Poisoning the Mind

Question 1

what is feral alcohol syndrome

Answer 1

serious developmental disorder caused by prenatal alcohol exposure of the fetus

Question 2

3 features of FAS

Answer 2

• Prenatal and/or postnatal growth retardation
• Central nervous system dysfunction

• Characteristic craniofacial abnormalities

Question 3

symptoms of heavy drinking

Answer 3

Insomnia 
Depression
Anxiety 
Attempted suicide/suicide 
Changes in personality 
Amnestic syndrome (korsakoff syndrome)
Dementia 
Delirium tremens 
Alcohol hallucinosis
Association with other addictions

Question 4

Agnosia

Answer 4

cannot recognise familiar things

Question 5

Aphasia

Answer 5

circumlocutions, cliches, circumstantiality

Question 6

Apraxia

Answer 6

senses intact, understand what asked, physically able to do it but still cant do it

Question 7

consequences of loss of executive functioning

Answer 7

Poor planning and organising of simple actions into more complicated sequences of action very poor adaptability. OK in familiar place but cannot cope with change in circumstance or surroundings, dependent on the familiar

Question 8

what is dementia

Answer 8

Must be decline from previous level 
Must be memory loss
At least one of these
agnosia
aphasia
apraxia

Question 9

what is chronic phase of Wenicke - Korsakoff syndrome

Answer 9

Korsakoff’s disease (amnesic syndrome) 


Question 10

4 symptoms of Wenicke - Korsakoff syndrome

Answer 10

1. Confusion
2. Eye symptoms = game paralysis, nystagmus
3. Gait ataxia
4. Neuropathological lesions: Lesions along the neural axis, particularly close to the ventricle wall

Question 11

4 differential diagnosis of hepatic encephalopathy

Answer 11

1. Metabolic encephalopathies - drugs/toxins
2. Intracranial structural disorders - infection
3. Seizures - Wernickes encephalopathy
4. Head injury

Question 12

other factors causing cognitive impairment WITH alcohol misuse

Answer 12

Intoxication
Seizures 
Alcohol neurotoxicity 
Vitamin deficiency- particularly vitamin B1/thiamine 
Hypoglycaemia 
Head injury 
Cerebrovascular accidents 
Withdrawal delirium
Hepatic encephalopathy
Hypoxia 
Non-alcohol related cerebral pathology in older people

Question 13

daily requirement of thymine

Answer 13

1-2mg

Question 14

total body

Answer 14

30mg

Question 15

Alcohol related brain damage causes

Answer 15

Neuropathies
Cerebellar degeneration
Dementia
Wernicke - forsakoff syndrome / amnestic syndrome

Question 16

Nutritional/thyiamine deficiency symptoms

Answer 16

Weight loss in the past year
Reduced BMI
High carbohydrate intake
Recurrent episodes of vomiting

Question 17

Amnesic syndrome/ Korsakoff syndrome

Answer 17

A syndrome associated with chronic prominent loss of recent memory; remote memory is sometimes impaired ,while immediate recall is preserved. Disturbances of time sense and ordering of events are usually evident, as are difficulties in learning new material.

Question 18

Precipitating factors of hepatic encephalopathy

Answer 18

Increased protein load eg upper GI haemorrhage
Decreased excretion of ammonia eg renal failure
Others electrolyte disturbance
Dehydration, paracentesis, creation of portacaval shunts, infection, drugs, superimposed acute liver injury

Question 19

factors affecting alcohol tolerance in relation to aging

Answer 19

decreased total body water
decrease in gastric alcohol dehydrogenase increases BAC
liver oxidation decreases
sensitivity of the brain to alcohol

Question 20

what does encephalopathy indicate

Answer 20

liver failure

Question 21

Non-alcohol related form of Wernicke-Korsakoff syndrome

Answer 21

due to thiamine depletion

Question 22

combination of which 2 factors can lead to cortical and subcortical brain damage

Answer 22

cortical (alcohol-induced)

sub-cortical (alcohol and thiamine depletion induced)

Question 23

2 important compounds in the pathogenesis of

Answer 23

ammonia and glutamate-glutamine cycle

Question 24

how is there an increase in osmotic stress and astrocyte glutamine in hepatic encephalopathy

Answer 24

Blood-brain barrier more permeable to ammonia with down regulation of glutamate receptors and uptake