Alcohol

Chapter 8 Alcohol




Clinical Case Problem 1 A 45-Year-Old Man with an Enlarged Liver


A 45-year-old executive comes to your office for his periodic health assessment. He tells you that he has been feeling “weak, tired, and just not myself lately.” He also tells you that he has been so tired that he “has had to stay home from work for many days at a time.” He is beginning to question his ability to function effectively as the chief executive officer of a transportation company. When you inquire about other symptoms, he tells you that he also has suffered from “profound headaches” and that his sex life with his wife is “the pits.” On direct questioning, he tells you that the headaches “have been a problem for the past 6 months” and his “lack of interest in sex” has been a problem for approximately the same amount of time.


He has no serious past medical, surgical, or psychiatric illnesses. He tells you that he is taking no over-the-counter or prescription drugs.


The patient describes himself as a “social drinker,” and his use of alcohol is “strictly to relax.” He then states, “I hope you do not think that I’m an alcoholic, Doc!” There is no evidence of acute intoxication at this time.


He does state, on more persistent questioning, “Well, maybe I am using more alcohol than I did a few years ago. Sometimes, I think it might be a good idea to cut down a bit. I do get annoyed with my wife, who points out that I am drinking more than I used to. Sometimes I even feel guilty and wonder if that’s affecting our sex life. There are mornings that I wake up with the shakes and having an ‘eye opener’ really helps.”


His father died of complications of “yellow jaundice” at age 61. His mother died of complications of heart failure at age 69. He has three brothers and two sisters; all are well.


On physical examination, his blood pressure is 160/104   mm Hg. His pulse is 96 and regular. Examination findings of the head and neck, respiratory system, and musculoskeletal system are normal. Examination of the cardiovascular system reveals a point of maximal impulse (PMI) in the fifth intercostal space on the anterior axillary line. He subsequently describes recent episodes of “waking up at night short of breath” and “shortness of breath on exertion.” Examination of the gastrointestinal system reveals no tenderness or rebound tenderness. The liver edge is palpated approximately 5   cm below the right costal margin. Examination of the neurologic system reveals intermittent carpal spasms of both extremities. He has a fine tremor of his hands. He cannot perform serial 7   s and has difficulty with recall of information on the mental status examination.



Select the best answer to the following questions




1. With the history given, what is the best description of the most likely diagnosis in this patient?


a. somatization disorder

b. adjustment disorder with depressed and anxious mood

c. major depressive disorder

d. alcohol dependence

e. alcohol abuse

2. Which of the following signs or symptoms further substantiate your diagnosis in this patient?


a. the location of the PMI

b. the patient’s elevated blood pressure

c. the abdominal signs on physical examination

d. the hand tremors

e. all of the above

3. What are signs and symptoms of acute alcohol intoxication?


a. facial flushing

b. slurred speech

c. nystagmus

d. ataxia

e. all of the above

4. What is the most likely cause of the patient’s liver edge palpated at 5   cm below the right costal margin?


a. tricornute liver (congenital malformation)

b. alcoholic hepatitis or cirrhosis

c. congestive heart failure

d. “the deep diaphragm pushing the liver down” syndrome

e. hepatorenal syndrome

5. There is a high correlation between the disorder diagnosed in question 1 and which of the following syndromes?


a. generalized anxiety disorder

b. major depressive disorder

c. schizophrenia

d. opioid abuse

e. all of the above

f. b and d only

6. The patient’s inability to perform serial 7   s and information recall is most likely caused by which of the following?


a. Alzheimer dementia

b. alcoholic dementia

c. alcoholic amnestic syndrome

d. all of the above are equally likely

e. b and c

7. At what amount of blood alcohol level is a driver determined to be “impaired” in most states?


a. 0.02% (20   mg/dL)

b. 0.05% (50   mg/dL)

c. 0.1% (100   mg/dL)

d. 0.5% (500   mg/dL)

e. 1.0% (1000   mg/dL)

8. Regarding risk factors for the condition diagnosed in question 1, which of the following statements most accurately reflects risk factor status and identification?


a. there are no risk factors for this disease; it just happens

b. there is no single factor that accounts for increased relative and absolute risk in first-degree relatives of patients with this disorder

c. risk factors or risk environments for this disorder include genetic, familial, environmental, occupational, socioeconomic, cultural, and personality factors; life stressors; psychiatric comorbidity; biologic and social learning factors; and behavioral conditioning

d. there is a clear risk factor stratification for this disorder

e. b and c

9. Which organ systems can be affected by alcohol abuse?


a. cardiovascular system

b. endocrine system

c. pulmonary system

d. hematologic system

e. all of the above

10. Which drug(s) is (are) useful in the treatment of alcohol withdrawal?


a. benzodiazepine

b. clonidine

c. barbiturates

d. anticonvulsants

e. all of the above

11. How is alcohol withdrawal syndrome best defined?


a. a state in which a syndrome of drug-specific withdrawal signs and symptoms follows the reduction or cessation of drug use

b. a state in which the physiologic or behavioral effects of a constant dose of a psychoactive substance decrease over time

c. a pathologic state that follows cessation or reduction in the amount of drug used

d. a and b

e. all of the above

12. How is alcohol abuse syndrome best defined?


a. a maladaptive state leading to clinically significant impairment

b. a maladaptive state leading to clinically significant distress

c. a maladaptive state leading to significant impairment defined by laboratory value

d. either a or c

e. either a or b

13. Considering the patient described, which of the following diagnostic imaging procedures is (are) definitely indicated?


a. chest radiograph

b. cardiac echocardiography

c. computed tomography (CT) scan of the head

d. abdominal ultrasound

e. all of the above

14. Which of the following is the most likely explanation for the tremors observed on physical examination?


a. delirium tremens (early)

b. alcohol withdrawal syndrome

c. thiamine deficiency

d. alcoholic encephalopathy (early)

e. Korsakoff psychosis

15. A 26-year-old man comes to your office for a periodic health examination before he gets married. When you question him about his lifestyle and ask him about his alcohol intake, he replies that he is a “social drinker.” Once that is established, what should you do?


a. congratulate him on avoiding problems with alcohol

b. accept “social drinking” at face value and move on to the next question

c. ask him whether he ever has a drink while alone

d. ask him to very specifically define social drinking

e. request an estimate of the number of drinks per week and a specification on the kind of alcoholic beverages consumed


Clinical Case Problem 2 A Patient with Short-Term Memory Deficits


A patient who you suspect of alcohol dependence demonstrates significant short-term memory deficits. He then tries to cover up those deficits by making up answers to questions.



16. Which of the following is the most likely diagnosis?


a. Wernicke encephalopathy is the most likely diagnosis

b. alcohol-induced persisting amnestic disorder (Korsakoff psychosis)

c. alcohol-induced psychotic disorder with delusions

d. alcohol-induced psychotic disorder with hallucinosis

e. alcohol-induced persisting dementia

17. The feature described as “making up answers to questions” is known as which of the following?


a. confabulation

b. alcoholic lying

c. alcoholic delirium

d. alcoholic paranoia

e. memory loss encephalopathy

18. What is the cause of the disorder described in this case?


a. riboflavin deficiency

b. thiamine deficiency

c. zinc deficiency

d. cerebral atrophy caused by alcohol abuse

e. cerebellar atrophy caused by alcohol abuse

Related posts:

  1. Tobacco Dependency
  2. Colorectal Cancer and Other Colonic Disorders
  3. Sexual Dysfunction
  4. Illustrated Review

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Alcohol

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