Psychiatry · USMLE Step 2 CK

USMLE Step 2 CK Psychiatry: Substance Use and Personality Disorders

Substance intoxication and withdrawal management plus personality disorder cluster recognition scenarios tested on USMLE Step 2 CK.

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How soon after the last drink do alcohol withdrawal symptoms typically begin?
6 to 24 hours
In alcohol withdrawal, during what time window do withdrawal seizures most commonly occur?
12 to 48 hours after the last drink
In alcohol withdrawal, during what time window does delirium tremens typically appear?
48 to 96 hours after the last drink
What are the key features of delirium tremens?
Autonomic instability, severe confusion, and visual or tactile hallucinations
What is the first-line drug class for treating alcohol withdrawal?
Benzodiazepines
What is the classic triad of Wernicke encephalopathy?
Confusion, ataxia, and ophthalmoplegia
In a malnourished alcoholic patient, ____ should be given before glucose to avoid precipitating Wernicke encephalopathy.
thiamine
What is the hallmark feature distinguishing Korsakoff syndrome from Wernicke encephalopathy?
Anterograde amnesia with confabulation
What are the characteristic symptoms of opioid withdrawal?
Diarrhea, rhinorrhea, piloerection, yawning, and muscle aches
Which two medications are used for medication-assisted treatment of opioid use disorder?
Methadone and buprenorphine
What is the classic triad of opioid overdose?
Miosis (pinpoint pupils), respiratory depression, and CNS depression
What is the antidote used to reverse opioid overdose?
Naloxone
What is the major medical risk of untreated benzodiazepine withdrawal?
Life-threatening seizures
What is the recommended approach to managing sedative-hypnotic (e.g., benzodiazepine) withdrawal?
A gradual, tapered dose reduction
What are the signs of cocaine or amphetamine intoxication?
Euphoria, tachycardia, hypertension, and pupillary dilation

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