USMLE-Rx Step 2 Practice Q's

USMLE-Rx Step 2 Qmax Challenge #21088

Check out today’s Step 2 CK Qmax Question Challenge.

Know the answer? Post it in the comments below! Don’t forget to check back for an update with the correct answer and explanation (we’ll post it in the comments section below).

A 35-year-old patient is admitted to the trauma unit after a motor vehicle accident. He has an open fracture of the lower leg and is taken to the operating room for surgery. Later during his hospitalization, he is disoriented, agitated, and claims to be seeing creatures climbing up the walls. He is tachycardic with a heart rate of 120/min. Blood pressure is 190/110 mm Hg, and his temperature is 38.3°C (101°F). Within 1 hour he has a seizure and lapses into unconsciousness.

How long after the patient’s last alcohol intake would one typically expect to see these symptoms?

A. 1-6 hours
B. 6-12 hours
C. 12-36 hours
D. 24-48 hours
E. 48-96 hours

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6 replies »

  1. The withdrawal from alcohol usually occurs from 2 to 4 days since the last alcohol the person has consumed. This makes the correct answer E.

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  2. The correct answer is E. This patient has signs and symptoms of delirium tremens (DT), a serious clinical diagnosis with a mortality rate of up to 20% if untreated. Treatment consists of seizure prophylaxis with benzodiazepines, preferably those that are liver sparing. DT is most often seen 48-96 hours after the patient stops drinking, although it may occur up to 7-10 days after the last drink. DT consists of a waxing and waning of consciousness, hallucinations, disorientation, agitation, diaphoresis, hyperthermia, tachycardia, and tremulousness in the setting of acute reduction or abstinence from alcohol. Patients can have seizures without experiencing DT and vice versa. Fluid and electrolyte status may also be greatly impacted by severe alcohol withdrawal. Most patients in acute withdrawal are hypovolemic due to diaphoresis, hyperthermia, tachypnea, and vomiting. Hypokalemia is also common due to potassium losses, fluctuations in aldosterone levels, and changes in the distribution of potassium across the cell membrane. Hypomagnesemia can be present as well with DT which often predisposes to dysrhythmias and seizures.

    A is not correct. At 1-6 hours after the last intake of alcohol, the patient should demonstrate signs of intoxication rather than withdrawal.

    B is not correct. Within 6-12 hours after the last intake of alcohol, the patient may exhibit either intoxication or mild/minor withdrawal syndrome. This includes tremulousness, mild anxiety, headache, diaphoresis, palpitations, anorexia, and GI upset with normal mental status. The onset of minor withdrawal symptoms is typically between 6-36 hours.

    C is not correct. Within 12-36 hours of alcoholic consumption, the patient may exhibit alcoholic hallucinosis. These signs and symptoms include visual, auditory, and/or tactile hallucinations with intact orientation and normal vital signs. Alcoholic hallucinosis refers to hallucinations that develop within 12 to 48 hours of abstinence and typically resolve within 24 to 48 hours.

    D is not correct. At 24-48 hours, the patient will demonstrate worsening symptoms, hallucinations, and tremulousness.

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  3. A 35-year-old patient is admitted to the trauma unit after a motor vehicle accident. He has an open fracture of the lower leg and is taken to the operating room for surgery. Later during his hospitalization, he is disoriented, agitated, and claims to be seeing creatures climbing up the walls.

    Like

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