Psych 4.2 Flashcards

A patient presents with new-onset paranoia and severe anxiety that fluctuate with heavy drinking and improve during abstinent periods. Which framing best fits this pattern?
A. Primary schizophrenia with alcohol use
B. Panic disorder with self-medication
C. Alcohol-induced psychiatric symptoms
D. Adjustment disorder with anxiety

Which drinking pattern most strongly suggests an alcohol use disorder?
A. Months sober, then weeks-long binges
B. Rare drinks only at weddings
C. Two beers nightly
D. Occasional champagne on holidays

A patient repeatedly tries to control drinking by “going on the wagon” and restricting alcohol to certain times of day, but relapses into heavy use. This behavior most directly reflects:
A. Successful harm reduction
B. Physiologic dependence only
C. Normal social drinking strategy
D. Inability to cut down

Which behavior is a severity marker specifically noted for alcohol use disorders?
A. Drinking only with meals
B. Drinking nonbeverage alcohol
C. Switching from beer to wine
D. Avoiding alcohol at work

In most U.S. states, the legal definition of intoxication for driving generally corresponds to:
A. 0.02 g/dL blood ethanol
B. 0.08–0.10 g/dL ethanol
C. 0.15–0.20 g/dL ethanol
D. 0.30 g/dL blood ethanol

Someone has a blood ethanol level around 150 mg/dL but shows little motor or mental impairment. The best inference is:
A. Lab error is most likely
B. They metabolize ethanol faster
C. Significant pharmacodynamic tolerance
D. Concurrent stimulant intoxication

After a night of drinking, a patient recalls arriving at a bar but cannot recall events from the next several hours, yet friends report he paid bills and navigated home. This most specifically describes:
A. Alcohol-related blackout episode
B. Delirium tremens
C. Korsakoff syndrome
D. Alcohol-induced dementia

Which factor can predispose to or aggravate alcohol withdrawal symptoms?
A. Hyperthyroidism
B. High-protein diet
C. Mild seasonal allergies
D. Malnutrition

DSM-5 alcohol withdrawal allows which additional specifier?
A. With perceptual disturbances
B. With catatonic features
C. With dissociative symptoms
D. With panic attacks

The classic earliest sign emphasized for alcohol withdrawal is:
A. Fever with rigors
B. Auditory hallucinations
C. Tremulousness
D. Fixed delusional beliefs

Which finding is least consistent with alcohol withdrawal autonomic hyperactivity?
A. Tachycardia
B. Miosis
C. Diaphoresis
D. Mild hypertension

Regarding alcohol withdrawal progression, which statement is most accurate?
A. Seizures always precede tremor
B. DTs require prior hallucinations
C. Symptoms always progress linearly
D. Withdrawal can skip to DTs

Alcohol withdrawal seizures are typically:
A. Generalized tonic–clonic
B. Focal motor with aura
C. Absence with staring spells
D. Atonic drop attacks

Wernicke–Korsakoff lesions are noted to involve the:
A. Mammillary bodies
B. Caudate nucleus only
C. Primary motor cortex only
D. Optic chiasm exclusively

Status epilepticus in alcohol withdrawal occurs in:
A. About one-third of patients
B. Less than 3% patients
C. Around 20% patients
D. Nearly all ICU patients

A patient with a known alcohol history has a seizure. Which alternate etiology must still be actively considered per the text?
A. Allergic rhinitis
B. Irritable bowel syndrome
C. Restless legs syndrome
D. CNS infection

Long-term severe alcohol abuse can produce which metabolic problem associated with seizures?
A. Hypercalcemia
B. Hyperphosphatemia
C. Hypomagnesemia
D. Hyperchloremia

Alcohol withdrawal delirium (DTs) is particularly dangerous because patients may:
A. Become assaultive or suicidal
B. Have persistent bradycardia
C. Develop chronic aphasia
D. Lose deep tendon reflexes

