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Psych 4.2

front 1 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	back 1 C. Alcohol-induced psychiatric symptoms
front 2 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	back 2 A. Months sober, then weeks-long binges
front 3 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	back 3 D. Inability to cut down
front 4 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	back 4 B. Drinking nonbeverage alcohol

front 5 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	back 5 B. 0.08–0.10 g/dL ethanol
front 6 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	back 6 C. Significant pharmacodynamic tolerance
front 7 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	back 7 A. Alcohol-related blackout episode
front 8 Which factor can predispose to or aggravate alcohol withdrawal symptoms? A. Hyperthyroidism B. High-protein diet C. Mild seasonal allergies D. Malnutrition	back 8 D. Malnutrition

front 9 DSM-5 alcohol withdrawal allows which additional specifier? A. With perceptual disturbances B. With catatonic features C. With dissociative symptoms D. With panic attacks	back 9 A. With perceptual disturbances
front 10 The classic earliest sign emphasized for alcohol withdrawal is: A. Fever with rigors B. Auditory hallucinations C. Tremulousness D. Fixed delusional beliefs	back 10 C. Tremulousness
front 11 Which finding is least consistent with alcohol withdrawal autonomic hyperactivity? A. Tachycardia B. Miosis C. Diaphoresis D. Mild hypertension	back 11 B. Miosis
front 12 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	back 12 D. Withdrawal can skip to DTs

front 13 Alcohol withdrawal seizures are typically: A. Generalized tonic–clonic B. Focal motor with aura C. Absence with staring spells D. Atonic drop attacks	back 13 A. Generalized tonic–clonic
front 14 Wernicke–Korsakoff lesions are noted to involve the: A. Mammillary bodies B. Caudate nucleus only C. Primary motor cortex only D. Optic chiasm exclusively	back 14 A. Mammillary bodies
front 15 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	back 15 B. Less than 3% patients
front 16 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	back 16 D. CNS infection

front 17 Long-term severe alcohol abuse can produce which metabolic problem associated with seizures? A. Hypercalcemia B. Hyperphosphatemia C. Hypomagnesemia D. Hyperchloremia	back 17 C. Hypomagnesemia
front 18 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	back 18 A. Become assaultive or suicidal
front 19 Untreated DTs have high mortality, most often due to: A. Pulmonary embolism B. Massive GI bleeding C. Acute appendicitis D. Intercurrent medical illness	back 19 D. Intercurrent medical illness
front 20 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	back 20 C. Alcohol withdrawal delirium

front 21 Typical DTs epidemiology in the text most fits: A. 30s–40s B. Teenagers C. 40s–50s D. Elderly after five glass wine	back 21 A. 30s–40s after years heavy use
front 22 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	back 22 B. Concurrent hepatitis or pancreatitis
front 23 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	back 23 D. Global cognitive impairment syndrome
front 24 In a patient trying to keep drinking, the symptom that prevents intake is: A. Rash B. Aphasia C. Vomiting D. Chest pain	back 24 C. Vomiting

front 25 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	back 25 A. Improve after a year abstinent
front 26 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	back 26 B. Younger than 35
front 27 The pathophysiologic link between Wernicke encephalopathy and Korsakoff syndrome is: A. Folate deficiency B. Vitamin B12 excess C. Iron overload D. Thiamine deficiency	back 27 D. Thiamine deficiency
front 28 Wernicke encephalopathy is best identified by: A. Fever, rash, lymphadenopathy B. Hemiparesis, facial droop C. Ataxia, confusion, ocular signs D. Hyperreflexia, spasticity, clonus	back 28 C. Ataxia, confusion, ocular signs

front 29 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	back 29 A. Anterograde amnesia in alert patient
front 30 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	back 30 B. Heavy drinking limited to weekends
front 31 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	back 31 C. Intoxicated all day, at least two days
front 32 Tremor that briefly improves after alcohol most supports: A. Stroke recovery pattern B. Withdrawal tremor C. Parkinson progression D. Essential tremor confirmation	back 32 B. Withdrawal tremor

front 33 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	back 33 D. Traffic accidents while intoxicated
front 34 Stopping heavy prolonged drinking can precipitate withdrawal with: A. Photophobia, neck stiffness B. Insomnia and anxiety C. Polyuria, polydipsia D. Rash with mucosal ulcers	back 34 B. Insomnia and anxiety
front 35 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	back 35 C. Autonomic hyperactivity with mydriasis
front 36 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	back 36 A. Alert but startle easily

front 37 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	back 37 D. Nausea and vomiting
front 38 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	back 38 B. Continuous tremor over eight hertz
front 39 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	back 39 C. Burst tremor slower than eight hertz
front 40 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	back 40 A. Within one week after stopping

front 41 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	back 41 D. Fluctuating lethargy to agitation
front 42 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	back 42 C. Act on delusions as real threats
front 43 Untreated DT mortality is high, often due to illnesses such as: A. Acute appendicitis B. Pneumonia C. Hyperthyroidism D. Asthma exacerbation	back 43 B. Pneumonia
front 44 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	back 44 D. Five to fifteen years heavy

