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Old 10-11-2012
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Arrow Gyrus Daily Questions; Toxicology #3

A 26-year-old bar employee is brought to the emergency room because of agitated, combative behavior in which three people had to restrain her She has also been hallucinating this entire period. Her temperature is 37.7C (100F), blood pressure is 160/90 mmHg,pulse is 126/min and respirations are 18/min. She is confused and agitated dunng the examination Pupils are 6 mm in diameter and respond to light, prominent nystagmus is present' The remainder of her examination is unremarkable.Which of the
followinvng is the most likely diagnosis?

A. Barbiturate intoxication
B. Phencyclidine intoxication
C. Cocaine intoxication
D. Marijuana Intoxication
E. Opioid intoxication MN
F. Alcohol intoxication

Last edited by cingulate.gyrus; 10-11-2012 at 08:15 AM. Reason: Spelling
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PCP intoxication
Letter B

Amphetamine and PCP are quite similar, however combative behavior is seen most often in PCP intoxicaton, which can also give both vertical and horizontal nystagmus (if you guys have studied for the step 1 and have listened to the french guy that teaches pharm youll never forget this)
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did not even read after combative behavior - angel dust.
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Old 10-12-2012
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Answer is b. Phencyclidine toxicity.

This woman is most likely under the influence of phencyclidine, a commonly abused street drug which causes hallucinations. dissociative feelings, agitation, confusion, pupillary dilation, tachycardia, and nystagmus.

It is the only illicit drug that causes vertical nystagmus, but horizontal and rotatory nystagmus can also occur, In many cases, it can lead to psychotic and violent behavior_ High doses can cause severe hypertension, seizures, and life-threatening hyperthermia. Benzodiazepines are used for treatment of severe psychomotor aclftatjon.

Barbiturate (sedative), intoxication presents with drowsiness, incoordination and slurred speech, while agitation is not characteristic of barbiturate use.

Cocaine intoxication is characterized by elevated blood pressure and heart rate, feelings of euphoria, and increased alertness. Nystagmus and hallucinations are not characteristic of cocaine use.

Marijuana intoxication can cause tachycardia, elevated blood pressure, euphoria, and paranoia. It can also cause conjunctival injection and impaired reaction time. Nystagmus or combativeness are not commonly seen in marijuana use

Opioid intoxication is characterized by constricted pupils, depressed mental status, and Tespiratory depression. A characteristic finding of opioid abuse is the presence of needle track markings on the users arms. Agitation and nystagmus are not characteristic of opioid intoxication.


Alcohol is a CHS depressant and intoxication can lead to incoordination, lethargy, confusion. dismhbition and nystagmus. It can also cause aggressive behavior but does not cause hallucinations.
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