chapter 2 alcoholism

Question 1

thiamine deficiency

Answer 1

ophthalmoplegia

memory disturbance, korsakoff

give thiamine before glucose

Question 2

if alcoholic + polyneuropathy

Answer 2

also give b12

Question 3

SCD

Answer 3

B12 deficiency

Question 4

wernicke

Answer 4

encephalopathy
nystagmus, conjugate gaze
ataxia

Question 5

korsakoff

Answer 5

anterograde/retrograde amnesia
confabulation
mammilary bodies damage + thalamic nuclei

Question 6

oral cavity, larynx, gastric, esophagus, liver, lung, colon, breast, pancreatic

Answer 6

cancers ass w/ alcoholism

Question 7

alcohol can precipitate hypoglycemia?

Answer 7

true

but give thaimine first then glucose

Question 8

if you give glucose before thiamine?

Answer 8

precipitates wernickes

Question 9

alcohol withdrawal is fatal?

Answer 9

yes

Question 10

how to treat alcohol withdrawal

Answer 10

benzos taper

Question 11

stages of withdrawal

Answer 11

12-48: tremors, sweats, hyperreflexia, seizures
24-72: AVH
2-7 days: DT - can be fatal

POD 2 - dt

Question 12

physical stigmata of cirrhosis

Answer 12

caput medusae
testicular atrophy
esophageal varices
encephalopathy
internal hemorrhoids
edema
palmar erythema/spider angiomas
gynecomastia
terry nails -- white nails with GG ppearance and no lunaulae
sweet breath
duputrene contractures = knots in hands = palmar fiborisis

Question 13

macrocytic anemia
prolonged PT
hyperbilirubinemia
hypoalbuminemia
thrombocytepenia

Answer 13

alcohol labs

Question 14

alcohol causes

Answer 14

hepatits
mallory weiss
acute/chronic pancreatitis
PN
cerebellar degeneration - past pointing
dilated CM
rhabdo

Question 15

AST/ALT : 2/1

Answer 15

alcoholic hepatitis

Question 16

tx for alcoholism?

Answer 16

AA is the best

disulfaram – makes aldehyde dehydrogenase inhibitor

Question 17

alcohol in pregnancy

Answer 17

most common cause of preventable ID

Question 18

smooth philtrum
microophtalmia
microcephalia
midface hypoplasia
short palpebral fissues

Answer 18

FAD

Question 19

homeless alcoholic pneumonia

Answer 19

ASPIRATION
ecoli
strep
staph
klebsiella - thick mucoid capsules

Question 20

electrolytes

Answer 20

low mag
low sodium 
low potassium
high uric acid -- gout
def of folate and thiamine
poor nutrition

Question 21

tx of bleeding esophageal varices?

Answer 21

stabilize with IVF
give FFP, fresh blood, vitamin
upper EGD to deterine cause
sclerotherapy w/ cauterization or banding or vasopressin

transjugular intrahepatic (TIPS) over shunt for most definitive treatment
splenorenal shunt is rarely done

Question 22

how to tx varices without bleeding

Answer 22

nonselective beta blockers

timolol, propanolol, nadalol to relieve portal HTN