Alcohol Use Disorders — MCQs
What is the drug used in uncomplicated alcohol withdrawal?
Which of the following is NOT associated with Wernicke's encephalopathy?
CAGE questionnaire is used in:
In chronic alcoholism and its complications, which of the following is seen?
A 55-year-old chronic alcoholic male, presented with irrelevant talks, tremor and sweating. He had his last drink 3 days back. What is the probable diagnosis?
A 58-year-old patient presents with confusion, ataxia, and ophthalmoplegia. He has a history of alcohol use. Which treatment is most appropriate?
A 45-year-old male with a history of chronic alcohol use is admitted to the hospital. He presents with anxiety, tremors, and agitation after his last drink 24 hours ago. Which of the following medications is most appropriate for controlling alcohol withdrawal symptoms?
A 56-year-old man is brought to the emergency department by his wife because of memory loss and difficulty walking. She has noticed personality changes, truancy from work, and lack of personal care over the past 1 year. On examination, he appears unkempt, smells of urine, and is uncooperative. He cannot recall the date or season and gets angry when asked questions. His answers are often fabricated when checked with his wife. The blood pressure is 150/90 mm Hg, pulse 100/min, and he is diaphoretic and tremulous. His gait is wide-based, and motor strength and reflexes are normal. His ocular movements are normal, but there is nystagmus on lateral gaze. In the past, he has had multiple admissions for alcohol withdrawal. Which of the following is the most appropriate next step in management?
A 45 year old male with a history of alcohol dependence presents with confusion, nystagmus and ataxia. Examination reveals 6th cranial nerve weakness. He is most likely to be suffering from:
A 46 year old lady on vegan diet for a decade presents with chief complaints of tingling and numbness in lower limbs for two months and a history of swaying while walking through narrow corridors. Which one of the following blood tests is advisable for diagnosis in this patient?
Alcohol Use Disorders Indian Medical PG Practice Questions and MCQs
Question 1: What is the drug used in uncomplicated alcohol withdrawal?
- A. Diazepam (Correct Answer)
- B. Clonidine
- C. Methadone
- D. Propranolol
Explanation: ***Diazepam***- **Benzodiazepines** like diazepam are the cornerstone of treatment for alcohol withdrawal due to their ability to mitigate severe symptoms such as **seizures** and **delirium tremens** [1].- Diazepam, with its **long half-life**, provides a sustained therapeutic effect, helping to prevent symptom re-emergence.*Clonidine*- While clonidine can alleviate **autonomic symptoms** like elevated heart rate and blood pressure, it does not prevent **seizures or delirium**, which are critical concerns in alcohol withdrawal.- It is often used as an **adjunct** but not as monotherapy for uncomplicated withdrawal.*Methadone*- Methadone is an **opioid agonist** primarily used in the treatment of **opioid addiction**, not alcohol withdrawal.- It has no role in directly managing symptoms of alcohol withdrawal and could be dangerous if misused in this context.*Propranolol*- Propranolol is a **beta-blocker** that can help reduce some **autonomic symptoms** such as **tremors** and **tachycardia**.- Similar to clonidine, it does not address the risk of **seizures** or **delirium tremens**, making it unsuitable as a primary treatment.
Question 2: Which of the following is NOT associated with Wernicke's encephalopathy?
- A. Alteration in mental function
- B. 6th nerve palsy
- C. Ataxia
- D. Cogwheel rigidity (Correct Answer)
Explanation: **Cogwheel rigidity** - **Cogwheel rigidity** is a characteristic sign of **Parkinson's disease** due to increased muscle tone [2], not Wernicke's encephalopathy. - Wernicke's encephalopathy is primarily associated with **thiamine deficiency**, affecting brain regions involved in eye movement, balance, and cognition [3]. *Alteration in mental function* - **Confusion**, **disorientation**, and **memory impairment** are common presentations of Wernicke's encephalopathy due to its impact on **thalamic** and **hypothalamic** function. - This symptom complex is a key component of the Wernicke's triad. *6th nerve palsy* - **Ophthalmoplegia**, including **6th nerve palsy** (abducens nerve palsy), is a classic sign of Wernicke's encephalopathy, often presenting as **nystagmus** [1] or gaze palsies. - This ocular abnormality is a direct result of thiamine deficiency affecting brainstem oculomotor nuclei [3]. *Ataxia* - **Ataxia**, particularly a wide-based gait, is a hallmark feature of Wernicke's encephalopathy [1], stemming from damage to the **cerebellum** and **vestibular system** [1]. - This symptom contributes significantly to the characteristic triad of Wernicke's, along with ocular abnormalities and mental status changes [3].
