A 28-year-old man with opioid use disorder last used heroin 24 hours ago. He presents with anxiety, restlessness, lacrimation, rhinorrhoea, yawning, and piloerection. Which of the following physical signs is most characteristic of opioid withdrawal?
- A Pinpoint pupils
- B Hypothermia
- C Mydriasis ✓
- D Bradycardia
Correct answer: C. Mydriasis
Explanation
Opioid withdrawal produces a sympathetic overdrive state, causing mydriasis, piloerection, diarrhoea, and tachycardia. Pinpoint pupils, bradycardia, and hypothermia are features of opioid intoxication, not withdrawal. The presence of dilated pupils in a patient with autonomic hyperactivity strongly points to opioid withdrawal.
Reference: Harrison's Principles of Internal Medicine, 20th ed.
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