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Zorluk: KolaySubstance-Related and Addictive Disorders

A 19-year-old college student is evaluated in the university health center. His roommate brought him in because he has been "acting strange" for the past two hours. The roommate notes that the patient has been laughing inappropriately, speaking slowly, and eating unusually large amounts of snack foods. The patient has no past medical history and takes no medications. Vital signs show a temperature of 37.0°C (98.6°F), blood pressure of 115/75 mm Hg, pulse of 118/min, and respirations of 14/min. Physical examination shows prominent conjunctival injection and a dry oral mucosa. Pupils are equal and reactive to light. Neurologic examination is unremarkable, and there is no nystagmus. Which of the following is the most likely cause of this patient's current condition?

  1. Cannabis intoxicationCevap
  2. B
    Cocaine intoxication
  3. C
    Phencyclidine (PCP) intoxication
  4. D
    Lysergic acid diethylamide (LSD) intoxication
  5. E
    Methamphetamine intoxication

Cevap

Cannabis intoxication
The correct answer accurately identifies the classic presentation of acute cannabis (marijuana) intoxication. Patients typically present with a combination of behavioral changes (euphoria, inappropriate laughter, slowed time perception, delayed reaction times) and distinct physiologic signs. The most highly specific physical examination finding is prominent conjunctival injection (red eyes). Other common signs include tachycardia, dry mouth (xerostomia), and a significantly increased appetite (hyperphagia). The absence of nystagmus, pupillary changes, and aggression helps rule out other common substances of abuse.

Adım Adım Çözüm

1
Analyze the patient's behavioral presentation.
The patient exhibits inappropriate laughter, slow speech, and significantly increased appetite.
Identifying the behavioral changes helps narrow the differential diagnosis of substance use.
2
Evaluate the physical examination and vital signs.
The patient has tachycardia (118/min), prominent conjunctival injection (red eyes), and dry oral mucosa, without nystagmus or pupillary dilation.
Specific physical signs act as key differentiators between various toxidromes.
3
Synthesize the findings to determine the causative substance.
The combination of increased appetite, conjunctival injection, dry mouth, and tachycardia points directly to cannabis.
This is the classic physiologic and behavioral signature of acute marijuana use.

Anahtar Kavram

The diagnosis of acute cannabis intoxication is clinical and relies on recognizing signs such as conjunctival injection, tachycardia, increased appetite, and dry mouth.
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Substance-Related and Addictive Disorders

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