Wernicke's/Korsakoff encephalopathy Flashcards
Does alcohol increase or decrease the following:
- HR
- BP
- wakefulness
- decreases everything
- ethanol is a depressant
During withdrawal from alcohol, patients can experiencer tonic/clonic seizures that resemble epilepsy. Which of the following is also common?
1 - Tremor
2 - Sweating
3 - Anxiety
4 - Tachycardia
5 - Insomnia
6 - Nausea/vomiting
7 - All of the above
7 - All of the above
- occur because ethanol is a suppressant and suppresses all of these functions
- remove the suppressant and these functions are in overdrive
What scoring tool is used to assess a patients alcohol withdrawal?
1 - CIWA
2 - Wells score
3 - Chad-vasc score
4 - AUDIT-C
1 - CIWA
- Clinical Institute Withdrawal Assessment
Typically, how long is it before a patient begins to have withdrawal symptoms following cessation of alcohol?
1 - <6hours
2 - <12 hours
3 - <24 hours
4 - <48 hours
2 - <12 hours
- can be variable though
Delirium tremens can occur in a patient in alcohol withdrawal, typically after 3 days. Which of the following are features of delirium tremens?
1 - rapid onset of confusion
2 - severe tremor
3 - clouding of consciousness
4 - paranoia
5 - agitation
6 - autonomic instability
7 - all of the above
7 - all of the above
- high mortality rate if not treated
- some patients report feeling of insects crawling on their arms
Does alcohol consumption increase or decrease blood glucose in an acute and chronic phase?
- acute = hyperglycaemia
- chronic = hypoglycaemia
In a patient with alcohol withdrawal, which 2 imaging modalities can often be used?
1 - MRI
2 - chest X-ray
3 - CT scan
4 - ultrasound
2 - chest X-ray
3 - CT scan
In alcohol use and withdrawal, Ca2+ levels can be affected. How does this occur?
1 - alcohol reduces Ca2+ absorption in GIT
2 - alcohol reduces conversion of the pre cursor of vitamin D into active vitamin D
3 - increased cortisol release, which increases bone breakdown
4 - all of the above
4 - all of the above
- Ca2+ may appear normal, but patients can develop osteoporosis
Does alcohol increase of decrease the absorption of Mg2+?
- decreases the absorption
In acute alcohol use what would we expect to see in GABA-A and NMDA receptors?
1 - GABA and NMDA agonist
2 - GABA and NMDA antagonist
3 - GABA agonist and NMDA antagonist
4 - GABA antagonist and NMDA agonist
3 - GABA agonist and NMDA antagonist
- NMDA is glutamate
Patients who associate alcohol with a positive valence (which increases dopamine release) and associate with a feeling of reward when consumed will have increased dopamine release from the ventral tegmental area (VTA). What effect does alcohol then have on the VTA?
1 - NMDA (glutamate) antagonist of cortical input disinhibits VTA and increases dopamine
2 - GABA receptor antagonist of cortical input disinhibits VTA and decreases dopamine
3 - NMDA (glutamate) agonist of cortical input disinhibits VTA and decreases dopamine
1 - NMDA (glutamate) antagonist of cortical input disinhibits VTA and increases dopamine
- causes an increase in dopamine release to the nucleus accumbens
- means we continue to want alcohol to get the same reward effects
- nucleus accumbens = main dopamine nucleus)
- located in the midbrain
Which of the following drugs is used to treat alcohol dependence?
1 - adenosine
2 - haloperidol
3 - disulfiram
4 - lithium
3 - disulfiram
Disulfiram is used to treat alcohol dependence. What is the mechanism of action of this drug?
1 - agonist of NMDA receptors and increases glutamate
2 - inhibits GABA A receptors
3 - inhibits aldehyde dehydrogenase
4 - all of the above
3 - inhibits aldehyde dehydrogenase
In chronic alcohol we can see dependency, which is where the patient cannot function normally without alcohol. What would we expect to see in GABA and NMDA receptors?
1 - GABA and NMDA receptors upregulated
2 - GABA and NMDA receptors downregulated
3 - GABA receptors downregulated and NMDA receptors upregulated
4 - GABA receptors upregulated and NMDA receptors downregulated
3 - GABA receptors downregulated and NMDA receptors upregulated
- down regulation of GABA-A receptors as alcohol is acting as an agonist so we dont need as many
- up-regulation of NMDA receptors as alcohol is an antagonist so we need more to increase sensitivity
- the increased NMDA receptors means the firing of NMDA receptors returns to a normal level as a compensatory mechanism
Which of the following medications is typically used in alcohol withdrawal?
