QuestionSBA
QuestionChoice
This patient is suffering from benzodiazepine toxicity. Benzodiazepine toxicity leads to muscarinic effects such as ataxia, dysarthria and nystagmus and in severe cases, respiratory depression which can be fatal.
50146
a
Diazepam
QuestionChoice
MDMA is a stimulant recreational drug known as 'ecstasy'. MDMA toxicity leads to confusion, coma, convulsions, ventricular arrhythmias, hyperthermia, rhabdomyolysis, acute renal failure, acute hepatitis, disseminated intravascular coagulation, adult respiratory distress syndrome, hyperreflexia, hypotension and intracerebral haemorrhage. Self-induced water intoxication can also lead to hyponatraemia.
50148
c
Methylenedioxymethamphetamine (MDMA)
QuestionChoice
Amphetamines are stimulant recreational drugs. Toxicity leads to signs such as wakefulness, excessive activity, paranoia, hallucinations, hypertension and in more severe cases; exhaustion, convulsions, hyperthermia, and coma.
50150
e
Amphetamine
QuestionChoice
Oxycodone is an opioid that is sometimes used recreationally. Opioid overdose has a similar clinical presentation to this patient in the form of respiratory depression and drowsiness. However, opioid toxicity causes different eye signs, most notably, constricted pinpoint pupils.
50147
b
Oxycodone
QuestionChoice
Cocaine is a stimulant drug used recreationally. Cocaine toxicity can lead to effects signs such as agitation, dilated pupils, tachycardia, hypertension, hallucinations, hyperthermia, hypertonia, and hyperreflexia. In severe cases, cocaine can cause myocardial infarction and arrhythmias.
50149
d
Cocaine
QuestionComment
who's doing diazepam as a recreational drug 
61595
User
subscriber
Epidermis Benign
Concept
Chapter
Osteoporosis, otherwise known as thin bones, is a condition associated with high risk of low trauma fractures due to reduced bone mineral density. Osteoclast activity exceeds osteoblast activity, meaning that bone resorption is occurring at a greater rate than bone formation.

**Symptoms and Signs**

- Generally asymptomatic until a fragility fracture occurs
- Back pain
- Kyphosis (stooped posture)
- Fragility fractures

**Risk factors**

- Female sex
- Increasing age
- Smoking
- Corticosteroid use
- Low BMI (< 20-25kg/m<sup>2</sup>)
- Low body weight (<58kg)
- Vitamin D deficiency

**Protective factors**

- Higher BMI
- Exercise - mechanical loading stimulates bone formation

**Diagnosis**
Osteoporosis can be detected on dual-energy x-ray absorptiometry (DEXA) scan.
A T score of < -2.5 indicates osteoporosis

**Management**

- Fall prevention
- Vitamin D and calcium supplementation
- Hormone replacement therapy (postmenopausal women)
- Oral bisphosphonates
2657
3609
Benzodiazepine toxicity
Topic
9
Internal Medicine
10077
Case Presentation: A 21-year-old female patient is brought to A&E drowsy and confused. Her friend reports that she has been taking recreational drugs. 


**PMH**
None

**On examination**
* Chest: clear, RR 12
* HS: S1 S2 + no added sounds
* Cranial Nerves: Nystagmus and dysarthria. Pupils are equal and reactive to light, normal size.

**Investigation**

Routine blood tests are normal.

Question: Which recreational drug is most likely to have caused these clinical signs?
a