{"id":10157,"date":"2026-06-08T00:05:26","date_gmt":"2026-06-08T08:05:26","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=10157"},"modified":"2026-05-29T16:07:02","modified_gmt":"2026-05-30T00:07:02","slug":"usmle-step-2-ck-question-of-the-day-withdrawal-symptoms","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-withdrawal-symptoms","title":{"rendered":"USMLE\u00ae Step 2 CK Question of the Day:\u00a0Withdrawal symptoms"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-withdrawal-symptoms\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_2_Question_is%E2%80%A6\" >The correct answer to today\u2019s USMLE\u00ae Step 2 Question is\u2026<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-withdrawal-symptoms\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-withdrawal-symptoms\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-withdrawal-symptoms\/#Major_Takeaway\" >Major Takeaway<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-withdrawal-symptoms\/#Want_to_learn_more_about_this_topic\" >Want to learn more about this topic?<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-withdrawal-symptoms\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>Today\u2019s USMLE\u00ae Step 1 question of the day features a young woman with anxiety and tremors after stopping alcohol use. What\u2019s the best next step in management? Let\u2019s find out!<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A 21-year-old woman<\/strong> presents to the emergency department for <strong>moderate anxiety.<\/strong> She last consumed alcohol approximately <strong>36 hours ago<\/strong> and has been <strong>binge drinking regularly<\/strong> at her university about <strong>four days a week for the past 10 months.<\/strong> She reports drinking <strong>6\u20137 mixed drinks each time she drinks.<\/strong> She has never attempted to quit drinking, and she has had <strong>no prior withdrawal symptoms.<\/strong> She is not experiencing headaches, nausea, vomiting, hallucinations, or visual or tactile disturbances. The patient has no significant past medical history. She vapes tobacco products and uses marijuana occasionally. Temperature is 37\u00b0C (98.6\u00b0F), blood pressure is <strong>148\/80 mmHg<\/strong>, pulse is <strong>98\/min<\/strong>, respiratory rate is 16\/min, oxygen saturation is 99% on room air. She has <strong>moderately sweaty palms.<\/strong> She has a <strong>moderate tremor with hands outstretched.<\/strong> A complete blood count, complete metabolic profile, alcohol level, and magnesium and phosphate levels are within normal limits. The patient is given <strong>IV fluids, thiamine, and glucose.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Which of the following is the <em><span style=\"text-decoration: underline;\">best<\/span> next step<\/em> in management?<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Administer intravenous phenobarbital and admit to the ICU<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Discharge home with a prescription for oral gabapentin<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Administer intravenous lorazepam and admit to the hospital<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Discharge with a follow-up appointment with addiction medicine<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Discharge with a prescription for oral buprenorphine<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em>Scroll down for the correct answer!<\/em><\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Osmosis.org at the University College London, UK\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/DIp3u0oTLo4?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_2_Question_is%E2%80%A6\"><\/span>The correct answer to today\u2019s USMLE\u00ae Step 2 Question is\u2026<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Discharge home with a prescription for oral gabapentin<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Correct:<\/strong> See Main Explanation.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_Answer_Explanations\"><\/span>Incorrect Answer Explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Administer intravenous phenobarbital and admit to the ICU<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> This patient does not demonstrate severe features of alcohol withdrawal, nor does she have significant risk factors for complications from alcohol withdrawal that would warrant administration of phenobarbital or ICU admission.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Administer intravenous lorazepam and admit to the hospital<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> This patient does not demonstrate severe features of alcohol withdrawal, nor does she have significant risk factors for complications that would warrant hospitalization and IV benzodiazepine therapy.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Discharge with a follow-up appointment with addiction medicine<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Discharge without pharmacologic therapy for alcohol withdrawal would not be appropriate.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Discharge with a prescription for oral buprenorphine<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Buprenorphine is indicated in the management of opiate use disorder, not alcohol withdrawal.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>This patient presents with mild alcohol withdrawal based on the Clinical Institute Withdrawal Assessment of Alcohol Scale Revised (CIWA-Ar) score, and she has no risk factors for severe withdrawal.<\/strong> Therefore, she can be discharged home with a prescription for <strong>oral anticonvulsants, such as gabapentin.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Patients presenting with alcohol withdrawal should have disease severity assessed with a tool like the <strong><strong><a href=\"https:\/\/www.osmosis.org\/learn\/Alcohol_withdrawal:_Clinical_sciences\">CIWA-Ar scale<\/a><\/strong>.<\/strong> Additionally, the risk of <strong>severe withdrawal symptoms and complications from alcohol withdrawal<\/strong> should be determined. Patients with <strong>minimal to mild symptoms and a low risk for complications of severe withdrawal can be discharged home on oral medications.<\/strong> For mild withdrawal, <strong>anticonvulsants (e.g. gabapentin, carbamazepine) are preferred.