Untreated DTs have high mortality, most often due to:
A. Pulmonary embolism
B. Massive GI bleeding
C. Acute appendicitis
D. Intercurrent medical illness

A hospitalized patient admitted for an unrelated condition becomes delirious and tremulous on hospital day 3. This timing most strongly suggests:
A. Acute opioid intoxication
B. Hepatic encephalopathy only
C. Alcohol withdrawal delirium
D. Primary manic episode

Typical DTs epidemiology in the text most fits:
A. 30s–40s
B. Teenagers
C. 40s–50s
D. Elderly after five glass wine

Which context most increases DT risk per the text?
A. Excellent physical conditioning
B. Concurrent hepatitis or pancreatitis
C. A high-fiber diet
D. Daily multivitamin use

Alcohol-induced persisting dementia is best characterized as:
A. Purely visual memory loss
B. Always fully reversible
C. Only occurs before age 25
D. Global cognitive impairment syndrome

In a patient trying to keep drinking, the symptom that prevents intake is:
A. Rash
B. Aphasia
C. Vomiting
D. Chest pain

Structural brain changes in alcohol-induced persisting dementia may:
A. Improve after a year abstinent
B. Worsen only with exercise
C. Never appear on imaging
D. Require surgery for reversal

Alcohol-induced persisting amnestic disorder is rare in people:
A. Over age 65
B. Younger than 35
C. With insomnia symptoms
D. With mild anxiety

The pathophysiologic link between Wernicke encephalopathy and Korsakoff syndrome is:
A. Folate deficiency
B. Vitamin B12 excess
C. Iron overload
D. Thiamine deficiency

Wernicke encephalopathy is best identified by:
A. Fever, rash, lymphadenopathy
B. Hemiparesis, facial droop
C. Ataxia, confusion, ocular signs
D. Hyperreflexia, spasticity, clonus

Korsakoff syndrome most classically features:
A. Anterograde amnesia in alert patient
B. Rapid recovery in most cases
C. Primary loss of remote memory
D. Always requires confabulation

Which pattern is specifically noted as strongly suggesting alcohol use disorder?
A. One drink nightly with dinner
B. Heavy drinking limited to weekends
C. Drinking only during vacations
D. Drinking only at celebrations

In this text, a “binge” is exemplified as:
A. Two drinks before bedtime
B. One fifth in a sitting
C. Intoxicated all day, at least two days
D. Drinking beer with each meal

Tremor that briefly improves after alcohol most supports:
A. Stroke recovery pattern
B. Withdrawal tremor
C. Parkinson progression
D. Essential tremor confirmation

Which is listed as a legal difficulty linked to alcohol use?
A. Missing clinic appointments
B. Losing interest in hobbies
C. Poor grooming at work
D. Traffic accidents while intoxicated

Stopping heavy prolonged drinking can precipitate withdrawal with:
A. Photophobia, neck stiffness
B. Insomnia and anxiety
C. Polyuria, polydipsia
D. Rash with mucosal ulcers

A patient in alcohol withdrawal has dilated pupils. This reflects:
A. Nicotinic receptor blockade
B. Opioid withdrawal mechanism
C. Autonomic hyperactivity with mydriasis
D. Serotonin syndrome physiology

Early alcohol withdrawal patients are generally:
A. Alert but startle easily
B. Somnolent and unarousable
C. Comatose with fixed pupils
D. Aphasic with focal deficits

Which GI symptom set is described in alcohol withdrawal?
A. Constipation with bloating
B. Hematemesis with melena
C. Watery diarrhea only
D. Nausea and vomiting

The withdrawal tremor can resemble physiologic tremor defined by:
A. Bursts slower than eight hertz
B. Continuous tremor over eight hertz
C. Resting tremor at four hertz
D. Intention tremor with cogwheeling

The withdrawal tremor can resemble familial tremor defined by:
A. Continuous high amplitude tremor
B. Sustained clonus at ankle
C. Burst tremor slower than eight hertz
D. Myoclonus triggered by sound

