ASAM TEST BANK QUESTIONS WITH
100% CORRECT ANSWERS |
ALREADY PASSED
A 47-year-old woman with a history of polysubstance abuse presents because of
difficulties with sleep. Most recently, she had been misusing opioids. She has made
every effort to discontinue use of all substances. Unfortunately, as she has tried to taper
off all opioids she has had particular difficulties with sleep. Initially, she describes
problems with sleep initiation. She notes particular problems when she tries to relax.
She notes a long history of problems getting herself to relax in an attempt to fall asleep.
Although you are suspicious that an underlying anxiety disorder is the major issue with
regard to sleep, you also decide to pursue other possibilities. In particular, you are
concerned about a possible unmasking of another disorder as she had withdrawn from
the use of opioids. She then notes particular urge to move as she tries to relax in bed.
She actually notes a similar sensation when she is a pas - Answer- A sleep study to
screen for a rhythmic movement disorder.
In follow-up visits, the sense of restlessness seems to fade into the background with
treatment. The patient also confesses that she is actually bothered by vivid dreams, but
has attributed this to the SSRI that was started about a year ago by her primary care
physician. Her anxiety improved considerably with the use of the medication and, for
several months, she thought that her symptoms were improving. Unfortunately, she
discontinues the SSRI because of side effects. Over time, she tries several other
medications, but is confronted with other side effects. Sleep initiation is becoming an
increasing problem. She starts to fixate on her inability to fall asleep. You consider
some options. She is also concerned about her susceptibility to addiction. The next
approach that will avoid this concern and avoid other potential side effects, might
include: - Answer- Cognitive-behavioral therapy (CBT).
After several years, the patient started to gradually increase her alcohol consumption.
Initially, she noted that it helped with her sleep initiation. Ironically, the improvement in
sleep initiation did not make her sleep more refreshing. Fortunately, after several years
of heavy, chronic use, she was able to give up the alcohol. She sees you again, after
being sober for about a year. She describes her sleep as being fragmented. There is a
history of snoring, recent weight gain since discontinuing cigarettes, and a recent onset
of hypertension. You decide to order a sleep study to rule out obstructive sleep apnea.
Although she has not consumed any alcohol in more than a year, you would still expect
,which of the following features on the PSG? - Answer- Persistent sleep fragmentation
with a decrease in SWS.
What % of individuals visiting the emergency department who have been drinking and
are injured in MVCs may connect their alcohol use to the injury event. - Answer- 30%
The six elements (FRAMES) and sequence of the brief intervention as proposed by
Miller and Sanchez include: - Answer- Feedback, responsibility, advice, menu of
strategies, empathy, and self-efficacy.
A 41-year-old man has a screening bone density showing a spine T-score of −4.4 and a
femoral neck T-score of −2.8. His past medical history includes type 1 diabetes mellitus,
hypothyroidism, and chronic back pain due to multiple compression fractures, treated
with 60 mg of methadone spaced throughout the day as well as oxycodone 15 to 30 mg
for breakthrough pain. He has a distant history of IV cocaine use and heavy alcohol use
and quit smoking cigarettes 3.5 months ago. He drinks 32 ounces of coffee daily.
Physical exam reveals a thin WM in NAD; blood pressure 102/76; heart rate 116 bpm;
weight 168 pounds; height 70 inches; mild bilateral gynecomastia; the spine slightly
tender to palpation; thyroid firm and nonenlarged; the liver not enlarged; and testes
without lesions, small, and soft. Remainder of examination was unremarkable. His
laboratory assessment is as follows: Total testosterone 185 (280 to 800) ng/dL -
Answer- current history of opioid use.
Which of the following is a possible consequence of his coffee use? - Answer-
increased sensitivity to hypoglycemia.FALSE: increased bone density, decreased blood
pressure, increased risk of diabetes mellitus.
Provided a pituitary tumor is ruled out, which of the following is the best option for
treatment? - Answer- start testosterone therapy.
A 27-year-old woman with pregnancy at 25 weeks' gestation presents for evaluation.
She is gravida 6, had one elective abortion, had one spontaneous abortion, and has
three children ages 10, 7, and 3 years. She has a history of using heroin daily for the
past 8 years, and drinking two bottles of wine daily for several years. She has been
through inpatient detox for a week at a time, with the last time 4 months ago. She has
been using $40 of heroin daily by intranasal insufflation, with the last use this morning.
