Alcohol

Question 1

What are the effects of low doses of alcohol?

Answer 1

Euphoria
Reduced anxiety
Relaxation
Sociability

Question 2

What are the effects of higher doses of alcohol?

Answer 2

Impaired attention and judgement Unsteadiness 
Flushing
Nystagmus
Mood instability
Disinhibition
Slurring
Stupor
Unconsciousness

Question 3

What is the criteria for diagnosing alcohol dependence?

Answer 3

3 or more of the following for >1month or repeatedly over 12 months:
Cravings/compulsions to take
Difficulty controlling use
Primacy
Increased tolerance
Physiological withdrawal on reduction/cessation
Persistence despite harmful consequences

Question 4

What are the symptoms of alcohol withdrawal state?

Answer 4

Tremor
Weakness 
Nausea
Vomiting
Anxiety
Seizures
Confusion
Agitation
Death

Question 5

How can alcohol effects mental health?

Answer 5

Anxiety
Depression
Sleep disruption
Morbid Jealousy
Alcoholic hallucinosis
Deliberate self-injury
Suicidal thoughts/acts

Question 6

What are the symptoms of Wernicke’s encephalopathy?

Answer 6

Confusion
Ataxia
Opthalmoplegia
Nystagmus

Question 7

What are the symptoms of Korsakoff’s psychosis?

Answer 7

Prominent impairment of recent and remote memory
Preservation of immediate recall
No general cognitive impairment
Retrograde and anterograde memory Impaired learning and disorientation
May exhibit nystagmus and ataxia

Question 8

What is the cause of Wernicke’s encephalopathy and Korsakoff’s psychosis?

Answer 8

Thiamine deficiency (vitamin B1)

Question 9

How can alcohol affect relationships?

Answer 9

Agression (verbal, physical)
Marital difficulties
Poor parenting/neglect/ loss of parenting rights
Loss of friendships and social support

Question 10

What is included in the CAGE screening tool?

Answer 10

Have you tried to Cut down?
Have you felt Annoyed by people criticising your drinking?
Have you felt Guilty about drinking?
Have you felt the need to have an Eye-opener?

Question 11

What are the other screening tools used to in diagnosing alcohol problems?

Answer 11

AUDIT (Alcohol Use Disorders Identification Test)
FAST
PAT (Paddington Alcohol Test, used in A&E)

Question 12

What are the management options for alcohol problems?

Answer 12

Support for patient and family
Psychological help (e.g. CBT, group therapy)
Social work input (benefits, housing, child protection)
Skills training
Community Support (eg AA, ADA)
Inpatient or residential treatment
Medication

Question 13

What is the treatment for Wernicke-Korsakoff syndrome?

Answer 13

Thiamine

Question 14

What medication is available for alcohol withdrawal?

Answer 14

Benxodiazepines (Chlordiazepoxide)

Question 15

What medications can be used to treat aversion/deterrent?

Answer 15

Disulfiram

Question 16

What are some examples of anti-craving medication?

Answer 16

Acamprosate (Campral)
Naltrexone
Nalmefene
(Baclofen)

Question 17

What liver conditions can be related to alcohol?

Answer 17

Inflammation
Fatty infiltrates
Hepatitis
Cirrhosis

Question 18

What are the clinical features if alcoholic hepatitis?

Answer 18

Alcohol intake >6 unites per day
Drinking until previous 3 weeks
Jaundice with bilirubin >80
No evidence of other liver disease or biliary obstruction

Question 19

What are the treatment options for hepatocellular cancer?

Answer 19

Surgical resection
Liver transplant 
Radiofrequency / Microwave ablation
Transarterial Chemoembolisation (TACE)
Chemotherapy (sorafanib)

Question 20

What are the resistant complications of cirrhosis?

Answer 20

Jaundice
Ascites
Coagulopathy
Encephalopathy