A 21-year-old university student is brought to the emergency department by his friends. He has dilated pupils, increased energy, excessive talking, and sweating. He is agitated and reports hearing voices. What is the most likely cause? A) Alcohol withdrawal B) Cannabis intoxication C) Cocaine intoxication D) Benzodiazepine overdose E) Opioid intoxication Correct Answer: C) Cocaine intoxication Explanation: This patient has cocaine intoxication, characterized by dilated pupils, tachycardia, hyperactivity, and psychotic symptoms. A) Alcohol withdrawal → Incorrect. Alcohol withdrawal presents with tremors, seizures, and hallucinations, not dilated pupils. B) Cannabis intoxication → Incorrect. Cannabis can cause euphoria and paranoia but rarely causes severe agitation or psychosis. D) Benzodiazepine overdose → Incorrect. Benzodiazepines cause sedation, confusion, and respiratory depression, not hyperactivity. E) Opioid intoxication → Incorrect. Opioid overdose presents with pinpoint pupils, respiratory depression, and unconsciousness. Key Tips for PLAB 1: ✅ Cocaine intoxication → Dilated pupils, hyperactivity, psychosis, and tachycardia. ✅ Benzodiazepines (e.g., lorazepam) can help calm agitation. ✅ Beta-blockers should be avoided in cocaine users (risk of unopposed alpha stimulation and hypertension).
