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NBME 21 Answers

nbme21/Block 4/Question#12

A 24-year-old man with a history of drug abuse has ...

Heroin

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 +2  upvote downvote
submitted by usmleuser007(126),

Can someone please explain why can't alcohol be correct in this setting?

niboonsh  rhinorrhea is specific to withdrawal from opioids (aka heroin). Look at page 554 in FA2018 +4  
dr_jan_itor  what if the alcoholic just has a concurrent rhinovirus infection ;) +1  




 +2  upvote downvote
submitted by hungrybox(241),

Great video I used to learn this material.

  1. There are 3 major types of drugs: uppers (stimulants), downers (depressants), and hallucinogens.
  2. Heroin is an opioid. Opioids are downers.*
  3. Downers do what it sounds like. They cause "down" symptoms: sedation/decreased anxiety (and thus behavorial disinhibition), respiratory depression.
  4. Thus withdrawal will cause the opposite: hypertension/tachycardia, anxiety.
hungrybox  *other downers: alcohol, benzodiazepines, barbiturates +  
nwinkelmann  THANK YOU! for the link to the video. this is one thing I've ALWAYS struggled with. +  




 +0  upvote downvote
submitted by divya(1),

Why is there rhinorrhea in opioid withdrawal? And also, if stimulants like cocaine cause nasal vasoconstriction, shouldn't opioid withdrawal do the same?





one does not simply “walk into morder”