ASAM QUESTION BANK QUESTIONS AND VERIFIED
ANSWERS
1. A 32-year-old woman is being evaluated for alcoholism. This is her first time in
treatment. She has a 15-year history of alcohol dependence. Which of the following is
the most appropriate medication? - Answers - Naltrexone
2. A 14-year-old boy comes to the office for an annual examination. During the
interview, he tells his physician that he has switched from smoking cigarettes to using
smokeless tobacco because he does not want to get lung cancer. The physician should
tell the patient that he is now at increased risk for cancer of which of the following? -
Answers - Esophageal
3. A 32-year-old woman comes to the office seeking assistance with smoking cessation.
She has smoked two packs of cigarettes daily for the past eight years. She has
attempted to quit twice before but was unable to overcome the withdrawal symptoms.
She is using a nicotine transdermal system to assist her in smoking cessation. Which of
the following is a side effect she should still expect to experience during her withdrawal
of nicotine? - Answers - Impaired reaction time
4. A 42-year-old physician who specializes in ear, nose, and throat conditions is being
interviewed for a position by a hospital. She has active licenses in Arizona, Idaho, and
Missouri (her last place of residence for seven years). The training listed on her CV
received has been verified by a primary source. The National Data Bank contains no
adverse records. Which of the following is troublesome to require? - Answers -
Polygraph test
5. A 45-year-old injection drug user was started on methadone maintenance one month
prior to his current hospitalization for pneumonia. On a routine inpatient
electrocardiogram, he has a prolonged QT interval. In addition to his methadone dose,
which of the following factors increases his risk for developing an arrhythmia? - Answers
- Hypokalemia
6. A 30-year-old woman began taking alprazolam 0.25 mg four times daily two weeks
ago for generalized anxiety disorder (GAD). She now has increased sedation as
treatment continues. For this patient, select the most appropriate term: - Answers -
Sensitization
7. A 45-year-old woman who has been taking alprazolam 0.5 mg four times daily for
GAD ruminates about the next dose beginning two hours after the last dose. For this
patient, select the most appropriate term: - Answers - Pseudowithdrawal
,8. A 45-year-old man took alprazolam for GAD for one year. He was weaned off the
medication over a three-month period. Two weeks after complete cessation, he notices
increased worry. For this patient, select the most appropriate term: - Answers -
Symptom recurrence (not true withdrawal)
9. A 45-year-old man was placed on alprazolam 0.25 mg three times daily for GAD and
treatment was successful. He was tapered off of the medication over three months. One
week after complete cessation, he is tormented by anxiety and is sleeping only two
hours per night. For this patient, select the most appropriate term: - Answers - Rebound
(not true withdrawal)
10. A 36-year-old man who has a 20-year history of smoking cigarettes comes to the
office for counseling about smoking cessation. He has heard that "light" cigarettes may
be safer and less addictive and asks whether they could help him stop smoking. Which
of the following statements about light cigarettes is supported by scientific evidence? A:
Smokers adjust their current nicotine level by adjusting puffing habits - Answers -
Smokers adjust their current nicotine level by adjusting puffing habits
11. A 50-year-old man with alcohol dependency is hospitalized with signs of acute
withdrawal. Which of the following drugs should be administered to prevent Wernicke's
encephalopathy in this patient? - Answers - thiamine
12. A 25-year-old man is brought to the emergency department by his partner because
of a two-day history of agitation. The patient says he left his work early because his
boss was spying on him. His speech is pressured. He says he has been taking
medication for the past three months. His partner reports that the patient had been
taking more than the prescribed dose because he was preparing for a college
examination. Which of the following medications is the most likely cause of his
symptoms? - Answers - methylphenidate
13. A 45-year-old man has jaundice caused by chronic alcohol abuse. His physician
spends several minutes asking him about his drinking habits and encourages him to
consider stopping drinking. The patient is not ready to contemplate stopping at that visit,
