7: Clinician's perspective

Question 1

Scotland is the UK country with the (highest / lowest) rate of alcohol-related deaths.

Answer 1

highest

Question 2

Which sex has the higher rate of alcohol-related deaths?

Answer 2

Males

Question 3

Alcohol-related disease is a large financial ___ on the NHS.

Answer 3

burden

Question 4

How many hospital admissions per year are related to alcohol?

Answer 4

> 1 million

Question 5

What factors affect the impact of alcohol consumption on health?

Answer 5

Age

Gender

BMI

Drinking patterns

Volume of alcohol consumed

Length of time (infrequent, frequent, chronic)

Question 6

What may chronic alcoholics experience 6-8 hours after their last drink?

Answer 6

Alcohol withdrawal

Question 7

The severity of alcohol withdrawal symptoms depends on the degree of the patient’s alcohol ___.

Answer 7

dependence

Question 8

The presentation of which condition, following alcohol withdrawal, should be treated as a medical emergency?

Answer 8

Delirium tremens

Question 9

How is alcohol withdrawal assessed in the wards?

Which drug is then used to manage it?

Answer 9

Assessed at set intervals for symptoms and scored

Chlordiazepoxide / diazepam

Question 10

What are some “positive” brain/NS effects of alcohol?

Answer 10

Sedative, mild anaesthetic

Pleasurable

Sense of wellbeing, reduced inhibitions, euphoria

Question 11

What are some negative behavioural effects of alcohol intoxication?

Answer 11

Accidental injury

Aggression

Drowsiness

Slurred speech, unsteadiness

Loss of consciousness

Question 12

A common neuro presentation of alcohol withdrawal is ___.

Answer 12

seizures

Question 13

Alcohol can precipitate seizures in patient who are known to have ___.

Answer 13

epilepsy

Question 14

What are some nerve/muscle consequences of heavy drinking?

Answer 14

Peripheral neuropathy - alcohol damages peripheral nerves + nutrient deficiencies

Compression neuropathy - e.g falling asleep on your own arm

Myopathy - muscle pain, both acute and chronic

Question 15

What is the reversible condition caused by thiamine deficiency in heavy drinkers?

What are the symptoms?

How is it treated?

Answer 15

Wernicke’s encephalopathy

Ataxia, unsteadiness, abnormal eye movements

Thiamine replacement therapy

Question 16

What is the irreversible condition caused by thiamine deficiency in heavy drinkers?

What is the exact pathology?

What are the symptoms?

Answer 16

Korsakoff syndrome

Cerebral atrophy

Memory loss, confabulation

Question 17

How is Korsakoff syndrome treated?

Answer 17

No cure - abstinence from alcohol and adequate nutrition

Question 18

Which common neuro disease is common in chronic drinkers?

Answer 18

Dementia

Question 19

Which type of stroke commonly presents in chronic drinkers?

Answer 19

Haemorrhagic stroke

Question 20

People who drink alcohol in moderation seem to have a(n) (increased / reduced) risk of coronary artery disease.

Answer 20

reduced

Question 21

Which kind of cardiomyopathy is seen in chronic drinkers?

Answer 21

Dilated cardiomyopathy

Question 22

Why does alcohol cause dilated cardiomyopathy?

Answer 22

Impaired ventricular function

Chronic inflammation

Fibrosis

Question 23

Which arrythmias may be seen in acutely intoxicated patients?

Answer 23

Atrial fibrillation

Holiday heart syndrome (supraventricular tachycardia)

Question 24

Chronically, alcohol excess may lead to which arrythmia?

Answer 24

Long QT syndrome

Question 25

Alcohol is the leading cause of ___ disease.

Answer 25

**liver**

Question 26

What is the pathomechanism of cirrhosis in regular heavy drinkers?

Answer 26

**Regular heavy drinking** \> Steatosis \> Inflammation (acute -\> chronic) \> Fibrosis

Question 27

What liver disease is almost universal in heavy drinkers and is reversible with abstinence?

Answer 27

**Alcoholic fatty liver disease** i.e steatosis

Question 28

What is an acute, life-threatening liver disease associated with heavy drinking? What are the symptoms? How is it treated?

Answer 28

**Alcoholic hepatitis** Jaundice, coagulopathy (heavy bleeding), fever etc. Abstinence and nutrition, wait and see

Question 29

Is alcoholic hepatitis the same as cirrhosis?

Answer 29

**No, acute life-threatening presentation typically seen in young people**

Question 30

What develops alongside cirrhosis?

Answer 30

**Portal hypertension**

Question 31

A lot of people don't know they have cirrhosis because their disease is \_\_\_.

Answer 31

**compensated**

Question 32

What are the signs of decompensated cirrhosis?

Answer 32

**Ascites** **Encephalopathy** **Jaundice** **Portal hypertension signs** (varices inc. spider naevi and caput medusae) **Cutaneous signs** (erythema, Dupuytren's)

Question 33

Decompensated cirrhosis is a disease associated with high \_\_\_.

Answer 33

**mortality**

Question 34

What must be maintained in a patient with liver disease?

Answer 34

**Abstinence** and **nutrition**

Question 35

Cirrhosis patients have an increased risk of developing ___ \_\_\_.

Answer 35

**hepatocellular carcinoma**

Question 36

Which cancers are associated with alcohol consumption?

Answer 36

**Head and neck** **Oesophageal** **Liver** **Breast** **Colorectal**

Question 37

Which metabolite of ethanol is thought to be carcinogenic?

Answer 37

**Acetaldehyde** so the more alcohol you drink, the more "" metabolised at sites other than the liver and the greater your risk of cancer

Question 38

The level of which hormone is higher in alcohol drinkers? What disease may this fact be associated with?

Answer 38

**Oestrogen** **Breast cancer**

Question 39

What consultation tactic can be used to talk to patients about their alcohol intake?

Answer 39

**Brief intervention**

Question 40

Patients can also be referred to alcohol ___ services.

Answer 40

**support**

Question 41

What are some drugs which can be used to help patients with abstinence from alcohol?

Answer 41

**Acamprosate** **Disulfiram** **Naltrexone**