Question 3: CAGE questionnaire is used in:
- A. Opiate poisoning
- B. Alcohol dependence (Correct Answer)
- C. Dhatura poisoning
- D. Barbiturate poisoning
Explanation: ***Alcohol dependence*** - The **CAGE questionnaire** is a widely used screening tool for identifying potential **alcohol problems** and dependence. - The acronym CAGE stands for Cutting down, Annoyance by criticism, Guilty feelings, and Eye-openers, all related to drinking habits. *Opiate poisoning* - Screening for opiate use or poisoning typically involves asking about **drug use history**, conducting **urine drug screens**, and observing specific clinical signs like **pinpoint pupils** and **respiratory depression**. - The CAGE questionnaire is not designed to screen for opiate use. *Dhatura poisoning* - **Dhatura poisoning** is characterized by anticholinergic symptoms like **dilated pupils**, **dry mouth**, **tachycardia**, and **delirium**. - Diagnosis relies on clinical presentation and a history of exposure, not a specific questionnaire like CAGE. *Barbiturate poisoning* - **Barbiturate poisoning** presents with central nervous system depression, including **sedation**, **respiratory depression**, and **hypotension**. - Diagnosis involves a clinical assessment, history of barbiturate use, and toxicology screens, not the CAGE questionnaire.
Question 4: In chronic alcoholism and its complications, which of the following is seen?
- A. Wernicke's syndrome
- B. Delirium tremens
- C. Korsakoff psychosis
- D. All of the options (Correct Answer)
Explanation: ***All of the options*** - **Wernicke's syndrome**, **Delirium tremens**, and **Korsakoff psychosis** are all well-recognized neurological and psychiatric complications associated with **chronic alcoholism** - Chronic alcohol abuse leads to nutritional deficiencies (especially **thiamine deficiency**) and neurotoxicity, predisposing individuals to these distinct but related conditions *Wernicke's syndrome* - Acute neurological disorder caused by **thiamine deficiency** - Characterized by classic triad: **ataxia**, **ophthalmoplegia**, and **confusion** - If untreated, can progress to **Korsakoff psychosis** *Delirium tremens* - Severe form of **alcohol withdrawal** in individuals with long history of heavy drinking - Symptoms include **delirium**, **severe agitation**, **tremors**, **hallucinations**, and autonomic hyperactivity (**tachycardia**, **hypertension**, **fever**) - Medical emergency requiring prompt treatment *Korsakoff psychosis* - Occurs due to chronic **thiamine deficiency**, often following Wernicke's encephalopathy - Characterized by severe **anterograde and retrograde amnesia**, **confabulation**, and relative preservation of other cognitive functions - Often results in permanent cognitive impairment
Question 5: A 55-year-old chronic alcoholic male, presented with irrelevant talks, tremor and sweating. He had his last drink 3 days back. What is the probable diagnosis?
- A. Delirium tremens (Correct Answer)
- B. Korsakoff psychosis
- C. Post-Acute withdrawal syndrome
- D. Discontinuation syndrome
Explanation: ***Delirium tremens*** - The presentation of **irrelevant talks**, **tremor**, and **sweating** in a chronic alcoholic who stopped drinking 3 days prior is highly characteristic of **delirium tremens**. - **Delirium tremens** is a severe form of acute **alcohol withdrawal**, typically occurring 2-4 days after the last drink, and involves extreme agitation, disorientation, hallucinations, and autonomic hyperactivity. *Korsakoff psychosis* - **Korsakoff psychosis** is a chronic neuropsychiatric syndrome associated with **thiamine deficiency**, often seen in chronic alcoholics. - It primarily presents with severe **anterograde and retrograde amnesia**, **confabulation**, and **apathy**, rather than acute, fluctuating consciousness and autonomic instability seen in delirium tremens. *Post-Acute withdrawal syndrome* - **Post-Acute Withdrawal Syndrome (PAWS)** involves persistent, milder symptoms that can last weeks or months after acute withdrawal. - Symptoms are generally less severe and acute than described, often including mood swings, anxiety, sleep disturbances, and cognitive impairment, not the acute delirium and autonomic overactivity presented. *Discontinuation syndrome* - **Discontinuation syndrome** refers to a cluster of symptoms that can occur after stopping or reducing certain medications, particularly antidepressants. - It is not directly related to alcohol withdrawal and typically presents with symptoms like dizziness, nausea, sensory disturbances, and flu-like symptoms.
Question 6: A 58-year-old patient presents with confusion, ataxia, and ophthalmoplegia. He has a history of alcohol use. Which treatment is most appropriate?
