Tuesday, December 02, 2003
Back to MRCPsych revision
Drug & Alcohol
1. Ataxia is a characteristic feature of Wernicke’ encephalopathy T
2. Diplopia is a characteristic feature of Wernicke’ encephalopathy T
3. Confusion is a characteristic feature of Wernicke’ encephalopathy T
4. Peripheral neuropathy is a characteristic feature of Wernicke’ encephalopathy T
5. Dysphasia is a characteristic feature of Wernicke’ encephalopathy F
6. Wernicke’ encephalopathy presents with ophthalmoplegia T
7. Wernicke’ encephalopathy presents with nystagmus T
8. Wernicke’ encephalopathy presents with Ataxia T
9. Wernicke’ encephalopathy presents with abnormal pupil reaction T
10. Wernicke’ encephalopathy presents with altered consciousness T
11. Characteristic features of the history in alcoholic include a tendency to exaggerate drinking F
12. Characteristic features of the history in alcoholic include absenteeism on Fridays F
13. Characteristic features of the history in alcoholic include a family history of schizophrenia F
Characteristic features of the history in alcoholic include reinstatement after abstinence T
14. Characteristic features of the history in alcoholic include wanting an eye opener T
15. In heroin addiction inspection of the limbs could reliably exclude IV use F
16. In heroin addiction the stated amount of consumption by the patient is a reliable estimate F
17. In heroin addiction HIV testing is mandatory F
18. In heroin addiction tricuspid valve endocarditis is a recognised complication T
19. In heroin addiction
20. is a known cause of drug induced psychosis F
21. Delirium tremens Can be precipitated by emergency surgery T
22. Delirium tremens begins 12 hours after the last drink F 2-3 days
23. In delirium tremens hallucinations can occur in several modalities T
24. Lilliputian hallucination is a feature of delirium tremens T
25. Plucking behaviour is seen in delirium tremens T
Symptoms of DT: clouding of consciousness, misinterpretation of environment, & fear. VH are the main modality but AH &tactile hallucination can occur. Other features include disorientation, tremor & autonomic over activity.
26. Features of alcoholic hallucinosis include clouding of consciousness F
27. Features of alcoholic hallucinosis include auditory hallucinations T
28. Risk of alcoholism is increased in Schizophrenia F
29. A family history of affective disorder increases the risk of alcoholism T
30. working in the catering business increases the risk of alcoholism T
31. Living in rural areas increases the risk of alcoholism F
32. Preference for spirits over beer increases risk of alcoholism F
33. Features of alcohol dependency include macrocytic anaemia F
34. Features of alcohol dependency include narrowing of drinking repertoire T
35. Features of alcohol dependency include altered tolerance to alcohol T
36. Features of alcohol dependency include aggressive behaviour when drunk F
37. alcohol hallucinosis It is included in DSM IV but not ICD 10
38. In alcohol hallucinosis auditory hallucinatios are more common than visual hallucinations T
39. Paranoid delusional believes occur in alcohol hallucinosis T
40. Alcohol hallucinosis is commoner in young adults F
Alcoholic hallucinosis
Occurs in long term drinkers & consists of persistent & well framed critical AH in clear consciousness. Voices are usually offensive, the patient is anxious & distressed .It generally lasts few days although some controversy as to whether this pattern occur in people vulnerable to mental illness especially schizophrenia .The main point of the question is for you to be clear about the difference this & DT. In DT the hallucinations are far more likely to visual & occur in clouded consciousness after the patient abruptly stop or cut down significantly their alcohol intake.
41. The risk of becoming alcoholic is increased in Doctors T
42. The risk of becoming alcoholic is increased in rural areas F
43. The risk of becoming alcoholic is increased in countries with a high per capita consumption of alcohol T
44. The risk of becoming alcoholic is increased in Hindus F
Evidence of genetic component to alcoholism ,MZ > concordance than DZ twins .P300 ( a visual evoked potential may be a marker )is attenuated in sons of alcoholics who are also less sensitive to alcohol. The variance of aldehyde dehydrogenase in some groups (parts of Asia) tolerance to alcohol is low & so alcoholism is rare.
