is a consequence of his depression, which in turn, is secondary to alcohol use. Continued use of a substance despite knowledge of persistent or recurrent physical or psychological problems is also a criterion for dependence.
Tolerance (choice E) is defined as the need to increase substance use to achieve the desired effect, or diminished effect with continuous use of the same amount. Tolerance is a major criterion of dependence.

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