The essential feature of alcohol withdrawal delirium is delirium:
A. Within one week after stopping
B. Only during active intoxication
C. Only after head trauma
D. After one month abstinence

DTs include psychomotor changes best described as:
A. Constant stupor without fluctuation
B. Fixed agitation without periods
C. Uniform catatonia throughout episode
D. Fluctuating lethargy to agitation

DT behavior can be dangerous because patients may:
A. Always recognize hallucinations as unreal
B. Become mute and withdrawn
C. Act on delusions as real threats
D. Have purely chronic memory loss

Untreated DT mortality is high, often due to illnesses such as:
A. Acute appendicitis
B. Pneumonia
C. Hyperthyroidism
D. Asthma exacerbation

DTs typically begin after what drinking history?
A. One year of light use
B. Two weeks of daily use
C. Less than six months use
D. Five to fifteen years heavy

DTs are most likely to present in which age range?
A. Thirties or forties
B. Early teenage years
C. Childhood under ten
D. Early twenties only

Which statement about DT risk is most consistent with the text?
A. Best predicted by BMI alone
B. Requires prior hallucinations always
C. Rare in good physical health
D. Occurs only with opioid use

In alcohol-induced persisting dementia, long-term disability occurs in about:
A. Nearly all patients
B. Half of affected patients
C. Fewer than one percent
D. No patients after abstinence

Approximately what fraction show enlarged ventricles and sulcal shrinkage?
A. Fifty to seventy percent
B. Five to ten percent
C. Ten to twenty percent
D. Ninety to ninety-five percent

Alcohol-induced persisting amnestic disorder is primarily a disturbance in:
A. Language fluency
B. Visuospatial neglect
C. Motor coordination
D. Short-term memory

Wernicke ocular signs are usually:
A. Unilateral and symmetric
B. Always absent early
C. Bilateral but not symmetric
D. Only present during seizures

Wernicke encephalopathy can:
A. Never progress if untreated
B. Clear spontaneously or progress
C. Require decades to develop
D. Present only with seizures

In Korsakoff syndrome, confabulation:
A. Always absent
B. Always prominent
C. Is diagnostic requirement
D. May be present or absent

Thiamine deficiency in Wernicke–Korsakoff can result from:
A. Malabsorption problems
B. Excess dietary thiamine
C. Hypercalcemia
D. High-protein intake

Thiamine is described as a cofactor for:
A. Hemoglobin synthesis enzymes
B. Steroidogenesis enzymes
C. Several critical enzymes
D. Immunoglobulin assembly enzymes

Beyond enzyme roles, thiamine may be involved in:
A. Dopamine receptor upregulation
B. Axonal conduction and synaptic transmission
C. Myelin antibody production
D. Renal bicarbonate reabsorption

The neuropathologic lesions in Wernicke–Korsakoff are described as:
A. Asymmetric and cortical only
B. Unilateral temporal sclerosis
C. Diffuse peripheral demyelination
D. Symmetrical and paraventricular

During an alcohol blackout, patients typically have:
A. Loss of procedural skills
B. Global aphasia
C. Intact remote memory
D. Permanent dementia onset

The short-term memory deficit in blackouts is classically inability to recall:
A. Childhood events
B. Prior five to ten minutes
C. Names learned years ago
D. Remote autobiographical memories

Alcohol is described as causing acute and chronic changes in:
A. Almost all neurochemical systems
B. Dopaminergic reward circuits
C. Glutamatergic signaling
D. Serotonergic signaling

Increasing regular alcohol consumption can cause:
A. Autoimmune sensitization
B. Tolerance development
C. Demyelinating disease
D. Fixed psychosis

Chronic alcohol use can create adaptation such that stopping drinking precipitates:
A. Serotonin syndrome
B. Hepatic coma
C. Withdrawal syndromes
D. Neuroleptic malignant syndrome