Anti social PD predisposes to alcoholism.
Social learning from family & friends.
Psychiatric disorders such as anxiety, depression, social phobias etc….
Some occupations have greater risk i.e. doctors, vets, publicans, seamen, journalists
Ethnicity is relevant mainly due to social factors. Decreased rates in Muslims, Hindus & Jews.
The population at large to some degree dictates drinking habit .the greater the overall consumption in a population the greater the number of alcoholics.
45. Awareness of compulsion to drink is diagnostic of alcohol dependence T
46. daily consumption of Alcohol is diagnostic of alcohol dependence F
47. Guilt about level of drinking is diagnostic of alcohol dependence F
Edward & Gross ( 1976 ) described in a classical paper in BMJ key features of alcohol dependence which also apply to addiction to other substances .Most features are used in ICD 10 to diagnose the dependence syndrome
ICD 10 criteria
Subjective awareness of compulsion to drink .
Increased tolerance.
Narrowing of drinking repertoire (same drink on week days or weekends with no regard to social constrains)
Relief drinking (in the morning blood alcohol level is lower & drinking relieves the start of withdrawal symptoms)
Drink seeking behaviour.
Reinstatement of drinking after a period of abstinence
48. features of Wernicke’ encephalopathy include vestibular paralysis T
49. features of Wernicke’ encephalopathy include apathy T
50. features of Wernicke’ encephalopathy include hypothermia T
51. features of Wernicke’ encephalopathy include papilloedema T
52. Characteristics of Wernicke’ encephalopathy include flapping tremor of the hands
53. Characteristics of Wernicke’ encephalopathy include grand mal seizures F
54. Characteristics of Wernicke’ encephalopathy include nystagmus on lateral gaze T
55. Characteristics of Wernicke’ encephalopathy include Paralysis of lateral rectus T
56. Characteristics of Wernicke’ encephalopathy include Petechial haemorrhage in mamillary bodies T
57.
Acute encephalopathy from alcohol or other causes of thiamine deficiency (vitamin B1) i.e. stomach cancer, hyper emesis gravidarum & starvation .IT is due to ischaemic damage to brain stem & connectios. There is a triad of
- Ocular signs; nystagmus, lateral rectus palsy, conjugate gaze palsy & papilledema.
- Ataxia; cerebellar signs occur as does vestibular paralysis.
- Confusion; apathy, restlessness & stupor occur.
Hypothermia & hyperthermia due to thalamic damage is rare. Peripheral neuropathy can occur; often signs of malnutrition are seen.
58. Ascorbic acid excess is associated with Korsakoff’ psychosis F
59. Confabulation is associated with Korsakoff’ psychosis T
60. Disorientation for time is associated with Korsakoff’ psychosis T
61. Inability to learn new material is associated with Korsakoff’ psychosis T
62. Hypotension is associated with Korsakoff’ psychosis F
63. Pathological drunkenness classically present with senseless violence T
64. Pathological drunkenness classically present with an effect lasting an hour or more T
65. Pathological drunkenness classically present with euphoria post drinking F
66. Pathological drunkenness classically present with amnesia for the entire episode T
67. Pathological drunkenness classically present with uncontrollable rage & excitement T
68. In treating heroin dependence the knowledge of drug sub culture terminology is irrelevant F
69. In treating heroin dependence the quantities consumed as stated by the patient should be taken seriously T
70. Predisposing factors for alcoholism include low acetylase phenotype F
71. Characteristic features for DT include disorientation for person F
72. Characteristic features for DT include proneness to sensory deception T
73. Characteristic features for DT include Increased fast activity on EEG
74. Characteristic features for DT include craving for alcohol F
75. Characteristic features for DT include negligible mortality F
76. Hyper reflexia is associated with withdrawal in alcohol dependency T
77. Fits are associated with withdrawal in alcohol dependency T
78. Anxiety is associated with withdrawal in alcohol dependency T
79. Sweating is associated with withdrawal in alcohol dependency T
80. Increased REM sleep is associated with withdrawal in alcohol dependency T
81. In Wernicke’s encephalopathy medial is more common than lateral rectus palsy F
82. The G in CAGE questionnaire stands for Gauge the level of alcohol intake F
83. In organic states confabulation is common in Korsakoff’s psychosis T
84. History that patients give about drug & alcohol should be taken at face values F
85. Delirium Tremens DT develops within 24 hours of stopping drinking by an alcohol dependent person F
86. 1/4th of patients in surgical ITU suffer from delirium T
87. Withdrawal symptoms on stopping heroin typically last 2-3 weeks F 7-10 days
88. Confusion & ataxia are common features of Wernick’s T
89. Cerebellar lesions are seen Korsakoff’s psychosis T
90. Long term cannabis use is associated with lack motivation & apathy T
91. Death can result even from occasional use of ecstasy T
92. Heightened consciousness can occur with the use of illicit drugs T
93. Voices in alcoholic hallucinosis respond very well to neuroleptics F respond to stopping drinking
94. The absence of withdrawal symptoms on cessation of drinking rules out a diagnosis of alcohol dependence F ICD criteria for dependence , any 3 of a. strong desire to take the substance b. difficulty in controlling intake c. psychological withdrawal d. neglect of alternative pursuits e. use despite harmful consequences f. tolerance .
