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Retired NBME Free 120 Answers

free120/Block 1/Question#12 (reveal difficulty score)
A 17-year-old boy is brought to the emergency ...
PCP (phencyclidine) ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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 +6  upvote downvote
submitted by โˆ—mkenerly(11)
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I've been taught that any overdose vignette with a patient assaulting the doctor is a dead ringer for PCP due to their aggression.

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 +4  upvote downvote
submitted by โˆ—bwdc(697)
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PCP is a sedative-hypnotic and dissociative anesthetic that generally acts as a downer but can also cause incredible aggression coupled with pain insensitivity (the superman drug). Vertical nystagmus is a commonly mentioned physical exam finding.

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azibird  FA specifically mentions hypertension and tachycardia, so I ruled it out immediately. But you're right, it's a hallucinogen, I thought it was a stimulant. +2
azibird  "PCP (10mg/kg, s.c.) causes hypertension that is associated with decrease or tendency to decrease the levels of epinephrine and norpinephrine in the hypothalamus and the brainstem regions." https://www.sciencedirect.com/science/article/abs/pii/0006899384901847 "Over 50% of adult patients present with the classic toxidrome of PCP intoxication: violent behavior, nystagmus, tachycardia, hypertension, anesthesia, and analgesia." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2859735/ +1
schep  I spent so much time on this question. I also ruled out cocaine, methamphetamine and PCP because (I thought) his vitals didn't match. Then I was forced to convince myself that someone on oxy or a benzo would suddenly get violent... +3



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