When assessing life problems and psychiatric symptoms, clinicians should consider:
A. Only primary psychiatric disorders
B. Only personality disorders
C. Only endocrine disorders
D. Effects of alcohol use

Wernicke–Korsakoff lesions are noted to involve the:
A. Mammillary bodies
B. Caudate nucleus
C. Primary motor cortex
D. Optic chiasm

A legal difficulty specifically mentioned with alcohol use is:
A. Curfew violations only
B. Divorce proceedings only
C. Arrest for intoxicated behavior
D. Missed rent payments

Recurrent arguments with family about drinking most directly reflect:
A. Improved coping strategies
B. Stable interpersonal functioning
C. Enhanced family cohesion
D. Interpersonal impairment

Which condition can predispose to worse withdrawal?
A. Fatigue
B. Hyperlipidemia
C. Seasonal allergies
D. Myopia

Which condition can aggravate withdrawal symptoms?
A. Mild acne
B. Depression
C. Lactose intolerance
D. Low vitamin C

Which condition can aggravate withdrawal symptoms?
A. Controlled asthma
B. Mild eczema
C. Physical illness
D. Nearsightedness

DSM-5 alcohol withdrawal requires:
A. New psychosis after sobriety
B. Elevated blood ethanol level
C. Recent weekend-only drinking
D. Cessation after heavy prolonged use

Withdrawal syndromes in this text can include:
A. Insomnia
B. Hyperreflexia
C. Bradycardia
D. Photosensitivity

Besides tremor and GI upset, withdrawal can include:
A. Euphoria
B. Irritability
C. Urinary retention
D. Constipation

Patients with withdrawal seizures often have:
A. Exactly one seizure only
B. No recurrence after first
C. Only nocturnal seizures
D. More than one seizure

Long-term severe alcohol abuse can cause:
A. Hyponatremia
B. Hyperkalemia
C. Hypercalcemia
D. Hypernatremia

Even with alcohol history, seizures should prompt evaluation for:
A. Carpal tunnel syndrome
B. Head injuries
C. Lactose intolerance
D. Seasonal allergies

Even with alcohol history, seizures should prompt evaluation for:
A. Otitis externa
B. Tendinitis
C. CNS neoplasms
D. Gallstones

Even with alcohol history, seizures should prompt evaluation for:
A. Migraine only
B. GERD only
C. Fibromyalgia only
D. Cerebrovascular disease

In DSM-5, delirium tremens is termed:
A. Alcohol delirium
B. Alcohol intoxication disorder
C. Alcohol panic disorder
D. Alcohol catatonia

Untreated delirium tremens mortality is about:
A. 2%
B. 20%
C. 50%
D. 80%

A named intercurrent cause of DT mortality is:
A. Otitis media
B. Appendicitis
C. Heart failure
D. Nephrolithiasis

A symptom explicitly listed for delirium tremens is:
A. Fixed phobia
B. Persistent euphoria
C. Catatonic stupor
D. Delusions

A core delirium tremens feature is:
A. Disorientation
B. Hyperphagia
C. Polydipsia
D. Hemiparesis

An autonomic sign listed for delirium tremens is:
A. Hypothermia
B. Fever
C. Miosis
D. Bradycardia

DSM-5 and ICD-10 alcohol diagnoses generally:
A. Use alcohol-specific unique rules
B. Exclude functional impairment
C. Require daily morning drinking
D. Follow substance-use template

Needing large daily alcohol amounts to “function” most strongly suggests:
A. Alcohol use disorder
B. Social drinking pattern
C. Mild intoxication only
D. Adjustment reaction

“Large amount in one sitting” best matches:
A. Two beers over hours
B. One glass nightly
C. Fifth of spirits in one sitting
D. Sips at celebrations

Years of daily heavy beer and wine intake most supports:
A. Low-risk drinking
B. Alcohol use disorder
C. Occasional binge only
D. Controlled social use