She complains of cramping in her low back, nausea with heartburn, and diarrhea; she
requests medication for her symptoms. She is currently drinking two 5-ounce. glasses of
wine daily; her last drink was 2 days ago; and she is not displaying any signs of alcohol
withdrawal currently. She smokes tobacco one pack per day and marijuana several
times weekly. She is considering cutting down further on drinking. - Answer- small for
gestational age.
After delivery, the newborn is monitored for neonatal abstinence syndrome. Which of
the following is an appropriate indication to treat with pharmacotherapy? - Answer-
failure to thrive.
, Of the various substances abused by this woman during pregnancy, which is most
likely to cause preterm labor? - Answer- heroin (NOT tobacco, alcohol or marijuana).
A 52-year-old man methadone maintenance for opioid dependence for the past 15
years is scheduled for an elective total knee replacement. His chronic pain has been
managed with ibuprofen and acetaminophen. He denies any illicit drug use for over 10
years. For the past 2 years, he has been drinking alcohol after work, up to 5 beers per
day. He denies a history of alcohol withdrawal symptoms when he stops drinking or any
negative consequences from his alcohol use. He has no history of liver disease and has
normal liver function and synthetic tests. He smokes tobacco, half pack per day and has
mild, well-controlled, COPD. His alcohol use (5 drinks per day) puts him at risk for which
of the following postoperative complications? - Answer- Increased risk of infection,
impaired wound healing, and bleeding.FALSE: No increased risk since he has no
evidence of liver disease or history of withdrawal; Increased risk of postoperative
hepatitis and encephalopathy; Increased risk of hepatorenal syndrome requiring
dialysis.
His tobacco use (half pack per day) puts him at risk for which of the following
postoperative complications? - Answer- Increased risk of cardiovascular events and
death.FALSE: No increase risk since his COPD is mild and well controlled, increase risk
of major bleeding, Increased risk of postoperative delirium.
How would you manage his postoperative pain? - Answer- Maintain methadone dose
with morphine IV patient-controlled analgesia.
"Bath salts" commonly consist of synthetic analogs of: - Answer- cathinone.
Prolonged substance-induced psychosis is common with chronic use of: - Answer-
amphetamines (NOT cannabis, PCP, LSD???)
Substance-induced panic attacks are frequently seen with: - Answer- alcohol
withdrawal and LSD intoxication.(NOT cannabis or cocaine withdrawal).
Substance-induced depression can be distinguished from independent major
depression by: - Answer- The resolution of depressive symptoms within the first month
of abstinence.(NOT the absence of insight, The absence of a family history of
depression, The presence of drugs or alcohol in the urine.
A 34-year-old man is admitted to a residential treatment program under pressure from
both his boss and his family. He has a 5-year history of gradually escalating alcohol
use, with daily use for the past 3 years (at least 5 to 6 drinks per day), frequent
absences from work, failure to carry out his household responsibilities, and impulsive
behavior (occasionally staying up all night, drunk driving, extramarital sex). On
admission, he also complains of persistent depressed mood and loss of interest and
enjoyment in family, friends, and work; middle and terminal insomnia; feeling a failure;
, and suicidal ideation, which has been increasing in intensity over the last 3 months as
his drinking has escalated further. In addition to alcohol dependence, what is the most
appropriate DSM-IV diagnosis after the initial evaluation? - Answer- Substance-induced
depression.
The patient participates in the residential treatment for 1 month. At the end of that
month, during which he has been abstinent from alcohol, his depression, low interest,
low appetite, insomnia, feelings of failure, and thoughts about death and suicide are
unchanged from when he was admitted. What would be the most appropriate next step
in his treatment? - Answer- sertraline.
A 26-year-old woman contacts you because she is considering performing an
intervention with her 30-year-old husband to get him into treatment. He has exhibited
bizarre and erratic behavior increasingly during the past year, staying up all night,
talking rapidly, and acting suspicious and sometimes frankly paranoid. He has also
experienced bouts of severe depression. She is quite sure that he has had affairs, and
he has gone deeply into debt. She knows that he has used some drugs in the past, but
does not know what. She thinks he may be using again. The most likely substance of
abuse that would explain at least some of these symptoms is: - Answer- cocaine.
