Alcohol

Question 1

What is alcoholism?

Answer 1

Physiologic tolerance and dependence with symptoms of withdrawal (tremor, tachycardia, hypertension, malaise, nausea, DTs) when intake is interrupted.

Question 2

What are complications of alcoholism?

Answer 2

Alcoholic cirrhosis, hepatitis, pancreatitis, peripheral neuropathy, testicular atrophy

Question 3

What are common treatments for alcoholism?

Answer 3

Disulfuram (to condition the patient to abstain from alcohol use), supportive care. AA and other peer support groups are helpful in sustaining abstinence.

Question 4

Wernicke-Korsakoff Syndrome

Answer 4

Caused by thiamine (B1) deficiency. Triad of confusion, ophthalmoplegia, and ataxia (wernicke’s encephalopathy). May progress to irreversible memory loss, confabulation, personality change (Korsakoff’s psychosis).

Question 5

Imaging finding for Wernicke-Korsakoff Syndrome?

Answer 5

Periventricular hemorrhage/necrosis of mammillary bodies.

Question 6

Treatment for Wernicke-Korsakoff Syndrome?

Answer 6

IV thiamine (**Never infuse glucose without thiamine because you can induce Korsakoff’s)

Question 7

Mallory-Weiss Syndrome

Answer 7

Longitudinal lacerations at the gastroesophageal junction caused by excessive vomiting (from alcohol intoxication). Often presents with hematemesis (blood vomit). Associated with pain (vs. esophageal varices).

Question 8

Delirium Tremens

Answer 8

Life-threatening alcohol withdrawal syndrome that peaks 2-5 days after last drink.

Question 9

Order of symptoms in alcohol withdrawal

Answer 9

“The shakes” (autonomic disturbance leads to tachycardia, tremors, anxiety), followed by psychotic symptoms (hallucinations, delusions), and confusion.

Question 10

Treatment for symptoms in alcohol withdrawal

Answer 10

Benzodiazepines

Question 11

Agents for treating alcohol dependence

Answer 11

Acamprosate, disulfiram, naltrexone, and topiramate (off-label)

Question 12

Alcohol dehydrogenase inhibitor

Answer 12

Fomepizole