Nutritional Deficiency And Alcohol

Question 1

Triad of Wernicke Encephalopathy

Answer 1

Ophthalmoplegia (with nystagmus)
Ataxia
Disturbances of mentation and consciousness

Question 2

Most common isolated manifestation of Wernicke-Korsakoff

Answer 2

Disturbances of consciousness and mentation

Question 3

Oculomotor abnormalities of Wernicke enceph

Answer 3

1. Nystagmus (most common)
2. LR weakness or paralysis (B but no necessarily symmetrical)
3. Conjugate gaze weakness or paralysis

Question 4

The impaired olfactory discrimination in the Korsakoff amnesic state is attributable to a lesion in which area?

Answer 4

Mediodorsal nucleus of the thalamus

Not the peripheral olfactory system

Question 5

Imaging findings in Wernicke-Korsakoff Syndrome

Answer 5

Small hemorrhagic lesions of the diencephalon and periventricular areas
Mammillary bodies shrunken
Sequence- T2 Flair and DWI

Question 6

Night blindness is caused by which vitamin deficiency

Answer 6

Vit B2 Riboflavin

Question 7

Triad of Pellagra or Niacin/ VitB3 deficiency

Answer 7

Dementia
Dermatitis
Diarrhea

Question 8

Pathologic change in Neuropathic beriberi

Answer 8

Axonal degeneration

Distal parts of the longest and largest myelinated fibers crural»brachial nerves

Question 9

Hemodialysis in the treatment of alcohol intoxication should be considered when:

Answer 9

Comatose patient with blood alcohol concentration >500mg/dL
With acidosis
Or ingested
Methanol or ethylene glycol

Question 10

Functional impairments associated with Blood alcohol levels in nonhabituated persons

Answer 10

30 mg/dL mild euphoria
50 mg/dL mild incoordination
100mg/dL obvious ataxia
200mg/dL confusion and reduced mental activity
300mg/dL stupor
400mg/dL deep anesthesia- potentially fatal

Question 11

Drug that when taken with alcohol causes accumulation of acetaldehyde hence nausea, vomiting, hypotension and even demise

Answer 11

Disulfiram (antabuse)

Other drugs similar of less potency
Metronidazole
Sulfonylureas
Furazolidone

Question 12

Indications for treatment with fomepizole (4-mehylpyrazole)

Answer 12

For either methanol or ethylene glycol poisoning with
Plasma alcohol level >20mg/dL
Or
>10mg/dL + osmolal gap over 10

For ethylene glycol, also if with
Oxaluria and acidosis

Question 13

Which CN affected by ethylene glycol toxicity

Answer 13

CN7 and 8 develop 6-18days after ingestion

Question 14

Main vulnerability to the fetal alcohol syndrome occurs during this period of gestation

Answer 14

Period of synaptogenesis from the 6th month of gestation onwards

Question 15

Contraindications to institution of Disulfiram for Alcohol dependence

Answer 15

Cardiac disease

Advanced liver disease

Question 16

Opioid overdose manifest in the mild degrees of intoxication as?
Usual syndrome?
Most advanced stage?

Answer 16

Mild: anorexia, nausea, vomiting, constipation, loss of sexual interest

Acute opioid poisoning: unresponsiveness, shallow respirations, slow RR, periodic breathing, pinpoint pupils, bradycardia, hypothermia

Most advanced: pupils DILATE, cyanotic, circulation fails

Question 17

Treatment of Opioid overdose

Answer 17

Naloxone 0.05mg repeated in larger increments (second dose 2mg usu) every 2mins to a dose of 15mg IV

Start with 0.1mg/kg in children

Question 18

Phases of opioid addiction

Answer 18

1. Intoxication or “euphoria”
2. Pharmacogenic dependence
3. Propensity to relapse after a period of abstinence

Question 19

Substitution of methadone for opioid. Equivalent doses?

Answer 19

1mg methadone for

1mg heroin
3mg morphine
20mg meperidine

Question 20

Drugs that can be used for treatment of opioid abstinence syndrome

Answer 20

Methadone
Clonidine 0.2-0.6 mg bid x 1 week
Diacetylmorphine
Naloxone or naltrexone under General anesthesia largely abandoned due to safety issues