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? - Answer-
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? - Answer- 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? - Answer- 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? - Answer-
Hypokalemia
100% CORRECT ANSWERS |
ALREADY PASSED
A 47-year-old woman with a history of polysubstance abuse presents because of
difficulties with sleep. Most recently, she had been misusing opioids. She has made
every effort to discontinue use of all substances. Unfortunately, as she has tried to taper
off all opioids she has had particular difficulties with sleep. Initially, she describes
problems with sleep initiation. She notes particular problems when she tries to relax.
She notes a long history of problems getting herself to relax in an attempt to fall asleep.
Although you are suspicious that an underlying anxiety disorder is the major issue with
regard to sleep, you also decide to pursue other possibilities. In particular, you are
concerned about a possible unmasking of another disorder as she had withdrawn from
the use of opioids. She then notes particular urge to move as she tries to relax in bed.
She actually notes a similar sensation when she is a pas - Answer- A sleep study to
screen for a rhythmic movement disorder.
In follow-up visits, the sense of restlessness seems to fade into the background with
treatment. The patient also confesses that she is actually bothered by vivid dreams, but
has attributed this to the SSRI that was started about a year ago by her primary care
physician. Her anxiety improved considerably with the use of the medication and, for
several months, she thought that her symptoms were improving. Unfortunately, she
discontinues the SSRI because of side effects. Over time, she tries several other
medications, but is confronted with other side effects. Sleep initiation is becoming an
increasing problem. She starts to fixate on her inability to fall asleep. You consider
some options. She is also concerned about her susceptibility to addiction. The next
approach that will avoid this concern and avoid other potential side effects, might
include: - Answer- Cognitive-behavioral therapy (CBT).
After several years, the patient started to gradually increase her alcohol consumption.
Initially, she noted that it helped with her sleep initiation. Ironically, the improvement in
sleep initiation did not make her sleep more refreshing. Fortunately, after several years
of heavy, chronic use, she was able to give up the alcohol. She sees you again, after
being sober for about a year. She describes her sleep as being fragmented. There is a
history of snoring, recent weight gain since discontinuing cigarettes, and a recent onset
of hypertension. You decide to order a sleep study to rule out obstructive sleep apnea.
Although she has not consumed any alcohol in more than a year, you would still expect
,which of the following features on the PSG? - Answer- Persistent sleep fragmentation
with a decrease in SWS.
What % of individuals visiting the emergency department who have been drinking and
are injured in MVCs may connect their alcohol use to the injury event. - Answer- 30%
The six elements (FRAMES) and sequence of the brief intervention as proposed by
Miller and Sanchez include: - Answer- Feedback, responsibility, advice, menu of
strategies, empathy, and self-efficacy.
A 41-year-old man has a screening bone density showing a spine T-score of −4.4 and a
femoral neck T-score of −2.8. His past medical history includes type 1 diabetes mellitus,
hypothyroidism, and chronic back pain due to multiple compression fractures, treated
with 60 mg of methadone spaced throughout the day as well as oxycodone 15 to 30 mg
for breakthrough pain. He has a distant history of IV cocaine use and heavy alcohol use
and quit smoking cigarettes 3.5 months ago. He drinks 32 ounces of coffee daily.
Physical exam reveals a thin WM in NAD; blood pressure 102/76; heart rate 116 bpm;
weight 168 pounds; height 70 inches; mild bilateral gynecomastia; the spine slightly
tender to palpation; thyroid firm and nonenlarged; the liver not enlarged; and testes
without lesions, small, and soft. Remainder of examination was unremarkable. His
laboratory assessment is as follows: Total testosterone 185 (280 to 800) ng/dL -
Answer- current history of opioid use.
Which of the following is a possible consequence of his coffee use? - Answer-
increased sensitivity to hypoglycemia.FALSE: increased bone density, decreased blood
pressure, increased risk of diabetes mellitus.
Provided a pituitary tumor is ruled out, which of the following is the best option for
treatment? - Answer- start testosterone therapy.
A 27-year-old woman with pregnancy at 25 weeks' gestation presents for evaluation.
She is gravida 6, had one elective abortion, had one spontaneous abortion, and has
three children ages 10, 7, and 3 years. She has a history of using heroin daily for the
past 8 years, and drinking two bottles of wine daily for several years. She has been
through inpatient detox for a week at a time, with the last time 4 months ago. She has
been using $40 of heroin daily by intranasal insufflation, with the last use this morning.