but the physician brings up the topic in a nonthreatening manner at subsequent visits
until the patient decides to take some action to stop drinking. The physician then offers
the patient several choices for accomplishing that goal. This framework of brief
interventions to promote healthful behavior is known as which of the following? -
Answers - motivational interviewing
14. A 17-year-old boy comes to the office for a sports physical examination. When
asked about his drug and alcohol use, he discloses that he recently started smoking
marijuana. Which of the following is the most likely source from which he obtained the
marijuana? - Answers - Friends
15. A retired physician works eight hours per week at a private general medicine clinic
in a rural community. The practice serves primarily economically stable, Medicare-
,eligible patients. Recently, the physician learned and implemented a new diagnostic test
with a sensitivity of 91% and specificity of 94% to diagnose a disease. However, one of
the physician's patients believes he has been incorrectly diagnosed as a result of this
test and retains a lawyer to file a suit against the physician. The successful court
argument against the use of the test by the physician is most likely based on which of
the following? - Answers - Cases in the population per year (prevalence)
16. Which of the following disorders would most likely benefit from treatment with
cannabinoid type 1 (CB1) receptor antagonists? - Answers - Obesity(ref : Trends
Neurosci. 2006 Feb 14; Links Involvement of the endocannabinoid system in drug
addiction. Maldonado R, Valverde O, Berrendero F. 6:Gadde KM. Endocannabinoid
receptor antagonists and other emerging pharma-cological strategies for weight
reduction. Curr Drug Targets Cardiovasc Haematol Disord. 2005 Dec;5(6):549-56.)
17. A patient comes to the emergency department because he is "hearing colors and
smelling sounds." He reports taking an unknown substance at a party several hours
ago. Vital signs show increased pulse rate and blood pressure. The patient is quite
agitated and wants these effects to go away. Which of the following drugs is most likely
to cause these effects? - Answers - Lysergic acid diethylamide (LSD)
18. Which of the following neurotransmitters is most closely associated with the function
of the brain reward circuitry? - Answers - Dopamine
19. A 19-year-old college student is brought to the emergency department after using
drugs for the first time. He says he initially felt as if he was "melting through the floor,"
but now feels as if he is "floating through alternate realities." The experience lasts about
one-half hour. Which of the following substances is the most likely cause of his
symptoms? - Answers - Salvia(ref: Lange JE, Reed MB, Croff JM, et al: College student
use of Salvia divinorum. Drug Alcohol Depend 2008;94:263-266.)
20. Which of the following problems with alcohol is likely to be most common among
patients admitted in outpatient settings? - Answers - at-risk drinking
21. A 25-year-old woman who has just given birth is concerned that her child has
inherited a predisposition for smoking. She and the child's father have recently quit
smoking, but many of their first- and second-degree family members smoke. The risk
that this child will smoke based on genetic factors alone is closest to what percentage? -
Answers - 60%(ref: Reference: Sullivan PF, Kendler KS: The genetic epidemiology of
smoking. Nicotine Tob Res 1999;1 Suppl 2: S51-S57.)
22. A 23-year-old man is currently undergoing treatment for heroin dependence. He
reports that his heroin dealer gave him a small supply while he was experiencing
withdrawal symptoms. The patient will most likely perceive heroin as which of the
following? - Answers - negative reinforcement (ref: Molecular Neuropharmacology,
Nestler, et al. 2001 p. 356)
, 23. A 25-year-old man is abusing a drug of choice daily and at relatively consistent
amounts. Which of the following drugs is he most likely using? - Answers - heroin (ref:
Molecular Neuropharmacology, Nestler, et al. 2001 p. 361)
24. A 48-year-old man comes for consultation after seeing light trails behind moving
objects and having the feeling that he could "smell colors" around him. These symptoms
first occurred one day after he began lifting weights to relieve work-related stress. He
says that he has used lysergic acid diethylamide (LSD), cocaine, gamma-
hydroxybutyrate (GHB), kava kava, and toluene in the past. Which of the following
drugs is most likely responsible? - Answers - LSD (ref: Weaver MF, Schnoll SH.
