CARN Assessment and Diagnosis 3 — Questions and Answers
Question 1: A 28-year-old patient presents with rhinorrhea, lacrimation, goosebumps, and a COWS score of 18. Which level of opioid withdrawal does this represent?
- Mild withdrawal
- Moderate withdrawal
- Moderately severe withdrawal
- Severe withdrawal (Correct answer)
Correct answer: Severe withdrawal
A COWS score of 13 or higher indicates severe opioid withdrawal requiring prompt clinical intervention.
Question 2: Which laboratory finding would most support a diagnosis of alcohol use disorder in a patient who denies heavy drinking?
- Elevated BUN and creatinine
- Elevated gamma-glutamyl transferase (GGT) and mean corpuscular volume (MCV) (Correct answer)
- Decreased serum potassium
- Thrombocytosis
Correct answer: Elevated gamma-glutamyl transferase (GGT) and mean corpuscular volume (MCV)
Elevated GGT and increased MCV (macrocytosis) are sensitive biomarkers for chronic heavy alcohol use.
Question 3: When using the SBIRT model, what does the 'BI' component involve for a patient who screens positive for risky substance use?
- Biological inventory of withdrawal symptoms
- Brief intervention to raise awareness and motivate change (Correct answer)
- Baseline intake for inpatient detoxification
- Blood and immunological testing
Correct answer: Brief intervention to raise awareness and motivate change
Brief Intervention (BI) in SBIRT involves a short, motivational conversation to increase awareness of substance use risks and encourage behavior change.
Question 4: A patient prescribed buprenorphine/naloxone reports feeling 'sick' after taking the first dose. Which assessment finding best explains precipitated withdrawal?
- The patient took the dose sublingually rather than swallowed
- The patient was still in full opioid intoxication when buprenorphine was given (Correct answer)
- The dose was too low to bind opioid receptors
- The naloxone component caused sedation
Correct answer: The patient was still in full opioid intoxication when buprenorphine was given
Precipitated withdrawal occurs when buprenorphine displaces full agonist opioids from receptors before sufficient withdrawal has occurred, causing abrupt withdrawal symptoms.
Question 5: Which instrument is the gold-standard structured interview for diagnosing substance use disorders according to DSM-5 criteria?
- AUDIT
- SCID-5 (Structured Clinical Interview for DSM-5) (Correct answer)
- MAST (Michigan Alcoholism Screening Test)
- CAGE questionnaire
Correct answer: SCID-5 (Structured Clinical Interview for DSM-5)
The SCID-5 is the gold-standard structured diagnostic interview used to assess and confirm DSM-5 substance use disorder diagnoses.
Question 6: A patient with alcohol use disorder undergoes assessment and scores a 7 on the CIWA-Ar. Which clinical response is most appropriate?
- Initiate intravenous benzodiazepine infusion immediately
- Increase monitoring frequency and consider PRN symptom-triggered medication (Correct answer)
- Discharge with follow-up in 48 hours
- Transfer to the ICU for intensive monitoring
Correct answer: Increase monitoring frequency and consider PRN symptom-triggered medication
A CIWA-Ar score of 7 indicates mild withdrawal; increased monitoring and symptom-triggered (PRN) benzodiazepines are appropriate at this level.
Question 7: Which assessment finding distinguishes cannabis use disorder from recreational cannabis use under DSM-5 criteria?
- Frequency of use exceeds once per week
- Presence of at least 2 of 11 diagnostic criteria causing significant impairment (Correct answer)
- Positive urine toxicology screen for THC metabolites
- Patient self-identifies as dependent on cannabis
Correct answer: Presence of at least 2 of 11 diagnostic criteria causing significant impairment
DSM-5 requires at least 2 of 11 specific criteria resulting in clinically significant impairment or distress to diagnose cannabis use disorder.
CARN Assessment and Diagnosis 3
A 28-year-old patient presents with rhinorrhea, lacrimation, goosebumps, and a COWS score of 18.
Which level of opioid withdrawal does this represent?