WBR262

Author	[[PageAuthor::Sapan Patel M.B.B.S]]
Exam Type	ExamType::USMLE Step 3
Main Category	MainCategory::Emergency Room
Sub Category	SubCategory::Psychiatry
Prompt	[[Prompt::The police bring a 22-year-old male into the emergency room after a disruption at the local college campus. According to his medical chart, he has been treated for a depressive episode in the past. He describes his mood as "great" but claims to have been awake for 4 days due to working on several inventions. He admits to rapid thoughts and believes that God has chosen him to be the next Messiah. In fact, angels have commanded him to steal from the student union in order to begin a new church. Urine toxicology performed in order to rule out a substance of abuse as a cause of his symptoms would most likely reveal which substance?]]
Answer A	AnswerA::Alcohol
Answer A Explanation	AnswerAExp::Incorrect- While alcohol can present with psychotic symptoms, it more commonly creates a depressed picture.
Answer B	AnswerB::Benzodiazepines
Answer B Explanation	AnswerBExp::Incorrect- Benzodiazepine intoxication rarely causes manic or psychotic symptoms.
Answer C	AnswerC::Cannabis
Answer C Explanation	AnswerCExp::Incorrect- Although cannabis use is not infrequently associated with paranoia, it rarely displays frank psychosis.
Answer D	AnswerD::Cocaine
Answer D Explanation	AnswerDExp::Correct- See explanation
Answer E	AnswerE::Opiates
Answer E Explanation	AnswerEExp::Incorrect- Opiate intoxication will appear more as a depressed syndrome.
Right Answer	RightAnswer::D
Explanation	[[Explanation::This patient displays criteria for bipolar disorder, manic with psychotic features. Individuals intoxicated with cocaine classically show signs similar to mania. Frank psychotic symptoms can occur in up to 50% of individuals. Cocaine is a powerful nervous system stimulant. Its effects can last from 15–30 minutes to an hour, depending on dosage and the route of administration. Cocaine increases alertness, feelings of well-being and euphoria, energy and motor activity, feelings of competence and sexuality. Athletic performance may be enhanced in sports where sustained attention and endurance is required. Anxiety, paranoia and restlessness can also occur, especially during the comedown. With excessive dosage, tremors, convulsions and increased body temperature are observed.With excessive or prolonged use, the drug can cause itching, tachycardia, hallucinations, and paranoid delusions. Overdoses cause hyperthermia and a marked elevation of blood pressure, which can be life-threatening. Educational objective: Individuals intoxicated with cocaine classically show signs similar to mania. Frank psychotic symptoms can occur in up to 50% of individuals. Educational Objective: References: ]]
Approved	Approved::Yes
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