Psychiatric symptoms that track heavy drinking should raise concern for:
A. Primary mood disorder only
B. Personality disorder primary
C. Endocrine disorder primary
D. Alcohol-related symptom effects

Panhandling for food while still seeking alcohol best indicates:
A. Severe functional deterioration
B. Preserved role functioning
C. Mild use without impairment
D. Primary eating disorder

Relying on alcohol for calories increases risk of:
A. Protection from withdrawal
B. More severe withdrawal symptoms
C. Lower seizure risk
D. Faster detox completion

Rambling, unfocused, continuous speech most indicates:
A. Expressive aphasia
B. Disorganized thought process
C. Catatonic mutism
D. Pure motor tremor

Intermittently mistaking the interviewer for a relative suggests:
A. Intact orientation
B. Stable recognition
C. Pure remote amnesia
D. Fluctuating recognition

Unable to state the correct date/time is:
A. Disoriented to person
B. Disoriented to time
C. Depersonalization
D. Normal stress response

Believing the hospital is a parking lot is:
A. Confabulation only
B. Intact orientation
C. Disoriented to place
D. Language disturbance

A gross tremor visible at rest is best termed:
A. Dystonia
B. Chorea
C. Rigidity
D. Resting tremor

Legal intoxication thresholds primarily reflect:
A. Driving-impairment risk standard
B. Dementia diagnosis cutoff
C. Withdrawal severity predictor
D. Thiamine deficiency marker

DSM-5 alcohol intoxication requires ingestion plus:
A. Persistent amnesia weeks
B. Maladaptive behavior plus physiologic sign
C. Fever plus seizures
D. Fixed hallucinations only

Drinking nightly until sleep most supports:
A. Rare celebratory drinking
B. Weekend-only heavy use
C. Daily prolonged drinking pattern
D. Time-limited controlled use

A factor that can aggravate withdrawal is:
A. Mild eczema
B. High fitness level
C. Nearsightedness
D. Depression

Alcohol-induced persisting dementia is described as:
A. Poorly studied
B. Uniform well-defined syndrome
C. Not linked to alcohol
D. Always fully reversible

With abstinence, alcohol-induced persisting dementia often:
A. Worsens rapidly always
B. Improves; some permanent deficits
C. Resolves immediately fully
D. Never changes at all

Wernicke encephalopathy is also called:
A. Viral encephalopathy
B. Autoimmune encephalopathy
C. Alcoholic encephalopathy
D. Hepatic encephalopathy

Intense urge to drink on awakening is best termed:
A. Craving
B. Delusion
C. Confabulation
D. Dissociation

Drinking alcohol “instead of meals” most suggests:
A. Normal appetite variation
B. Primary anorexia nervosa
C. Pure financial limitation
D. Alcohol replaces nutrition

Tremor that briefly improves after alcohol most supports:
A. Stroke recovery pattern
B. Withdrawal tremor
C. Parkinson progression
D. Essential tremor confirmation

In a patient trying to keep drinking, the symptom that prevents intake is:
A. Rash
B. Aphasia
C. Vomiting limits intake
D. Chest pain

Resting and intention tremor during cessation best fits:
A. Focal seizure aura
B. Primary motor neuron disease
C. Isolated neuropathy
D. Alcohol withdrawal tremor spectrum

Withdrawal tremulousness may prominently involve:
A. Tongue and eyelids
B. Ankles
C. Jaw
D. Fingers

Tremor with tachycardia but no confusion most argues against:
A. Alcohol withdrawal
B. Delirium tremens
C. Autonomic hyperactivity
D. Withdrawal tremor

"Alcohol never affected work” despite job loss best reflects:
A. Confirmed sobriety
B. Accurate insight
C. Minimization/poor insight
D. Full sustained remission

Picking at “bugs” during severe withdrawal most suggests:
A. Tactile hallucinations
B. Simple insomnia only
C. Isolated essential tremor
D. Normal startle response