Alcohol Use Disorder — MCQs
Which of the following is a validated screening tool for alcohol use disorder?
Among which of the following conditions is suicide risk highest?
Which of the following conditions is least likely to be associated with Wernicke's encephalopathy?
Disulfiram is a type of:-
Most common symptom of alcohol withdrawal is:
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 patient stopped alcohol consumption for 3 days and presented with irritability, disorientation, paranoid delusions, agitation, visual hallucinations, and altered sensorium. What is the likely diagnosis in this case?
A 58-year-old patient presents with confusion, ataxia, and ophthalmoplegia. He has a history of alcohol use. Which treatment is most appropriate?
A 50-year-old male with a history of chronic alcoholism presents with altered sensorium and signs of portal hypertension. What is the most appropriate initial management step?
CAGE questionnaire is used in:
Alcohol Use Disorder Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following is a validated screening tool for alcohol use disorder?
- A. AUDIT
- B. CAGE questionnaire
- C. SADQ
- D. All of the options (Correct Answer)
Explanation: ***CAGE questionnaire and AUDIT*** - Both **CAGE** and **AUDIT** are widely validated screening tools specifically designed for alcohol use disorder [1]. - **CAGE** is a brief 4-item tool focusing on **C**ut down, **A**nnoyed, **G**uilty, and **E**ye-opener - ideal for quick screening in clinical settings [1]. - **AUDIT** (Alcohol Use Disorders Identification Test) is a comprehensive 10-item tool assessing consumption patterns, drinking behaviors, and alcohol-related problems. - AUDIT is considered the **gold standard** for screening and can assess risk levels and severity. *Why not SADQ alone?* - **SADQ** (Severity of Alcohol Dependence Questionnaire) is primarily a **severity assessment tool**, not a screening tool. - It is a 20-item instrument used to measure the **degree of alcohol dependence** in individuals already identified with alcohol problems. - While valuable for treatment planning, SADQ is more detailed and designed for assessment rather than initial screening [1]. - However, all three tools are validated and used in alcohol use disorder evaluation - CAGE and AUDIT for screening, SADQ for severity assessment.
Question 2: Among which of the following conditions is suicide risk highest?
- A. Depression (Correct Answer)
- B. Alcohol dependence
- C. Dementia
- D. Schizophrenia
Explanation: ***Depression*** - **Major depressive disorder** is the psychiatric condition most frequently associated with **suicide**, accounting for a large percentage of completed suicides. - The presence of severe depression, especially with features like **hopelessness**, **agitation**, and **prior suicide attempts**, significantly elevate the risk. *Alcohol dependence* - While **alcohol dependence** is a significant risk factor for suicide, it often co-occurs with mood disorders like depression; alcohol can exacerbate suicidal ideation and impulsivity. - It is an important comorbidity, but **major depression** alone has a higher prevalence in suicide statistics than alcohol dependence as a primary factor. *Dementia* - **Dementia** generally poses a lower risk of completed suicide compared to mood disorders, as cognitive decline can impair the ability to plan and execute such acts. - Early stages of dementia, particularly when insight into cognitive decline is preserved, may carry some risk, but it is not the highest risk condition overall. *Schizophrenia* - Individuals with **schizophrenia** have a significantly elevated risk of suicide compared to the general population, often due to factors like **command hallucinations**, hopelessness, and adverse effects of medication. - However, **depression** remains the leading psychiatric diagnosis associated with suicide completions.
Question 3: Which of the following conditions is least likely to be associated with Wernicke's encephalopathy?
- A. Chronic alcoholic
- B. Hyperemesis gravidarum
- C. Peritoneal dialysis patients
- D. Hypothyroidism (Correct Answer)
Explanation: **Hypothyroidism** - There is **no established direct link** between hypothyroidism and the development of Wernicke's encephalopathy. - Wernicke's encephalopathy primarily results from **thiamine (vitamin B1) deficiency** [4]. *Chronic alcoholic* - **Chronic alcoholism** is a classic and highly prevalent cause of **thiamine deficiency** due to poor nutrition and impaired thiamine absorption/utilization [1], [3]. - This often leads to Wernicke's encephalopathy [2]. *Hyperemesis gravidarum* - Severe and protracted **vomiting** in hyperemesis gravidarum can result in significant nutritional deficiencies, including **thiamine depletion** [1]. - This makes it a known risk factor for Wernicke's encephalopathy. *Peritoneal dialysis patients* - Patients undergoing **peritoneal dialysis** are at risk for **thiamine deficiency** due to loss of water-soluble vitamins in the dialysate and often have inadequate dietary intake. - This places them at increased risk for Wernicke's encephalopathy.
Question 4: Disulfiram is a type of:-
- A. Anticraving therapy
- B. Detoxification
- C. Opioid management therapy
- D. Aversion therapy (Correct Answer)
Explanation: **Aversion therapy** - **Disulfiram** works by inhibiting aldehyde dehydrogenase, leading to the accumulation of acetaldehyde when alcohol is consumed, which causes unpleasant symptoms like flushing, nausea, and vomiting. - This creates an **aversive reaction** to alcohol, which discourages further drinking, making it a form of aversion therapy. *Anticraving therapy* - While disulfiram can indirectly reduce cravings by making alcohol consumption unpleasant, its primary mechanism is not to directly modulate craving pathways in the brain. - Drugs like **naltrexone** or **acamprosate** are more commonly categorized as specific anticraving agents for alcohol dependence. *Detoxification* - **Detoxification** refers to the supervised withdrawal from a substance to manage acute withdrawal symptoms and stabilize the patient. - Disulfiram is used after detoxification to help maintain abstinence, not during the acute withdrawal phase. *Opioid management therapy* - **Opioid management therapy** involves medications like **methadone** or **buprenorphine** used to treat opioid dependence. - Disulfiram is specifically used for **alcohol use disorder** and has no role in managing opioid dependence.
