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NBME 23 Answers

nbme23/Block 3/Question#19

A previously healthy 32-year-old man is brought to ...

Toxicology screening

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 +8  upvote downvote
submitted by seagull(716),

This patient is tripping balls. Better do a drug screen which seems obvious.

sympathetikey  When the answer is so obvious that you pick a stupid answer instead of it. DOH +12  
jooceman739  Funny thing I noticed is "he is alert and cooperative. He appears to be in pain" So he was so high that he was alert and cooperative during the basal ganglia hemorrhage +3  
yotsubato  @sympathetikey That fucking guy who drinks 2 six packs a day with liver failure got me like that. +1  
yogi  probably the "drug" have to be a stimulant or a hallucinogen which causes HTN & Tachycardia. +2  
charcot_bouchard  Lol. I got the right answer but took long time +  
goodkarmaonly  The patient's B.P. and pulse are raised + Bilateral dilated pupils = Most likely use of a stimulant Thats how I reasoned it anyways +  




"His friends believe there may have been drugs at the party", period. lmao...

aisel1787  ahahaha +  
qball  What a snitch +1  
bend_nbme_over  Good thing they were at the ED cause that friend is gonna need some stitches +  




 +1  upvote downvote
submitted by diabetes(10),

pupillary dilation ,hypertesion ,tachycardia,seisure ,wakefulness are typical for amphetamines intoxication.





 +0  upvote downvote
submitted by thotcandy(17),

i figured it was cocaine or amphetamines so I picked plasma free metanephrines. Why is this not correct?

According to this:

Sympathomimetics: Ephedrine, Pseudoephedrine (Sudafed), Amphetamines, Albuterol (Proventil) can cause positive results in serum metanephrines.

https://www.ncbi.nlm.nih.gov/books/NBK278970/table/pheochromocytoma.table4drug/

drzed  Because a toxicology screen would both answer your question (e.g. that it could be amphetamine abuse) and would also pick up any other drugs that the patient might have been using. So even though the pre-test probability is high for amphetamine use, lets say it was something else, well then the tox screen would pick that up as well. Or lets say that it was simultaneous use of two drugs, same scenario. +