95. Idiosyncratic alcohol intoxication occur after the consumption of large amount of alcohol F small amounts
96. The greatest advantage of using methadone in people with opiates dependence is that it is non addictive F it is a form of controlled addiction leading to reduced crime & less chaotic life style
97. Withdrawal symptoms on stopping opiates are life threatening F
98. Solvent use is typically a solitary activity F it is predominantly a group activity, 5% of use is solitary
99. Men are more sensitive to the harm inducing effects of alcohol F
100. Somatisation in females is associated with alcoholism in male relatives
101. In alcoholic hallucinosis the hallucinations are usually tactile F
102. Withdrawal symptoms from methadone begins within 1 –3 days after the last dose
103. 60% of alcohol abusers have raised MCV levels T
104. The incidence of schizophrenia is increased among cannabis abusers T
105. Amphetamine use can result in psychiatric illness undistinguished from schizophrenia T
106. Flash backs can occur after months or even years after using LSD T
Drug & Alcohol
1. Ataxia is a characteristic feature of Wernicke’ encephalopathy T
2. Diplopia is a characteristic feature of Wernicke’ encephalopathy T
3. Confusion is a characteristic feature of Wernicke’ encephalopathy T
4. Peripheral neuropathy is a characteristic feature of Wernicke’ encephalopathy T
5. Dysphasia is a characteristic feature of Wernicke’ encephalopathy F
6. Wernicke’ encephalopathy presents with ophthalmoplegia T
7. Wernicke’ encephalopathy presents with nystagmus T
8. Wernicke’ encephalopathy presents with Ataxia T
9. Wernicke’ encephalopathy presents with abnormal pupil reaction T
10. Wernicke’ encephalopathy presents with altered consciousness T
11. Characteristic features of the history in alcoholic include a tendency to exaggerate drinking F
12. Characteristic features of the history in alcoholic include absenteeism on Fridays F
13. Characteristic features of the history in alcoholic include a family history of schizophrenia F
Characteristic features of the history in alcoholic include reinstatement after abstinence T
14. Characteristic features of the history in alcoholic include wanting an eye opener T
15. In heroin addiction inspection of the limbs could reliably exclude IV use F
16. In heroin addiction the stated amount of consumption by the patient is a reliable estimate F
17. In heroin addiction HIV testing is mandatory F
18. In heroin addiction tricuspid valve endocarditis is a recognised complication T
19. In heroin addiction
20. is a known cause of drug induced psychosis F
21. Delirium tremens Can be precipitated by emergency surgery T
22. Delirium tremens begins 12 hours after the last drink F 2-3 days
23. In delirium tremens hallucinations can occur in several modalities T
24. Lilliputian hallucination is a feature of delirium tremens T
25. Plucking behaviour is seen in delirium tremens T
Symptoms of DT: clouding of consciousness, misinterpretation of environment, & fear. VH are the main modality but AH &tactile hallucination can occur. Other features include disorientation, tremor & autonomic over activity.