- A. Vitamin B12
- B. Benzodiazepines
- C. Thiamine (Correct Answer)
- D. Antipsychotics
Explanation: ***Thiamine*** - The classic triad of **confusion**, **ataxia**, and **ophthalmoplegia** in a patient with a history of alcohol use is highly suggestive of **Wernicke encephalopathy** [3], which is caused by **thiamine (vitamin B1) deficiency** [1]. - Immediate thiamine supplementation is crucial to prevent progression to **Korsakoff syndrome** and reverse neurological deficits [1],[2]. *Vitamin B12* - **Vitamin B12 deficiency** can cause neurological symptoms like **peripheral neuropathy** and **dementia**, but the specific triad of ophthalmoplegia and ataxia is not characteristic. - It is often associated with conditions like **pernicious anemia** or malabsorption. *Benzodiazepines* - **Benzodiazepines** are used to manage **alcohol withdrawal symptoms**, such as tremors, seizures, and delirium tremens, but they do not address the underlying thiamine deficiency causing Wernicke encephalopathy [2]. - Administering benzodiazepines without thiamine in this context would not treat the core problem and could mask symptoms. *Antipsychotics* - **Antipsychotics** are primarily used to treat psychotic disorders or severe agitation. - While patients with Wernicke encephalopathy may experience some agitation or altered mental status, antipsychotics do not address the **thiamine deficiency** and are not the primary treatment for this condition.
Question 7: A 45-year-old male with a history of chronic alcohol use is admitted to the hospital. He presents with anxiety, tremors, and agitation after his last drink 24 hours ago. Which of the following medications is most appropriate for controlling alcohol withdrawal symptoms?
- A. Lorazepam (Correct Answer)
- B. Fomepizole
- C. Disulfiram
- D. Buspirone
- E. Naltrexone
Explanation: ***Lorazepam*** - **Lorazepam**, a **benzodiazepine**, is the first-line treatment for alcohol withdrawal symptoms due to its ability to enhance **GABAergic activity**, which is deficient during withdrawal. - Its **intermediate half-life** and **lack of active metabolites** make it suitable for patients with liver impairment, common in chronic alcohol users. *Fomepizole* - **Fomepizole** is an antidote used to treat poisoning from **methanol** or **ethylene glycol**, not alcohol withdrawal. - It works by inhibiting **alcohol dehydrogenase**, an enzyme involved in the metabolism of these toxic alcohols. *Disulfiram* - **Disulfiram** is an **aldehyde dehydrogenase inhibitor** used to deter alcohol consumption in recovering alcoholics by causing unpleasant reactions if alcohol is consumed. - It is **not used to treat acute alcohol withdrawal symptoms** and can be dangerous if given during withdrawal due to potential interactions. *Buspirone* - **Buspirone** is an **anxiolytic** that acts as a **serotonin receptor agonist** and is used for generalized anxiety disorder. - It is **ineffective for acute alcohol withdrawal** due to its slow onset of action and lack of anticonvulsant properties. *Naltrexone* - **Naltrexone** is an **opioid receptor antagonist** used for relapse prevention and reducing alcohol craving in patients with alcohol use disorder. - It is **not effective for acute alcohol withdrawal symptoms** and does not prevent seizures or delirium tremens, which are life-threatening complications of withdrawal.
Question 8: A 56-year-old man is brought to the emergency department by his wife because of memory loss and difficulty walking. She has noticed personality changes, truancy from work, and lack of personal care over the past 1 year. On examination, he appears unkempt, smells of urine, and is uncooperative. He cannot recall the date or season and gets angry when asked questions. His answers are often fabricated when checked with his wife. The blood pressure is 150/90 mm Hg, pulse 100/min, and he is diaphoretic and tremulous. His gait is wide-based, and motor strength and reflexes are normal. His ocular movements are normal, but there is nystagmus on lateral gaze. In the past, he has had multiple admissions for alcohol withdrawal. Which of the following is the most appropriate next step in management?
