{"id":3244,"date":"2022-11-09T15:40:00","date_gmt":"2022-11-09T15:40:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=3244"},"modified":"2025-10-01T11:40:34","modified_gmt":"2025-10-01T19:40:34","slug":"usmle-step-1-question-of-the-day-stimulant-intoxication-and-withdrawal","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-stimulant-intoxication-and-withdrawal","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day: Stimulant Intoxication and Withdrawal"},"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-1-question-of-the-day-stimulant-intoxication-and-withdrawal\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\" >The correct answer to today&#8217;s USMLE\u00ae Step 1 Question is&#8230;<\/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-1-question-of-the-day-stimulant-intoxication-and-withdrawal\/#A_Amphetamine_Intoxication\" >A. Amphetamine Intoxication<\/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-1-question-of-the-day-stimulant-intoxication-and-withdrawal\/#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-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-stimulant-intoxication-and-withdrawal\/#A_Cannabis_Intoxication\" >A. Cannabis Intoxication<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-stimulant-intoxication-and-withdrawal\/#B_Serotonin_Syndrome\" >B. Serotonin Syndrome<\/a><\/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-1-question-of-the-day-stimulant-intoxication-and-withdrawal\/#D_Opiate_Withdrawal_Syndrome\" >D. &nbsp;Opiate Withdrawal Syndrome<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-stimulant-intoxication-and-withdrawal\/#E_Benzodiazepine_Intoxication\" >E. Benzodiazepine Intoxication<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-stimulant-intoxication-and-withdrawal\/#Main_Explanation\" >Main Explanation<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics.&nbsp;<\/em><\/strong><strong><em>Today&#8217;s case focuses on a 35-year-old-man who has a temperature is 100\u00b0F (37.7 \u00b0C), pulse is 117 bpm, respiratory rate is 18 breaths per minute, and blood pressure is 177\/90 mmHg. The patient has noted mydriasis bilaterally during physical examination. Can you figure it out?<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 35-year-old man is brought to the emergency department by EMS after he was found at a public park yelling at bystanders. Several unlabeled pill capsules are found in his belongings. Temperature is 100\u00b0F (37.7 \u00b0C), pulse is 117 bpm, respiratory rate is 18 breaths per minute, and blood pressure is 177\/90 mmHg. The patient appears agitated and diaphoretic. On physical examination, the patient has noted mydriasis bilaterally. There is absence of clonus in the lower extremities bilaterally. Oral mucosa appears moist. Intranasal examination reveals septal ulceration. Which of the following is the most likely etiology of this patient\u2019s clinical presentation?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Cannabis intoxication&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Serotonin syndrome<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Amphetamine intoxication&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. &nbsp;Opiate withdrawal syndrome<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Benzodiazepine intoxication&nbsp;<\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s USMLE\u00ae Step 1 Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"A_Amphetamine_Intoxication\"><\/span>A. Amphetamine Intoxication<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the Main Explanation, let&#8217;s look at the incorrect answer explanations. Skip to the bottom if you want to see the correct answer right away!<\/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\">The incorrect answers to today&#8217;s USMLE\u00ae Step 1 Question are&#8230;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"A_Cannabis_Intoxication\"><\/span>A. Cannabis Intoxication<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Symptoms of cannabis intoxication include conjunctival injection, increased appetite, euphoria, paranoid delusions and a dry mouth. Pupillary dilation and diaphoresis are not typical of cannabis intoxication.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B_Serotonin_Syndrome\"><\/span>B. Serotonin Syndrome<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Serotonin syndrome is characterized by hyperactive reflexes, mydriasis, and hyperadrenergic drive. One of the key findings in cases of serotonin syndrome is the presence of clonus, which is absent in this patient.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Opiate_Withdrawal_Syndrome\"><\/span>D. &nbsp;Opiate Withdrawal Syndrome<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Opiate withdrawal syndrome may manifest with many similar features of amphetamine intoxication syndrome including mydriasis, tachycardia, and hypertension. However, patients with opiate withdrawal syndrome will also typically exhibit piloerection, vomiting, and diarrhea.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Benzodiazepine_Intoxication\"><\/span>E. Benzodiazepine Intoxication<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Psychomotor depression, respiratory depression, ataxia, and hypotension are features of benzodiazepine intoxication. A normal respiratory rate and hypertension as seen in this patient suggests an alternative diagnosis.<\/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\">This patient presents with psychomotor agitation, tachycardia, hypertension, septal ulceration, and aggressive behavior \u2013 suggestive of stimulant intoxication. Cocaine and associated amphetamines (MDMA, ecstasy, methamphetamine) are psychoactive stimulants with varying effects on the enhancement of dopaminergic, serotonergic, and noradrenergic activity in the central nervous system. Non-specific features of stimulant intoxication include anxiety, aggressive behavior, psychomotor agitation, delirium, hypertension, tachycardia, pupillary dilation, mydriasis and diaphoresis. In high doses, hallucinations and paranoia may be present. In addition, serotonin syndrome may ensue if multiple, or high quantities of, serotonergic agents are ingested.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Abrupt cessation of stimulant use manifests with effects opposite to the intoxicating effects. These features include hypersomnia, increased appetite, pupillary constriction, psychomotor retardation and depression.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics.&nbsp;Today&#8217;s case focuses on a 35-year-old-man who has a temperature is 100\u00b0F (37.7 \u00b0C), pulse is 117 bpm, respiratory rate is 18 breaths per minute, and blood pressure is 177\/90 mmHg. The patient has noted mydriasis bilaterally during [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":3245,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,1369,44],"tags":[],"class_list":["post-3244","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-step-1-questions","category-step-1"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 1 Question of the Day: Stimulant Intoxication and Withdrawal - 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-1-question-of-the-day-stimulant-intoxication-and-withdrawal\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 1 Question of the Day: Stimulant Intoxication and Withdrawal - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"This week, we are sharing another USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics.&nbsp;Today&#8217;s case focuses on a 35-year-old-man who has a temperature is 100\u00b0F (37.7 \u00b0C), pulse is 117 bpm, respiratory rate is 18 breaths per minute, and blood pressure is 177\/90 mmHg. 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