26. Features of alcoholic hallucinosis include clouding of consciousness F
27. Features of alcoholic hallucinosis include auditory hallucinations T
28. Risk of alcoholism is increased in Schizophrenia F
29. A family history of affective disorder increases the risk of alcoholism T
30. working in the catering business increases the risk of alcoholism T
31. Living in rural areas increases the risk of alcoholism F
32. Preference for spirits over beer increases risk of alcoholism F
33. Features of alcohol dependency include macrocytic anaemia F
34. Features of alcohol dependency include narrowing of drinking repertoire T
35. Features of alcohol dependency include altered tolerance to alcohol T
36. Features of alcohol dependency include aggressive behaviour when drunk F
37. alcohol hallucinosis It is included in DSM IV but not ICD 10
38. In alcohol hallucinosis auditory hallucinatios are more common than visual hallucinations T
39. Paranoid delusional believes occur in alcohol hallucinosis T
40. Alcohol hallucinosis is commoner in young adults F
Alcoholic hallucinosis
Occurs in long term drinkers & consists of persistent & well framed critical AH in clear consciousness. Voices are usually offensive, the patient is anxious & distressed .It generally lasts few days although some controversy as to whether this pattern occur in people vulnerable to mental illness especially schizophrenia .The main point of the question is for you to be clear about the difference this & DT. In DT the hallucinations are far more likely to visual & occur in clouded consciousness after the patient abruptly stop or cut down significantly their alcohol intake.
41. The risk of becoming alcoholic is increased in Doctors T
42. The risk of becoming alcoholic is increased in rural areas F
43. The risk of becoming alcoholic is increased in countries with a high per capita consumption of alcohol T
44. The risk of becoming alcoholic is increased in Hindus F
Evidence of genetic component to alcoholism ,MZ > concordance than DZ twins .P300 ( a visual evoked potential may be a marker )is attenuated in sons of alcoholics who are also less sensitive to alcohol. The variance of aldehyde dehydrogenase in some groups (parts of Asia) tolerance to alcohol is low & so alcoholism is rare.
Anti social PD predisposes to alcoholism.
Social learning from family & friends.
Psychiatric disorders such as anxiety, depression, social phobias etc….
Some occupations have greater risk i.e. doctors, vets, publicans, seamen, journalists
Ethnicity is relevant mainly due to social factors. Decreased rates in Muslims, Hindus & Jews.
The population at large to some degree dictates drinking habit .the greater the overall consumption in a population the greater the number of alcoholics.
45. Awareness of compulsion to drink is diagnostic of alcohol dependence T
46. daily consumption of Alcohol is diagnostic of alcohol dependence F
47. Guilt about level of drinking is diagnostic of alcohol dependence F
Edward & Gross ( 1976 ) described in a classical paper in BMJ key features of alcohol dependence which also apply to addiction to other substances .Most features are used in ICD 10 to diagnose the dependence syndrome
ICD 10 criteria
Subjective awareness of compulsion to drink .
Increased tolerance.
Narrowing of drinking repertoire (same drink on week days or weekends with no regard to social constrains)
Relief drinking (in the morning blood alcohol level is lower & drinking relieves the start of withdrawal symptoms)
Drink seeking behaviour.
Reinstatement of drinking after a period of abstinence
48. features of Wernicke’ encephalopathy include vestibular paralysis T
49. features of Wernicke’ encephalopathy include apathy T
50. features of Wernicke’ encephalopathy include hypothermia T
51. features of Wernicke’ encephalopathy include papilloedema T
52. Characteristics of Wernicke’ encephalopathy include flapping tremor of the hands
53. Characteristics of Wernicke’ encephalopathy include grand mal seizures F
54. Characteristics of Wernicke’ encephalopathy include nystagmus on lateral gaze T
55. Characteristics of Wernicke’ encephalopathy include Paralysis of lateral rectus T
56. Characteristics of Wernicke’ encephalopathy include Petechial haemorrhage in mamillary bodies T
57.
Acute encephalopathy from alcohol or other causes of thiamine deficiency (vitamin B1) i.e. stomach cancer, hyper emesis gravidarum & starvation .IT is due to ischaemic damage to brain stem & connectios. There is a triad of
- Ocular signs; nystagmus, lateral rectus palsy, conjugate gaze palsy & papilledema.
