An emergency department physician is evaluating several patients presenting with acute psychiatric and physiologic changes related to substance use. Correlate each clinical vignette with the most appropriate diagnosis.
- A patient exhibiting multidirectional nystagmus, aggressive behavior, hyperthermia, and a profound lack of pain response to venipuncture.Phencyclidine (PCP) intoxication
- A patient presenting with intense dysphoria, profound fatigue, ravenous appetite, psychomotor retardation, and reports of intensely disturbing dreams.Stimulant withdrawal
- A patient demonstrating prominent conjunctival erythema, inappropriate laughter, mild tachycardia, and sluggish psychomotor responses.Cannabis intoxication
- A patient experiencing rhinorrhea, frequent yawning, diaphoresis, hyperactive bowel sounds, and prominent piloerection on the arms.Opioid withdrawal
Cevap
PCP intoxication pairs with nystagmus and analgesia; Stimulant withdrawal pairs with dysphoria and vivid dreams; Cannabis intoxication pairs with conjunctival erythema; Opioid withdrawal pairs with rhinorrhea and piloerection.
Each vignette represents the classic, highest-yield diagnostic signs for the respective toxidromes as frequently tested on Step 2 CK. PCP is identified by multidirectional nystagmus, stimulant withdrawal by the somnolent 'crash', cannabis by conjunctival injection, and opioid withdrawal by piloerection and rhinorrhea.
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Anahtar Kavram
Identifying specific physiological and psychiatric hallmarks of distinct substance intoxication and withdrawal toxidromes.