Alcohol use disorder (1 to 4 of 8) 15/02/24

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1) The police bring a 45-year-old man with altered mental status to the emergency department after he was found wandering around a park. He appears to be suffering from both hallucinations and delusions. He cannot provide a reliable history or answer questions appropriately, has no prior records available, and has no emergency contact. His vital signs are normal. On exam, he is awake and alert, is in no apparent distress, smells heavily of alcohol, and has a disheveled appearance. There are no obvious signs of trauma. What is the best next step in the management of this patient?

1 point

a. Administer intravenous benzodiazepines to prevent impending alcohol withdrawal.

b. Check ethanol level and correlate with the patient's mental state.

c. Obtain a brain CT to rule out intracranial pathology such as hemorrhage or cerebrovascular accident.

d. Obtain a psychiatric consult to delineate the patient's mental health disorder further.

Clear selection

2) A 50-year-old hospitalized woman suddenly develops agitation and tremulousness. She underwent an open cholecystectomy successfully 3 days ago. She received hydrocodone for pain relief and was doing well until this morning. Vital signs are temperature 37.8 C (100 F), blood pressure 165/95 mmHg, heart rate 123 bpm, respiratory rate 25 breaths/min, and oxygen saturation 97% on room air. On physical examination, she is diaphoretic and is talking to her pet dog, who is not in the room. She is restless and uncooperative, pulling out her intravenous lines and shouting at the nurses. Her pupils are 3 mm and reactive. Breath sounds are normal, and no heart murmurs are audible. The abdomen is soft and non-tender. The surgical scar is healing well with no erythema or warmth. The patient moves all extremities without limitations. What is the most likely cause of this patient's acute confusion?

1 point

a. Opioid intoxication

b. Delirium tremens

c. Opioid withdrawal

d. Elevated intracranial pressure

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3) A 54-year-old man with a past medical history of hypertension, hyperlipidemia, tobacco use disorder, and alcohol use disorder is hospitalized for community-acquired pneumonia. On morning rounds, he says he "could not sleep at all" through the night. He also reports nausea, anxiety, diaphoresis, and tremors . His morning vital signs show his blood pressure to be 187/100 mmHg, heart rate 120 bpm, respirations 18 breaths/min, oxygen saturation 95% on room air, and temperature 98.6 F (37 C). Pulmonary exam is notable for crackles in the right lower lobe. What is the next step in management?

1 point

a. Start IV labetalol to prevent hypertensive emergency

b. Start IV ethanol infusion to prevent delirium tremens

c. Start oral folate to prevent Wernicke-Korsakoff syndrome

d. Start IV phenobarbital to prevent alcohol withdrawal seizures

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4) A 65-year-old man presents with nausea, vomiting, and abdominal pain. A history of present illness reveals that he has been drinking heavily for several days but now cannot keep anything down. His medical history includes alcohol use disorder. He is not currently on any medicines. His vital signs are respiratory rate 28 breaths/min, heart rate 126 bpm, blood pressure 106/62 mm Hg, and temperature 98.5 °F (36.9 °C). On examination, he has dry mucous membranes, mild diffuse abdominal tenderness, no peritoneal signs, and clear lungs. He has a visible resting tremor which is worsened with finger-to-nose maneuvers. His bedside glucose is 70 mg/dL. What is the treatment?

1 point

a. Non-glucose-containing fluids with bicarbonate for the probable acidotic state.

b. Blood cultures, lactate, antibiotics, and initiation of sepsis protocols as the patient meets systemic inflammatory response syndrome (SIRS) criteria.

c. Treatment of the acidosis with glucose-containing solutions as well as insulin to help maintain euglycemia and resolve the ketosis.

d. A liter of dextrose containing thiamine and saline.

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