She complains of cramping in her low back, nausea with heartburn, and diarrhea; she
requests medication for her symptoms. She is currently drinking two 5-ounce. glasses of
wine daily; her last drink was 2 days ago; and she is not displaying any signs of alcohol
withdrawal currently. She smokes tobacco one pack per day and marijuana several
times weekly. She is considering cutting down further on drinking. - Answer- small for
gestational age.
After delivery, the newborn is monitored for neonatal abstinence syndrome. Which of
the following is an appropriate indication to treat with pharmacotherapy? - Answer-
failure to thrive.
, Of the various substances abused by this woman during pregnancy, which is most
likely to cause preterm labor? - Answer- heroin (NOT tobacco, alcohol or marijuana).
A 52-year-old man methadone maintenance for opioid dependence for the past 15
years is scheduled for an elective total knee replacement. His chronic pain has been
managed with ibuprofen and acetaminophen. He denies any illicit drug use for over 10
years. For the past 2 years, he has been drinking alcohol after work, up to 5 beers per
day. He denies a history of alcohol withdrawal symptoms when he stops drinking or any
negative consequences from his alcohol use. He has no history of liver disease and has
normal liver function and synthetic tests. He smokes tobacco, half pack per day and has
mild, well-controlled, COPD. His alcohol use (5 drinks per day) puts him at risk for which
of the following postoperative complications? - Answer- Increased risk of infection,
impaired wound healing, and bleeding.FALSE: No increased risk since he has no
evidence of liver disease or history of withdrawal; Increased risk of postoperative
hepatitis and encephalopathy; Increased risk of hepatorenal syndrome requiring
dialysis.
His tobacco use (half pack per day) puts him at risk for which of the following
postoperative complications? - Answer- Increased risk of cardiovascular events and
death.FALSE: No increase risk since his COPD is mild and well controlled, increase risk
of major bleeding, Increased risk of postoperative delirium.
How would you manage his postoperative pain? - Answer- Maintain methadone dose
with morphine IV patient-controlled analgesia.
"Bath salts" commonly consist of synthetic analogs of: - Answer- cathinone.
Prolonged substance-induced psychosis is common with chronic use of: - Answer-
amphetamines (NOT cannabis, PCP, LSD???)
Substance-induced panic attacks are frequently seen with: - Answer- alcohol
withdrawal and LSD intoxication.(NOT cannabis or cocaine withdrawal).
Substance-induced depression can be distinguished from independent major
depression by: - Answer- The resolution of depressive symptoms within the first month
of abstinence.(NOT the absence of insight, The absence of a family history of
depression, The presence of drugs or alcohol in the urine.
A 34-year-old man is admitted to a residential treatment program under pressure from
both his boss and his family. He has a 5-year history of gradually escalating alcohol
use, with daily use for the past 3 years (at least 5 to 6 drinks per day), frequent
absences from work, failure to carry out his household responsibilities, and impulsive
behavior (occasionally staying up all night, drunk driving, extramarital sex). On
admission, he also complains of persistent depressed mood and loss of interest and
enjoyment in family, friends, and work; middle and terminal insomnia; feeling a failure;
, and suicidal ideation, which has been increasing in intensity over the last 3 months as
his drinking has escalated further. In addition to alcohol dependence, what is the most
appropriate DSM-IV diagnosis after the initial evaluation? - Answer- Substance-induced
depression.
The patient participates in the residential treatment for 1 month. At the end of that
month, during which he has been abstinent from alcohol, his depression, low interest,
low appetite, insomnia, feelings of failure, and thoughts about death and suicide are
unchanged from when he was admitted. What would be the most appropriate next step
in his treatment? - Answer- sertraline.
A 26-year-old woman contacts you because she is considering performing an
intervention with her 30-year-old husband to get him into treatment. He has exhibited
bizarre and erratic behavior increasingly during the past year, staying up all night,
talking rapidly, and acting suspicious and sometimes frankly paranoid. He has also
experienced bouts of severe depression. She is quite sure that he has had affairs, and
he has gone deeply into debt. She knows that he has used some drugs in the past, but
does not know what. She thinks he may be using again. The most likely substance of
abuse that would explain at least some of these symptoms is: - Answer- cocaine.
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? - Answer-
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? - Answer- 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? - Answer- 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? - Answer-
Hypokalemia