Hallucinogens and club drugs. In M. Galanter & H. D. Klebert (Eds.), Textbook of
Substance Abuse Treatment, 4th Ed., Washington, D.C.: American Psychiatric Press,
pp 191-200, 2008)
25. A 48-year-old man comes for consultation after seeing light trails behind moving
objects and having the feeling that he could "smell colors" around him. These symptoms
first occurred one day after he began lifting weights to relieve work-related stress. He
says that he has used lysergic acid diethylamide (LSD), cocaine, gamma-
hydroxybutyrate (GHB), kava kava, and toluene in the past. Within which of the
following time frames did this patient most likely use this drug? - Answers - one year
(same ref as 23)
26. A 26-year-old man is brought to the emergency department by his roommates two
hours after he became agitated and confused. They report that he was not drinking
alcohol or using illicit drugs prior to the change in behavior. For the past six months, he
has been taking a liquid supplement obtained from a trainer at his gym. He had used
the supplement every two to four hours daily, but stopped six hours ago because he
had begun to need more of it to achieve its calming effect and he was unable to fall
asleep without using it. He has no history of serious illness and takes no other
medications. The patient is agitated and restless. He says he hears voices he does not
recognize and sees things "moving that are not moving." His pulse is 104/min and blood
pressure is 170/100 mm Hg. Physical examination shows vertical nystagmus and a fine
tremor in both of his upper extremities. He is unable to sit through the examinatio -
Answers - begin high-dose diazepam (ref: Graham et al. Principles of Addiction
Medicine: Third Edition. 2003, 686-690)
27. A 26-year-old man is brought to the emergency department by his roommates two
hours after he became agitated and confused. They report that he was not drinking
alcohol or using illicit drugs prior to the change in behavior. For the past six months, he
has been taking a liquid supplement obtained from a trainer at his gym. He had used
the supplement every two to four hours daily, but stopped six hours ago because he
had begun to need more of it to achieve its calming effect and he was unable to fall
asleep without using it. He has no history of serious illness and takes no other
medications. The patient is agitated and restless. He says he hears voices he does not
recognize and sees things "moving that are not moving." High-dose diazepam is
administered. The patient does not improve and he becomes increasingly combative.
ANSWERS
1. A 32-year-old woman is being evaluated for alcoholism. This is her first time in
treatment. She has a 15-year history of alcohol dependence. Which of the following is
the most appropriate medication? - Answers - Naltrexone
2. A 14-year-old boy comes to the office for an annual examination. During the
interview, he tells his physician that he has switched from smoking cigarettes to using
smokeless tobacco because he does not want to get lung cancer. The physician should
tell the patient that he is now at increased risk for cancer of which of the following? -
Answers - Esophageal
3. A 32-year-old woman comes to the office seeking assistance with smoking cessation.
She has smoked two packs of cigarettes daily for the past eight years. She has
attempted to quit twice before but was unable to overcome the withdrawal symptoms.
She is using a nicotine transdermal system to assist her in smoking cessation. Which of
the following is a side effect she should still expect to experience during her withdrawal
of nicotine? - Answers - Impaired reaction time
4. A 42-year-old physician who specializes in ear, nose, and throat conditions is being
interviewed for a position by a hospital. She has active licenses in Arizona, Idaho, and
Missouri (her last place of residence for seven years). The training listed on her CV
received has been verified by a primary source. The National Data Bank contains no
adverse records. Which of the following is troublesome to require? - Answers -
Polygraph test
5. A 45-year-old injection drug user was started on methadone maintenance one month
prior to his current hospitalization for pneumonia. On a routine inpatient
electrocardiogram, he has a prolonged QT interval. In addition to his methadone dose,
which of the following factors increases his risk for developing an arrhythmia? - Answers
- Hypokalemia
6. A 30-year-old woman began taking alprazolam 0.25 mg four times daily two weeks
ago for generalized anxiety disorder (GAD). She now has increased sedation as
treatment continues. For this patient, select the most appropriate term: - Answers -
Sensitization
7. A 45-year-old woman who has been taking alprazolam 0.5 mg four times daily for
GAD ruminates about the next dose beginning two hours after the last dose. For this
patient, select the most appropriate term: - Answers - Pseudowithdrawal
,8. A 45-year-old man took alprazolam for GAD for one year. He was weaned off the