Question 5: Most common symptom of alcohol withdrawal is:
- A. Diarrhea
- B. Rhinorrhea
- C. Tremor (Correct Answer)
- D. Bodyache
Explanation: ***Tremor*** - **Tremor** is one of the earliest and most common symptoms of alcohol withdrawal, often appearing within 6-12 hours after reduction or cessation of alcohol intake. - This symptom is due to hyperactivity of the central nervous system as it attempts to re-establish homeostasis without the depressant effects of alcohol. *Diarrhea* - While gastrointestinal issues can occur during alcohol withdrawal, **diarrhea** is not considered the most common or primary symptom. - Other more prominent symptoms related to central nervous system excitation typically precede or overshadow GI complaints. *Rhinorrhea* - **Rhinorrhea (runny nose)** is not a characteristic or common symptom of alcohol withdrawal. - This symptom is more commonly associated with opioid withdrawal or allergic reactions. *Bodyache* - **Body aches** can be a general symptom of discomfort or fatigue during withdrawal states, but it is not the most specific or common symptom of alcohol withdrawal. - Muscle cramps or myalgia can occur, but generalized body aches are less frequent than more distinct neurological manifestations.
Question 6: 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 7: A patient stopped alcohol consumption for 3 days and presented with irritability, disorientation, paranoid delusions, agitation, visual hallucinations, and altered sensorium. What is the likely diagnosis in this case?
- A. Wernicke's encephalopathy
- B. Alcohol withdrawal delirium (Correct Answer)
- C. Korsakoff's psychosis
- D. Alcohol intoxication
Explanation: ***Alcohol withdrawal delirium*** - The combination of **irritability, disorientation, paranoid delusions, agitation, visual hallucinations, and altered sensorium** developing 3 days after cessation of alcohol is classic for **delirium tremens**, the most severe form of alcohol withdrawal. - This condition is a medical emergency that can lead to seizures, cardiovascular collapse, and death if not treated promptly. *Wernicke's encephalopathy* - Characterized by the triad of **ataxia, ophthalmoplegia, and confusion**, which is due to **thiamine deficiency** and is not fully consistent with the patient's presentation. - While it can occur in chronic alcoholics, the rapid onset of severe agitation, hallucinations, and paranoia points more towards active withdrawal. *Korsakoff's psychosis* - This is a chronic neuropsychiatric syndrome that typically follows untreated Wernicke's encephalopathy, characterized by severe **anterograde and retrograde amnesia** and **confabulation**. - It does not present with the acute delirium, agitation, and prominent hallucinations described. *Alcohol intoxication* - This occurs when a person has recently consumed a large amount of alcohol, leading to symptoms like **slurred speech, impaired coordination, mood changes, and reduced inhibition**. - The patient's symptoms are occurring *after* stopping alcohol consumption for 3 days, indicating withdrawal, not active intoxication.
Question 8: 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 9: A 50-year-old male with a history of chronic alcoholism presents with altered sensorium and signs of portal hypertension. What is the most appropriate initial management step?
- A. Perform upper gastrointestinal endoscopy (UGIE)
- B. Administer chlordiazepoxide
- C. Administer thiamine
- D. Administer lactulose (Correct Answer)
Explanation: ***Administer lactulose*** - The patient's presentation with altered sensorium and chronic alcoholism, coupled with signs of portal hypertension, strongly suggests **hepatic encephalopathy**. [1] - **Lactulose** is the most appropriate initial management step because it helps to reduce ammonia absorption from the gut by acidifying the colon and acting as an osmotic laxative, thereby improving neurological function. [1] *Perform upper gastrointestinal endoscopy (UGIE)* - While **portal hypertension** can lead to varices and bleeding, an UGIE is an invasive procedure and not the immediate priority for a patient presenting with altered sensorium due to suspected hepatic encephalopathy. - UGIE would be indicated if there were active **gastrointestinal bleeding** (e.g., hematemesis, melena) or hemodynamic instability, which are not explicitly mentioned as the primary concern. *Administer chlordiazepoxide* - **Chlordiazepoxide** is a benzodiazepine used to treat **alcohol withdrawal syndrome** (delirium tremens), which can also cause altered mental status. - However, given the signs of portal hypertension, **hepatic encephalopathy** is a more likely cause of altered sensorium, and benzodiazepines can worsen it by precipifying sedation. *Administer thiamine* - **Thiamine** administration is crucial in chronic alcoholics to prevent and treat **Wernicke-Korsakoff syndrome**, which can cause altered mental status, ophthalmoplegia, and ataxia. [2] - While important in all chronic alcoholics, addressing the potentially life-threatening ammonia toxicity in **hepatic encephalopathy** with lactulose takes precedence in the immediate management of altered sensorium.
Question 10: 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.
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