Addiction Medicine Certification Emergency Procedures & Response 3

Question 1

A patient receiving inpatient alcohol detoxification develops sudden-onset confusion, fever, tachycardia, and profuse sweating on day 3. Which condition must be ruled out first?

Accepted Answer

Delirium tremens

Answer

Delirium tremens typically peaks at 48–96 hours after last drink and presents with autonomic instability, fever, and delirium, carrying up to 5% mortality if untreated.

Question 2

An adolescent is brought to the ED after ingesting an unknown quantity of prescription opioids. Parents report the teen also uses marijuana regularly. Which assessment tool is most appropriate for immediate triage of overdose severity?

Accepted Answer

Glasgow Coma Scale and respiratory rate assessment

Answer

GCS and respiratory rate provide the most immediate objective data for assessing opioid overdose severity and guiding naloxone administration in an emergency setting.

Question 3

A patient with alcohol use disorder develops sudden severe ataxia, ophthalmoplegia, and confusion in the ED. What should be administered IMMEDIATELY?

Accepted Answer

IV thiamine 500 mg before any glucose administration

Answer

This triad is Wernicke's encephalopathy; high-dose IV thiamine must precede glucose to avoid precipitating or worsening thiamine-dependent metabolic failure.

Question 4

During opioid overdose resuscitation, the patient regains consciousness after naloxone but becomes combative and tries to leave against medical advice. What is the most important clinical consideration?

Accepted Answer

Naloxone's duration of action (30–90 min) is shorter than most opioids, requiring observation for re-narcotization

Answer

Naloxone's half-life is shorter than most opioids, so re-narcotization can occur after the patient appears awake, necessitating monitored observation for at least 4 hours.

Question 5

A patient on high-dose prescribed opioids for chronic pain develops iatrogenic respiratory depression in a clinic. Naloxone is given but the patient goes into acute opioid withdrawal with severe pain. What is the safest approach?

Accepted Answer

Titrate low-dose naloxone (0.04 mg increments) to restore respirations without full reversal

Answer

Low-dose titrated naloxone (0.04 mg increments) restores adequate ventilation while minimizing acute withdrawal and pain crisis in opioid-dependent patients.

Addiction Medicine Certification Practice Test

Addiction Medicine Certification Practice Test

Addiction Medicine Certification Emergency Procedures & Response 3