medication over a three-month period. Two weeks after complete cessation, he notices
increased worry. For this patient, select the most appropriate term: - Answers -
Symptom recurrence (not true withdrawal)
9. A 45-year-old man was placed on alprazolam 0.25 mg three times daily for GAD and
treatment was successful. He was tapered off of the medication over three months. One
week after complete cessation, he is tormented by anxiety and is sleeping only two
hours per night. For this patient, select the most appropriate term: - Answers - Rebound
(not true withdrawal)
10. A 36-year-old man who has a 20-year history of smoking cigarettes comes to the
office for counseling about smoking cessation. He has heard that "light" cigarettes may
be safer and less addictive and asks whether they could help him stop smoking. Which
of the following statements about light cigarettes is supported by scientific evidence? A:
Smokers adjust their current nicotine level by adjusting puffing habits - Answers -
Smokers adjust their current nicotine level by adjusting puffing habits
11. A 50-year-old man with alcohol dependency is hospitalized with signs of acute
withdrawal. Which of the following drugs should be administered to prevent Wernicke's
encephalopathy in this patient? - Answers - thiamine
12. A 25-year-old man is brought to the emergency department by his partner because
of a two-day history of agitation. The patient says he left his work early because his
boss was spying on him. His speech is pressured. He says he has been taking
medication for the past three months. His partner reports that the patient had been
taking more than the prescribed dose because he was preparing for a college
examination. Which of the following medications is the most likely cause of his
symptoms? - Answers - methylphenidate
13. A 45-year-old man has jaundice caused by chronic alcohol abuse. His physician
spends several minutes asking him about his drinking habits and encourages him to
consider stopping drinking. The patient is not ready to contemplate stopping at that visit,
but the physician brings up the topic in a nonthreatening manner at subsequent visits
until the patient decides to take some action to stop drinking. The physician then offers
the patient several choices for accomplishing that goal. This framework of brief
interventions to promote healthful behavior is known as which of the following? -
Answers - motivational interviewing
14. A 17-year-old boy comes to the office for a sports physical examination. When
asked about his drug and alcohol use, he discloses that he recently started smoking
marijuana. Which of the following is the most likely source from which he obtained the
marijuana? - Answers - Friends
15. A retired physician works eight hours per week at a private general medicine clinic
in a rural community. The practice serves primarily economically stable, Medicare-
,eligible patients. Recently, the physician learned and implemented a new diagnostic test
with a sensitivity of 91% and specificity of 94% to diagnose a disease. However, one of
the physician's patients believes he has been incorrectly diagnosed as a result of this
test and retains a lawyer to file a suit against the physician. The successful court
argument against the use of the test by the physician is most likely based on which of
the following? - Answers - Cases in the population per year (prevalence)
16. Which of the following disorders would most likely benefit from treatment with
cannabinoid type 1 (CB1) receptor antagonists? - Answers - Obesity(ref : Trends
Neurosci. 2006 Feb 14; Links Involvement of the endocannabinoid system in drug
addiction. Maldonado R, Valverde O, Berrendero F. 6:Gadde KM. Endocannabinoid
receptor antagonists and other emerging pharma-cological strategies for weight
reduction. Curr Drug Targets Cardiovasc Haematol Disord. 2005 Dec;5(6):549-56.)
17. A patient comes to the emergency department because he is "hearing colors and
smelling sounds." He reports taking an unknown substance at a party several hours
ago. Vital signs show increased pulse rate and blood pressure. The patient is quite
agitated and wants these effects to go away. Which of the following drugs is most likely
to cause these effects? - Answers - Lysergic acid diethylamide (LSD)
18. Which of the following neurotransmitters is most closely associated with the function
of the brain reward circuitry? - Answers - Dopamine
19. A 19-year-old college student is brought to the emergency department after using
drugs for the first time. He says he initially felt as if he was "melting through the floor,"
but now feels as if he is "floating through alternate realities." The experience lasts about
one-half hour. Which of the following substances is the most likely cause of his
symptoms? - Answers - Salvia(ref: Lange JE, Reed MB, Croff JM, et al: College student
use of Salvia divinorum. Drug Alcohol Depend 2008;94:263-266.)