1 - chlordiazepoxide
2 - haloperidol
3 - disulfiram
4 - lithium
1 - chlordiazepoxide
- essentially benzodiazepines
- accentuates GABA, but allows it to be done in a controlled way, where the dosage can slowly be reduced to reduce the risk of side effects
Wernicke’s encephalopathy is a degenerative brain disorder caused by the lack of vitamin B1 (thiamine) and can occur in alcohol withdrawal. Which of the following is NOT part of the typical triad of Wernicke’s?
1 - Confusion
2 - Ataxia
3 - Ophthalmoplegia
4 - Tremor
4 - Tremor
- important to treat Wernicke’s asap as this can lead to permanent neurological damage
- Nystagmus can also occur
Delirium tremens can occur in a patient in alcohol withdrawal, typically after 3 days and carries a high mortality. Which 2 of the following is typically used to treat this?
1 - chlordiazepoxide
2 - haloperidol
3 - disulfiram
4 - thiamines
1 - chlordiazepoxide
4 - thiamines
A deficiency in which vitamin can be present in alcohol withdrawal and is the cause of Wernicke’s/Korsakoff encephalopathy?
1 - vitamin B12
2 - vitamin B1
3 - vitamin C
4 - vitamin D
2 - vitamin B1
- commonly called thiamine
A deficiency in thiamine (B1) can occur in alcohol withdrawal and cause Wernicke’s /Korsakoff encephalopathy. Which of the following is thiamine a cofactor of?
1 - co-factor for transketolase
2 - co-factor for pyruvate dehydrogenase
3 - co-factor for alpha ketoglutarate dehydrogenase
4 - all of the above
4 - all of the above
- all of these are involved in glucose metabolism
- impairments in glucose metabolism causes a decrease in cellular energy
What important functions does thiamine have in the brain?
1 - lipid metabolism
2 - carbohydrate metabolism
3 - maintaining amino acid homeostasis
4 - maintaining neurotransmitter homeostasis
5 - propagation of action potentials
6 - all of the above
6 - all of the above
Wernicke’s /Korsakoff encephalopathy is a spectrum of disease. Out of Wernicke’s vs. Korsakoff, which is the acute reversible phase?
- Wernicke’s
- if left untreated, it can lead to Korsakoff syndrome, which is chronic and irreversible
Wernicke’s encephalopathy is the acute reversible aspect of alcohol withdrawal and B1 (thiamine) deficiency. This can be seen in patients with the typical triad. Which of the following is NOT part of this triad?
1 - confusion
2 - coma and death
3 - opthalmopledgia (weakness/paralysis of eye muscles)
4 - ataxia and unsteady gait
2 - coma and death
- can occur but only if Wernicke’s encephalopathy is not treated
Korsakoff syndrome is the chronic irreversible aspect of alcohol withdrawal and B1 (thiamine) deficiency. Which part of the brain does this affect mostly?
1 - limbic system
2 - speech and language
3 - visual
4 - motor control
1 - limbic system
- causes severe memory impairment
- affects both ante and retrograde amnesia
Korsakoff syndrome is the chronic irreversible aspect of alcohol withdrawal and B1 (thiamine) deficiency. In addition to changes in the limbic system, causing ante and retrograde amnesia, which of the following is a common finding?
1 - lacrimal secretion
2 - hypophonia (soft speech)
3 - dissociation
4 - confabulations
4 - confabulations
- telling lies, but believing they are true
Does dry beri beri affect the CNS or cardiac tissue?
- CNS
- causes polyneuropathy and atrophy
- wet beri beri affects the heart causing oedema and heart failure
Typically diagnosis of patients with Wernicke’s /Korsakoff encephalopathy is made based on the clinical diagnoses. However, what other marker can be measured in the blood?
1 - TFTs
2 - LFTs
3 - vitamin B1
4 - vitamin D
3 - vitamin B1
- measures thiamine levels
- all the other would also be done though
Is Wernicke’s encephalopathy dangerous?
- yes
- medical emergency
- need to stop Korsakoff syndrome from developing
How is Wernicke’s /Korsakoff encephalopathy treated?
1 - chlordiazepoxide
2 - haloperidol
3 - disulfiram
4 - thiamines
4 - thiamines
- given as a drug called pabrinex over a few days
