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NBME 21 Answers

nbme21/Block 4/Question#12 (35.7 difficulty score)
A 24-year-old man with a history of drug ...

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submitted by hungrybox(963),
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eGtra idevo I duse to erlan this atmie.arl

  1. Trhee rea 3 aomrj pstey fo :drsgu repspu m(l)itatu,ssn noserwd ae)rs(dsnpe,ts nda e.igonullnsahc
  2. iorneH si an poiido. ipOodis era od.wren*s
  3. soDrnew do thwa ti dsuson .elki Tyeh uasec "do"wn m:tsopsym dnetieaoead/srsdec aeyixtn (dan utsh aiohvrlabe ioi,itiihdnsbn) roipsryrtae esi.npoedrs
  4. Tshu lawrhtidwa lwil eucsa the so:tieopp atyyo/e,etinsrchnaridcpah atnx.yie
hungrybox  *other downers: alcohol, benzodiazepines, barbiturates +2  
nwinkelmann  THANK YOU! for the link to the video. this is one thing I've ALWAYS struggled with. +  
qball  I get that this is a good rule of thumb to help narrow down between alcohol and heroin, BUT is still not enough to answer this question. Some key features for depressants (downer) is alcohol (if we are talking mild withdraw) - tremors , diaphoresis and delirium (heavy withdraw) . For Heroin - Dilated pupils, yawning and lacrimation are key exam findings. +1  

submitted by usmleuser007(370),
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anC soomnee aeepsl anxliep wyh nt'ac lalhcoo eb roccert in shit sientgt?

niboonsh  rhinorrhea is specific to withdrawal from opioids (aka heroin). Look at page 554 in FA2018 +11  
dr_jan_itor  what if the alcoholic just has a concurrent rhinovirus infection ;) +5  
lovebug  and FA2019 page 538. +  

submitted by divya(58),
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yWh is eerht inraorhreh in iodopi h?riwwdlata And s,loa if mustaintls lkie niacceo ceasu alasn titnvcnosoocar,is l'hsutnod pdooii hlawwdarit od the ea?ms

the_enigma28  Mechanism of opioid-induced rhinorrhoea, lacrimation, stomach cramps and diarrhoea is actually muscarinic receptor effects, rather than alpha adrenergic blockade caused by cocaine, causing nasal vasoconstriction. +1  
baja_blast  Symptoms of Opioid Withdrawal can be remembered with the phrase "anxious, hot, and moist" per SketchyPharm Opiods. Rhinorrhea is one way people can be "moist" during opioid withdrawal, but they can also sweat excessively and lacrimate too. +1