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Stimulant intoxication — USMLE Step 2 CK MCQ

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HardPsychiatryStimulant intoxicationUSMLE Step 2 CK

A 30-year-old is brought to the emergency department after smoking crack cocaine. He is extremely agitated, temperature is 40.1°C (104.2°F), heart rate is 148/min, and blood pressure is 202/118 mm Hg. ECG shows sinus tachycardia without ischemic changes. Which immediate treatment is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Give intravenous lorazepam and begin active external cooling

Explanation lettering: D = shown as C · E = shown as D · C = shown as E

B is correct: severe stimulant hyperadrenergic toxicity is treated first with a rapidly titrated benzodiazepine plus supportive care, and temperature above 40°C requires aggressive active cooling. A uses isolated beta blockade and worsens hyperthermia. C is too slow and inadequate for severe agitation. D leaves sympathetic excess and hyperthermia undertreated while increasing seizure and dysrhythmia concerns. E has no role in cocaine toxicity.

Reference: ASAM/AAAP clinical practice guideline on stimulant use disorder. https://downloads.asam.org/sitefinity-production-blobs/docs/default-source/quality-science/stud_guideline_document_final.pdf