20. Which of the following problems with alcohol is likely to be most common among
patients admitted in outpatient settings? - Answers - at-risk drinking
21. A 25-year-old woman who has just given birth is concerned that her child has
inherited a predisposition for smoking. She and the child's father have recently quit
smoking, but many of their first- and second-degree family members smoke. The risk
that this child will smoke based on genetic factors alone is closest to what percentage? -
Answers - 60%(ref: Reference: Sullivan PF, Kendler KS: The genetic epidemiology of
smoking. Nicotine Tob Res 1999;1 Suppl 2: S51-S57.)
22. A 23-year-old man is currently undergoing treatment for heroin dependence. He
reports that his heroin dealer gave him a small supply while he was experiencing
withdrawal symptoms. The patient will most likely perceive heroin as which of the
following? - Answers - negative reinforcement (ref: Molecular Neuropharmacology,
Nestler, et al. 2001 p. 356)
, 23. A 25-year-old man is abusing a drug of choice daily and at relatively consistent
amounts. Which of the following drugs is he most likely using? - Answers - heroin (ref:
Molecular Neuropharmacology, Nestler, et al. 2001 p. 361)
24. A 48-year-old man comes for consultation after seeing light trails behind moving
objects and having the feeling that he could "smell colors" around him. These symptoms
first occurred one day after he began lifting weights to relieve work-related stress. He
says that he has used lysergic acid diethylamide (LSD), cocaine, gamma-
hydroxybutyrate (GHB), kava kava, and toluene in the past. Which of the following
drugs is most likely responsible? - Answers - LSD (ref: Weaver MF, Schnoll SH.
Hallucinogens and club drugs. In M. Galanter & H. D. Klebert (Eds.), Textbook of
Substance Abuse Treatment, 4th Ed., Washington, D.C.: American Psychiatric Press,
pp 191-200, 2008)
25. A 48-year-old man comes for consultation after seeing light trails behind moving
objects and having the feeling that he could "smell colors" around him. These symptoms
first occurred one day after he began lifting weights to relieve work-related stress. He
says that he has used lysergic acid diethylamide (LSD), cocaine, gamma-
hydroxybutyrate (GHB), kava kava, and toluene in the past. Within which of the
following time frames did this patient most likely use this drug? - Answers - one year
(same ref as 23)
26. A 26-year-old man is brought to the emergency department by his roommates two
hours after he became agitated and confused. They report that he was not drinking
alcohol or using illicit drugs prior to the change in behavior. For the past six months, he
has been taking a liquid supplement obtained from a trainer at his gym. He had used
the supplement every two to four hours daily, but stopped six hours ago because he
had begun to need more of it to achieve its calming effect and he was unable to fall
asleep without using it. He has no history of serious illness and takes no other
medications. The patient is agitated and restless. He says he hears voices he does not
recognize and sees things "moving that are not moving." His pulse is 104/min and blood
pressure is 170/100 mm Hg. Physical examination shows vertical nystagmus and a fine
tremor in both of his upper extremities. He is unable to sit through the examinatio -
Answers - begin high-dose diazepam (ref: Graham et al. Principles of Addiction
Medicine: Third Edition. 2003, 686-690)
27. A 26-year-old man is brought to the emergency department by his roommates two
hours after he became agitated and confused. They report that he was not drinking
alcohol or using illicit drugs prior to the change in behavior. For the past six months, he
has been taking a liquid supplement obtained from a trainer at his gym. He had used
the supplement every two to four hours daily, but stopped six hours ago because he
had begun to need more of it to achieve its calming effect and he was unable to fall
asleep without using it. He has no history of serious illness and takes no other
medications. The patient is agitated and restless. He says he hears voices he does not
recognize and sees things "moving that are not moving." High-dose diazepam is
administered. The patient does not improve and he becomes increasingly combative.
