Alcohol misuse

Question 1

What is the recommended about of units per week

Answer 1

14 units

Question 2

How to calculate units

Answer 2

ABV (%) * volume (ml) / 1000

Question 3

Signs of intoxication

Answer 3

• Impaired speech
• Labile affect
• Impaired judgement
• Poor co-ordination
• Hyperglycaemia
• Stupor
• Coma

Question 4

Alcohol dependence (SAWDRIN)

Answer 4

S - Subjective awareness of compulsion to drink
A - Avoidance of relief of withdrawal by further drinking
W - Withdrawal Sx
D - Drink seeking behaviour
R - Reinstatement of drinking after attempted abstinence
I - Increased tolerance
N - Narrowing of drinking repetoire

Question 5

Symptoms after 6-12hrs after last drink

Answer 5

Malaise,
Tremor,
Nausea,
Insomnia,
Transient hallucination,
Autonomic hypersensitivity

Question 6

Symptoms 36 hrs after last drink

Answer 6

Seizures

Question 7

Syptoms 72 hrs after last drink

Answer 7

Delerium tremor

Question 8

Signs of delirium tremors

Answer 8

• Dehydration ± electrolyte disturbances
• Cognitive impairment
• Hallucinations/illusions
• Paranoid delusions
• Marked tremor
• Autonomic arousal

Question 9

Alcohol misuse questionnaires

Answer 9

Questionnaires: AUDIT, CAGE, SADQ and FAST

Question 10

Diagnostic criteria

Answer 10

Clinical Institute Withdrawal Assessment (CIWA)

Question 11

Treatment

Answer 11

FIRST LINE for acute withdrawal symptoms:
- CHLORDIAZEPOXIDE + IV Thiamine
- Motivational interviewing/CBT
- Alcoholics anonymous

Question 12

Maintenance and relapse prevention

Answer 12

Acamprosate = ‘Anti-craving’
Naltrexone
Disulfiram = Will make you vomit if you drink

Question 13

What is Wernicke’s encephalopathy?

Answer 13

Thiamine deficiency

Question 14

Clinical presentations of Wernickes encephalopathy (HONDA)

Answer 14

Hypothermia
Opthalmoplegia
Nystagmus
Delerium
Ataxia

Question 15

Wernickes encephalopathy treatment

Answer 15

IV Pabrinex (thiamine)

Question 16

Korsakoff’s syndrome symptoms (I Don’t reMember Anything)

Answer 16

I - Inability to lay down new memories
Don’t - Disorientation to time
reMember- Working memory impaired with confabulation
Anything - Ante/retrograde amnesia

Question 17

Diagnosis

Answer 17

• Psychiatric Hx + MSE
• Physical exam
• CT head
• ECG
• Bloods:
  = FBC,
  = U&Es,
  = LFTs (gamma-GT^),
  = TFTs,
  = vitamin B12/folate,
  = blood alcohol level,
  = amylase/lipase,
  = glucose
  = hepatitis serology