Alcoholism 3D

Question 1

what is seen on the hands in chronic alcoholism

Answer 1

palmar erythema, nail changes and dupuytrens contracture

Question 2

what is palmar erythema usually related to

Answer 2

underlying liver cirrhosis. inc oestrogen levels are thought to cause changes in the small anastomoses in the hand inc vascularity

Question 3

what else can cause Dupuytren’s Contracure

Answer 3

anti epileptic drugs

Question 4

what is Dupuytren’s Contracure

Answer 4

benign fibrosis of the palmar fascia

Question 5

name 3 effects of alcoholism on the nerves and muscles

Answer 5

peripheral neuropathy, compression neuropathy and myopathy

Question 6

peripheral neuropathy typical distribution

Answer 6

glove and sock - causes burning pain and weakness

Question 7

compression neuropathy

Answer 7

caused by direct pressure on a nerve causing temporary damage to the myelin sheath

Question 8

acute myopathy

Answer 8

occurs after a binge, myaliga, weakness, swollen tender muscles

Question 9

chronic myopathy

Answer 9

painless proximal weakness and atrophy

Question 10

compare the CK levels in acute and chronic myopathy

Answer 10

raised in acute, normal in chronic

Question 11

what vitamin is thiamine

Answer 11

B1

Question 12

what can occur in the brain

Answer 12

subdural haematoma - not uncommon to see multiple

Question 13

subdural haematoma

Answer 13

alcohol use is associated with falling and subsequent neurological damage, this is a common consequence

Question 14

name 3 consequences of deficiency of thiamine in the diet

Answer 14

wernicke’s encephalopathy, korsakoff’s syndrome and beri beri

Question 15

name a relevant role of thiamine

Answer 15

maintain peripheral nerves

Question 16

what is the classic triad of wernickes encephalopathy

Answer 16

• confusion, ataxia and opthalmoplegia
• need urgent thiamine replacement within hours, or can result in permanent signs and symptoms of Korwsakoff

Question 17

what is opthalmoplegia

Answer 17

paralysis of muscles within or surrounding the eye

Question 18

what tends to develop as wernickes goes away

Answer 18

korsakoffs syndrome

Question 19

korsakoffs syndrome

Answer 19

results from permanent damage to areas of the brain involved in memory and associated with recent memory loss anterograde and retrograde amnesia

Question 20

anterograde amnesia

Answer 20

inability to make new memories after the event that caused amnesia

Question 21

retrograde amnesia

Answer 21

loss of memory access to events that occurred before the incident

Question 22

confabulation

Answer 22

patients making up new memories in the absence of the real ones

Question 23

wet beri beri

Answer 23

affects CV system

Question 24

dry beri beri

Answer 24

nervous system

Question 25

does alcohol have a positive or negative inotropic effect on the heart

Answer 25

negative - 'heavy heart.' tachycardia the morning after drinking as heat tries to maintain CO

Question 26

holiday heart syndrome

Answer 26

* binge drinking in a person without any clinical evidence of heart disease that can result in acute cardiac rhythm/conductance disturbances * tends to be supraventricular tachyarrhythmia

Question 27

what type of cardiomyopathy does alcohol cause

Answer 27

dilated - most common cause

Question 28

what are the effects of alcohol on the stomach

Answer 28

natural irritant to the gastric mucosa, causes high conc of alcohol to be absorbed slower due to this irritation

Question 29

what is boerhaave syndrome

Answer 29

transmural oesophageal rupture due to persistent vomiting. Note Mallory-Weiss tear is a non-transmural rupture

Question 30

what component of alcohol metabolism is carcinogenic

Answer 30

acetaldehyde

Question 31

how does acetaldehyde cause cancer

Answer 31

as alcohol level inc, it is metabolised by alcohol dehydrogenase in areas other than the liver (stomach, upper Gi tract, upper airway). acetaldehyde builds up as there is a deficiency of aldehyde dehydrogenase.

Question 32

what unexpected type of cancer can alcohol cause

Answer 32

breast

Question 33

name a useful screening tool for alcohol dependence

Answer 33

AUDDIT

Question 34

delerium tremens

Answer 34

severe withdrawal symptom.- confusion, hyperactivity, can lead to CV collapse onset is 3 days in and lasts for 2 to 3 days

Question 35

how many calories does 1g of alcohol contain

Answer 35

7 calories

Question 36

what is used medically for assisted alcohol withdrawal

Answer 36

Chlordiazepoxide - benzodiazpeine class

Question 37

what is alcohols effect on HDL

Answer 37

increases it

Question 38

alcohol effect on the clotting factors

Answer 38

inhibits them - patients are more likely to bleed

Question 39

what type of receptors are GABA receptors

Answer 39

inhibitory

Question 40

what type of receptors are glutamate receptors

Answer 40

excitatory

Question 41

what does ethanol do to GABA and glutamate receptors

Answer 41

potentiate GABA and inhibit glutamate causing CNS depression

Question 42

what class of drugs are used in alcohol withdrawal and why

Answer 42

* benzodiazepines - enhance the effect of GABA * eg Chlordiazepoxide

Question 43

alcohol misuse - F10.1

Answer 43

pattern of use that is causing damage to health - mental or physical

Question 44

F10.2

Answer 44

Dependence syndrome, 3 or more of: * Strong desire or compulsion to take alcohol * Difficulties in controlling use * Persistent use despite clear evidence of harm * Preoccupation with substance use * Increased tolerance * Physiological withdrawal state

Question 45

aspiration pneumonia

Answer 45

* compounded by teh relaxant efects of alcohol on the upper airway musculature and effects on the CNS * most likely to occur on superior aspect of right lower lobe * Klebsiella often implicated

Question 46

mild alcohol withdrawal

Answer 46

* Fine tremor, sweating, anxiety, hyperactivity, inc. HR, inc. BP, fever, anorexia, nausea, retching

Question 47

moderate alcohol withdrawal

Answer 47

* Coarse tremor, sharking, agitation, confusion, disorientation, paranoia, seizures, hallucinations * up to 5 days

Question 48

severe alcohol withdrawal

Answer 48

* Risk of DT (medical emergency) around 48 hours, severe agitation, anxiety, confusion, delusions, hallucinations * Circulatory collapse and death can occur * Up to 7+ days

Question 49

delirium tremens

Answer 49

* Severe withdrawal * Rapid onset of confusion * Sympathetic overdrive, can lead to CV collapse, global confusion * Onset is usually 3 days into the withdrawal symptoms and lasts for 2 to 3 days

Question 50

define binge drinking

Answer 50

* **Binge drinking** is defined as greater than **8** units in one day for women and men.