<\/strong> For moderate withdrawal with low risk of complications, an <strong>oral benzodiazepine<\/strong> can be prescribed. Patients with <strong>moderate or severe withdrawal features and significant risk factors for complications should be admitted to the hospital for close monitoring.<\/strong> Inpatients should receive <strong>intravenous benzodiazepine therapy.<\/strong> Some severe cases may require <strong>ICU admission and phenobarbital.<\/strong> Additionally, <strong>thiamine should be administered to prevent or treat <a href=\"https:\/\/www.osmosis.org\/learn\/Wernicke-Korsakoff_syndrome\">Wernicke encephalopathy<\/a>.<\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Outpatient management of mild alcohol withdrawal should include pharmacotherapy with anticonvulsants (e.g. carbamazepine, gabapentin) to prevent progression of symptoms.<\/strong><\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Want_to_learn_more_about_this_topic\"><\/span>Want to learn more about this topic?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Watch the Osmosis video:<\/strong> <strong><a href=\"https:\/\/www.osmosis.org\/learn\/Alcohol_withdrawal%3A_Clinical_sciences\">Alcohol withdrawal: Clinical sciences<\/a><\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Wong, J., Saver, B. G., Scanlan, J., Gianutsos, L. P., Bhakta, Y., Walsh, J. J., Plawman, A. R., Sapienza, D., &amp; Rudolf, V. (2020). <strong>The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management.<\/strong>JournalofAddictionMedicine,14(3S),1\u201372. <a href=\"https:\/\/doi.org\/10.1097\/adm.0000000000000668\">https:\/\/doi.org\/10.1097\/adm.0000000000000668<\/a><\/li>\n\n\n\n<li>Mayo-Smith MF, Beecher LH, Fischer TL, et al. <strong>Management of Alcohol Withdrawal Delirium: An Evidence-BasedPracticeGuideline<\/strong>.ArchInternMed.2004;164(13):1405\u20131412. doi:10.1001\/archinte.164.13.1405<\/li>\n\n\n\n<li>Bayard M, McIntyre J, Hill KR, Woodside J Jr. <strong>Alcohol withdrawal syndrome<\/strong>. Am Fam Physician. 2004 Mar 15;69(6):1443-50. PMID: 15053409.<\/li>\n\n\n\n<li><strong>Alcohol Use Disorders<\/strong> &#8211; Goldman-Cecil Medicine &#8211; ClinicalKey Student<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full\"><a href=\"https:\/\/www.osmosis.org\/create\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png\" alt=\"\" class=\"wp-image-5904\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em><strong>Want more USMLE\u00ae Step 2 CK practice questions? <\/strong>Try <strong>Osmosis from Elsevier <\/strong>today<strong>! Get your&nbsp;<em><a href=\"http:\/\/osmosis.org\/create\" target=\"_blank\" rel=\"noreferrer noopener\">f<\/a><a href=\"http:\/\/osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\">ree trial<\/a><\/em>&nbsp;<\/strong>and <strong>discover why <\/strong>millions of current and future <strong>clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A young woman presents with anxiety and tremors after binge drinking. Can you determine the appropriate next step in managing this common but nuanced clinical scenario?<\/p>\n","protected":false},"author":208,"featured_media":10212,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[27,10,20,16,1366,1370,45],"tags":[3118,885,176,2967,2815,3117,3108,440,84,462,3119,261,887,3116,671],"class_list":["post-10157","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-clinical-skills","category-exam-prep","category-do","category-questions","category-step-2-questions","category-step-2","tag-addiction-medicine","tag-alcohol-withdrawal","tag-anxiety","tag-board-exam-prep","tag-case-study","tag-ciwa-scale","tag-clinical-vignette","tag-emergency-medicine","tag-medical-education","tag-osmosis","tag-outpatient-care","tag-pharmacology","tag-substance-use-disorder","tag-tremor","tag-usmle-step-2"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 2 CK Question of the Day:\u00a0Withdrawal symptoms - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-withdrawal-symptoms\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 2 CK Question of the Day:\u00a0Withdrawal symptoms - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"A young woman presents with anxiety and tremors after binge drinking. Can you determine the appropriate next step in managing this common but nuanced clinical scenario?\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-withdrawal-symptoms\" \/>\n<meta property=\"og:site_name\" content=\"Osmosis Blog\" \/>\n<meta property=\"article:published_time\" content=\"2026-06-08T08:05:26+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-05-30T00:07:02+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/06\/Withdrawal_symptoms_Blog.png\" \/>\n\t<meta property=\"og:image:width\" content=\"1080\" \/>\n\t<meta property=\"og:image:height\" content=\"1081\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/png\" \/>\n<meta name=\"author\" content=\"Rowan Bell, MD\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":[\"Article\",\"BlogPosting\"],\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-withdrawal-symptoms#article\",\"isPartOf\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-withdrawal-symptoms\"},\"author\":{\"name\":\"Rowan Bell, MD\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/#\/schema\/person\/87786c55677ccd769cb76475a1c7af25\"},\"headline\":\"USMLE\u00ae Step 2 CK Question of the Day:\u00a0Withdrawal symptoms\",\"datePublished\":\"2026-06-08T08:05:26+00:00\",\"dateModified\":\"2026-05-30T00:07:02+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-withdrawal-symptoms\"},\"wordCount\":732,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/#organization\"},\"image\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-withdrawal-symptoms#primaryimage\"},\"thumbnailUrl\":\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/06\/Withdrawal_symptoms_Blog.png\",\"keywords\":[\"addiction medicine\",\"alcohol withdrawal\",\"anxiety\",\"board exam prep\",\"case study\",\"CIWA scale\",\"clinical vignette\",\"emergency medicine\",\"medical education\",\"Osmosis\",\"outpatient care\",\"pharmacology\",\"substance use disorder\",\"tremor\",\"USMLE Step 2\"],\"articleSection\":[\"Allopathic Medicine (MD)\",\"Clinical Skills\",\"Exam Prep\",\"Osteopathic Medicine (DO)\",\"Questions of the Day\",\"USMLE Step 2\",\"USMLE\u00ae Step 2\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-withdrawal-symptoms#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-withdrawal-symptoms\",\"url\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-withdrawal-symptoms\",\"name\":\"USMLE\u00ae Step 2 CK Question of the Day:\u00a0Withdrawal symptoms - 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