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Stimulant intoxication — MCCQE Part 1 MCQ

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ModerateSubstance UseStimulant intoxicationMCCQE Part 1

A 23-year-old man presents with paranoia, auditory hallucinations, agitation, and dilated pupils after a party. He is hypertensive, tachycardic, and sweating; symptoms began abruptly 2 hours ago. What is the most likely diagnosis?

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Correct answer: D — Stimulant intoxication with psychosis

Acute psychosis with sympathetic activation, mydriasis, diaphoresis, and party exposure strongly suggests stimulant intoxication. Schizophrenia would not usually cause abrupt onset with marked autonomic signs. Alcohol withdrawal typically follows cessation after heavy use and includes tremor. Opioid intoxication causes miosis and respiratory depression.

Reference: Canadian substance use guidance; CAMH stimulant use resources