Rosh Psychiatry Board Practice Exam

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A 25-year-old man experiences withdrawal symptoms including restlessness and profuse sweating. Which substance is likely causing this?

Oxycodone
Cannabis
Alcohol
Lorazepam

The correct answer is: Oxycodone

The symptoms described—restlessness and profuse sweating—are indicative of withdrawal from substances that stimulate the autonomic nervous system or cause physical dependence. Oxycodone is an opioid, and withdrawal from opioids is characterized by a variety of symptoms including restlessness, sweating, anxiety, insomnia, nausea, and other flu-like symptoms. While both alcohol and benzodiazepines (like lorazepam) can cause withdrawal symptoms and could potentially fit the restlessness and sweating criteria, they typically present with a broader range of symptoms, which might include seizures and tremors, as well as high blood pressure. In this case, the presence of profuse sweating without those more severe symptoms does lend more credence to opioid withdrawal. Cannabis withdrawal can occur but typically does not present with the level of physical symptoms displayed here, particularly restlessness and sweating, which are more characteristic of opioid withdrawal. Therefore, considering the combination of symptoms and their alignment with the pharmacology of the substances listed, oxycodone stands out as the most likely culprit for the withdrawal symptoms described.