- A. Calcium administration
- B. Prophylactic carbamazepine administration
- C. Prophylactic phenytoin administration
- D. Prophylactic diazepam administration (Correct Answer)
Explanation: ***Prophylactic diazepam administration*** - The patient presents with symptoms highly suggestive of **Wernicke-Korsakoff syndrome** (memory loss, ataxia, nystagmus) superimposed on chronic alcohol abuse with a history of alcohol withdrawal, indicating a high risk for further withdrawal seizures or delirium tremens [1], [3]. - **Benzodiazepines** like diazepam are the cornerstone of treatment for alcohol withdrawal syndrome due to their anxiolytic, anticonvulsant, and sedative properties, preventing progression to more severe withdrawal manifestations [2]. *Prophylactic phenytoin administration* - **Phenytoin** is generally not recommended for the prevention or treatment of alcohol withdrawal seizures unless there is an underlying seizure disorder unrelated to alcohol. - Its efficacy in preventing recurrent alcohol withdrawal seizures is limited compared to benzodiazepines. *Prophylactic carbamazepine administration* - While **carbamazepine** can be used in some cases of alcohol withdrawal, particularly to reduce seizure risk and improve sleep, it is not considered first-line for acute prophylaxis against severe withdrawal or delirium tremens, especially in a patient with active tremulousness and autonomic hyperactivity. - Benzodiazepines offer a broader spectrum of action against the diverse symptoms of alcohol withdrawal. *Calcium administration* - There is no indication that the patient has a **calcium deficiency** or hypocalcemia related to alcohol withdrawal symptoms. - Calcium administration would not address the underlying neurochemical imbalances associated with acute alcohol withdrawal or the progression to Wernicke-Korsakoff syndrome.
Question 9: A 45 year old male with a history of alcohol dependence presents with confusion, nystagmus and ataxia. Examination reveals 6th cranial nerve weakness. He is most likely to be suffering from:
- A. Wernicke encephalopathy (Correct Answer)
- B. De Clerambault syndrome
- C. Korsakoff's psychosis
- D. Delirium tremens
Explanation: ***Wernicke encephalopathy*** - The classic triad of **confusion**, **nystagmus**, and **ataxia** in a patient with alcohol dependence is highly indicative of Wernicke encephalopathy [1], [2]. - The presence of **6th cranial nerve weakness (abducens palsy)** further supports this diagnosis, as ocular abnormalities are common [2]. *De Clérambault syndrome* - This is a delusional disorder where an individual believes another person, often of higher social status, is in love with them (also known as **erotomania**). - It is a psychiatric condition and does not present with neurological signs like ataxia, nystagmus, or cranial nerve palsies. *Korsakoff's psychosis* - While also associated with chronic alcohol abuse and often follows Wernicke encephalopathy, Korsakoff's psychosis is characterized primarily by **severe memory impairment (anterograde and retrograde amnesia)**, confabulation, and lack of insight [2]. - The acute presentation with confusion, nystagmus, and ataxia is more characteristic of Wernicke encephalopathy, which can progress to Korsakoff's if untreated [2]. *Delirium tremens* - This is a severe form of **alcohol withdrawal** characterized by profound confusion, agitation, disorientation, **hallucinations**, tachycardia, hypertension, and seizures [1]. - While confusion is present, the specific neurological signs of nystagmus, ataxia, and cranial nerve weakness are not typical features like they are in Wernicke encephalopathy.
Question 10: A 46 year old lady on vegan diet for a decade presents with chief complaints of tingling and numbness in lower limbs for two months and a history of swaying while walking through narrow corridors. Which one of the following blood tests is advisable for diagnosis in this patient?
- A. Serum protein electrophoresis
- B. Vitamin 25(OH) D level
- C. Vitamin B12 levels (Correct Answer)
- D. Anti-gliadin antibodies
Explanation: ***Vitamin B12 levels*** - A **vegan diet** for an extended period puts patients at high risk for **vitamin B12 deficiency**, as B12 is primarily found in animal products [1]. - Symptoms like **tingling, numbness (paresthesias)**, and **impaired gait (ataxia)** are classic neurological manifestations of severe vitamin B12 deficiency, often due to **subacute combined degeneration** of the spinal cord [1]. *Serum protein electrophoresis* - This test is used to detect and quantify various proteins in the serum, primarily for suspected **monoclonal gammopathies** like multiple myeloma or Waldenström macroglobulinemia. - Her symptoms are primarily neurological and directly attributable to her dietary choices, making ser um protein electrophoresis less relevant as an initial diagnostic step. *Vitamin 25(OH) D level* - While vegans are at risk for **vitamin D deficiency** due to limited dietary sources and insufficient sun exposure, the primary symptoms of vitamin D deficiency are typically **bone pain, muscle weakness**, or fatigue, not the present neurological signs [2]. - Although vitamin D deficiency can cause non-specific neurological symptoms, the specific combination of paresthesia and ataxia in a long-term vegan points more strongly to B12 deficiency. *Anti-gliadin antibodies* - These antibodies are ordered to screen for **celiac disease**, an autoimmune disorder triggered by gluten consumption. - While celiac disease can present with neurological symptoms, there is no information in the patient's history to suggest a malabsorption disorder other than dietary restrictions, and her strict vegan diet directly points to a lack of B12.
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