A 16-year-old male presents with widely dilated pupils, tachycardia, and hypertension. What is the most likely diagnosis?

The symptoms presented in the scenario—widely dilated pupils, tachycardia, and hypertension—are hallmark signs of stimulant use, particularly cocaine intoxication. Cocaine is known to stimulate the central nervous system, which leads to increased heart rate (tachycardia) and elevated blood pressure (hypertension). Additionally, the sympathetic nervous system activation from cocaine can cause mydriasis, the technical term for dilated pupils.

The other options do not typically present with the combination of these specific symptoms. Opiate abuse tends to cause miosis (constricted pupils), not dilated pupils, and usually presents with different vital sign changes. An acute anxiety attack may lead to tachycardia and possibly hypertension, but it usually does not produce dilated pupils as a consistent feature. Bipolar affective disorder does not typically present with such acute physical symptoms; rather, it involves mood disturbances that may not always be linked to immediate physiological changes like those induced by stimulant drugs.

Therefore, considering all these factors, cocaine intoxication aligns perfectly with the clinical presentation of the patient.