- Ataxia; cerebellar signs occur as does vestibular paralysis.
- Confusion; apathy, restlessness & stupor occur.
Hypothermia & hyperthermia due to thalamic damage is rare. Peripheral neuropathy can occur; often signs of malnutrition are seen.
58. Ascorbic acid excess is associated with Korsakoff’ psychosis F
59. Confabulation is associated with Korsakoff’ psychosis T
60. Disorientation for time is associated with Korsakoff’ psychosis T
61. Inability to learn new material is associated with Korsakoff’ psychosis T
62. Hypotension is associated with Korsakoff’ psychosis F
63. Pathological drunkenness classically present with senseless violence T
64. Pathological drunkenness classically present with an effect lasting an hour or more T
65. Pathological drunkenness classically present with euphoria post drinking F
66. Pathological drunkenness classically present with amnesia for the entire episode T
67. Pathological drunkenness classically present with uncontrollable rage & excitement T
68. In treating heroin dependence the knowledge of drug sub culture terminology is irrelevant F
69. In treating heroin dependence the quantities consumed as stated by the patient should be taken seriously T
70. Predisposing factors for alcoholism include low acetylase phenotype F
71. Characteristic features for DT include disorientation for person F
72. Characteristic features for DT include proneness to sensory deception T
73. Characteristic features for DT include Increased fast activity on EEG
74. Characteristic features for DT include craving for alcohol F
75. Characteristic features for DT include negligible mortality F
76. Hyper reflexia is associated with withdrawal in alcohol dependency T
77. Fits are associated with withdrawal in alcohol dependency T
78. Anxiety is associated with withdrawal in alcohol dependency T
79. Sweating is associated with withdrawal in alcohol dependency T
80. Increased REM sleep is associated with withdrawal in alcohol dependency T
81. In Wernicke’s encephalopathy medial is more common than lateral rectus palsy F
82. The G in CAGE questionnaire stands for Gauge the level of alcohol intake F
83. In organic states confabulation is common in Korsakoff’s psychosis T
84. History that patients give about drug & alcohol should be taken at face values F
85. Delirium Tremens DT develops within 24 hours of stopping drinking by an alcohol dependent person F
86. 1/4th of patients in surgical ITU suffer from delirium T
87. Withdrawal symptoms on stopping heroin typically last 2-3 weeks F 7-10 days
88. Confusion & ataxia are common features of Wernick’s T
89. Cerebellar lesions are seen Korsakoff’s psychosis T
90. Long term cannabis use is associated with lack motivation & apathy T
91. Death can result even from occasional use of ecstasy T
92. Heightened consciousness can occur with the use of illicit drugs T
93. Voices in alcoholic hallucinosis respond very well to neuroleptics F respond to stopping drinking
94. The absence of withdrawal symptoms on cessation of drinking rules out a diagnosis of alcohol dependence F ICD criteria for dependence , any 3 of a. strong desire to take the substance b. difficulty in controlling intake c. psychological withdrawal d. neglect of alternative pursuits e. use despite harmful consequences f. tolerance .
95. Idiosyncratic alcohol intoxication occur after the consumption of large amount of alcohol F small amounts
96. The greatest advantage of using methadone in people with opiates dependence is that it is non addictive F it is a form of controlled addiction leading to reduced crime & less chaotic life style
97. Withdrawal symptoms on stopping opiates are life threatening F
98. Solvent use is typically a solitary activity F it is predominantly a group activity, 5% of use is solitary
99. Men are more sensitive to the harm inducing effects of alcohol F
100. Somatisation in females is associated with alcoholism in male relatives
101. In alcoholic hallucinosis the hallucinations are usually tactile F
102. Withdrawal symptoms from methadone begins within 1 –3 days after the last dose
103. 60% of alcohol abusers have raised MCV levels T
104. The incidence of schizophrenia is increased among cannabis abusers T
105. Amphetamine use can result in psychiatric illness undistinguished from schizophrenia T
106. Flash backs can occur after months or even years after using LSD T
