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Old 08-01-2011
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A 58 year old Vietnam war veteran with an extensive history of drug abuse presents to the emergency department complaining of acute onset anxiety accompanied by visual hallucinations. He says that for the past 3 hours he has been re-experiencing scenes of his Vietnam war experiences and states that he can "taste" colors. He denies any difficulty sleeping in the past or any depressed mood or anxiety problems. He is not taking any medications and has no past psychiatric history.

On physical exam, the man appears tense and has dilated pupils. The rest of his exam is unremarkable. Which of the following is the most likely substances found on urine toxicology screen?
A. Lorazepam
B. Methamphetamine
C. LSD
D. Marijuana
E. Cocaine
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Old 08-01-2011
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C) LSD

Classic giveaway - Flashbacks
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Old 08-01-2011
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Quote:
Originally Posted by ricko335 View Post
A 58 year old Vietnam war veteran with an extensive history of drug abuse presents to the emergency department complaining of acute onset anxiety accompanied by visual hallucinations. He says that for the past 3 hours he has been re-experiencing scenes of his Vietnam war experiences and states that he can "taste" colors. He denies any difficulty sleeping in the past or any depressed mood or anxiety problems. He is not taking any medications and has no past psychiatric history.

On physical exam, the man appears tense and has dilated pupils. The rest of his exam is unremarkable. Which of the following is the most likely substances found on urine toxicology screen?
A. Lorazepam
B. Methamphetamine
C. LSD
D. Marijuana
E. Cocaine
well, with LSD you could taste colors!...sure!
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Old 08-01-2011
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C. LSD flashblacks big clue
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Old 08-02-2011
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This man is presenting with signs of LSD intoxication. LSD intoxication usually appears as anxiety and visual disturbances such as hallucinations. One characteristic diagnostic feature in LSD intoxication is the presence of flashbacks, or re-experiencing of prior events, especially those related to previous drug abuse. Since this man has a known history of extensive drug abuse, it is not unreasonable to assume he is having flashbacks to previous "trips" from LSD. Furthermore, he reports that he can "taste" colors. Synesthesia is a blending of the senses. People on LSD or similar hallucinogens often state that they experience blending of their senses (taste and vision for example).

Lorazepam is a benzodiazepine. Because benzodiazepines are CNS depressants, intoxication appears with somnolence, respiratory depression and ataxia. Withdrawal could cause rebound anxiety.

Cocaine and amphetamines have the same basic presentation: euphoria, impaired judgement, increased autonomic activity on vital signs (increased BP and HR). Hallucinations are also common. However, the presence of flashbacks in this patient make LSD more likely.
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Old 08-02-2011
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Quote:
Originally Posted by ricko335 View Post
A 58 year old Vietnam war veteran with an extensive history of drug abuse presents to the emergency department complaining of acute onset anxiety accompanied by visual hallucinations. He says that for the past 3 hours he has been re-experiencing scenes of his Vietnam war experiences and states that he can "taste" colors. He denies any difficulty sleeping in the past or any depressed mood or anxiety problems. He is not taking any medications and has no past psychiatric history.

On physical exam, the man appears tense and has dilated pupils. The rest of his exam is unremarkable. Which of the following is the most likely substances found on urine toxicology screen?
A. Lorazepam
B. Methamphetamine
C. LSD
D. Marijuana
E. Cocaine
flash back..LSD..
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