front 45 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	back 45 A. Thirties or forties
front 46 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	back 46 C. Rare in good physical health
front 47 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	back 47 B. Half of affected patients
front 48 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	back 48 A. Fifty to seventy percent

front 49 Alcohol-induced persisting amnestic disorder is primarily a disturbance in: A. Language fluency B. Visuospatial neglect C. Motor coordination D. Short-term memory	back 49 D. Short-term memory
front 50 Wernicke ocular signs are usually: A. Unilateral and symmetric B. Always absent early C. Bilateral but not symmetric D. Only present during seizures	back 50 C. Bilateral but not symmetric
front 51 Wernicke encephalopathy can: A. Never progress if untreated B. Clear spontaneously or progress C. Require decades to develop D. Present only with seizures	back 51 B. Clear spontaneously or progress
front 52 In Korsakoff syndrome, confabulation: A. Always absent B. Always prominent C. Is diagnostic requirement D. May be present or absent	back 52 D. May be present or absent

front 53 Thiamine deficiency in Wernicke–Korsakoff can result from: A. Malabsorption problems B. Excess dietary thiamine C. Hypercalcemia D. High-protein intake	back 53 A. Malabsorption problems
front 54 Thiamine is described as a cofactor for: A. Hemoglobin synthesis enzymes B. Steroidogenesis enzymes C. Several critical enzymes D. Immunoglobulin assembly enzymes	back 54 C. Several critical enzymes
front 55 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	back 55 B. Axonal conduction and synaptic transmission
front 56 del	back 56 del

front 57 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	back 57 D. Symmetrical and paraventricular
front 58 During an alcohol blackout, patients typically have: A. Loss of procedural skills B. Global aphasia C. Intact remote memory D. Permanent dementia onset	back 58 C. Intact remote memory
front 59 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	back 59 B. Prior five to ten minutes
front 60 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	back 60 A. Almost all neurochemical systems

front 61 Increasing regular alcohol consumption can cause: A. Autoimmune sensitization B. Tolerance development C. Demyelinating disease D. Fixed psychosis	back 61 B. Tolerance development
front 62 Chronic alcohol use can create adaptation such that stopping drinking precipitates: A. Serotonin syndrome B. Hepatic coma C. Withdrawal syndromes D. Neuroleptic malignant syndrome	back 62 C. Withdrawal syndromes
front 63 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	back 63 D. Effects of alcohol use
front 64 Wernicke–Korsakoff lesions are noted to involve the: A. Mammillary bodies B. Caudate nucleus C. Primary motor cortex D. Optic chiasm	back 64 A. Mammillary bodies

front 65 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	back 65 C. Arrest for intoxicated behavior
front 66 Recurrent arguments with family about drinking most directly reflect: A. Improved coping strategies B. Stable interpersonal functioning C. Enhanced family cohesion D. Interpersonal impairment	back 66 D. Interpersonal impairment
front 67 Which condition can predispose to worse withdrawal? A. Fatigue B. Hyperlipidemia C. Seasonal allergies D. Myopia	back 67 A. Fatigue
front 68 Which condition can aggravate withdrawal symptoms? A. Mild acne B. Depression C. Lactose intolerance D. Low vitamin C	back 68 B. Depression

front 69 Which condition can aggravate withdrawal symptoms? A. Controlled asthma B. Mild eczema C. Physical illness D. Nearsightedness	back 69 C. Physical illness
front 70 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	back 70 D. Cessation after heavy prolonged use
front 71 Withdrawal syndromes in this text can include: A. Insomnia B. Hyperreflexia C. Bradycardia D. Photosensitivity	back 71 A. Insomnia
front 72 Besides tremor and GI upset, withdrawal can include: A. Euphoria B. Irritability C. Urinary retention D. Constipation	back 72 B. Irritability

front 73 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	back 73 D. More than one seizure
front 74 Long-term severe alcohol abuse can cause: A. Hyponatremia B. Hyperkalemia C. Hypercalcemia D. Hypernatremia	back 74 A. Hyponatremia
front 75 Even with alcohol history, seizures should prompt evaluation for: A. Carpal tunnel syndrome B. Head injuries C. Lactose intolerance D. Seasonal allergies	back 75 B. Head injuries
front 76 Even with alcohol history, seizures should prompt evaluation for: A. Otitis externa B. Tendinitis C. CNS neoplasms D. Gallstones	back 76 C. CNS neoplasms

front 77 Even with alcohol history, seizures should prompt evaluation for: A. Migraine only B. GERD only C. Fibromyalgia only D. Cerebrovascular disease	back 77 D. Cerebrovascular disease
front 78 In DSM-5, delirium tremens is termed: A. Alcohol delirium B. Alcohol intoxication disorder C. Alcohol panic disorder D. Alcohol catatonia	back 78 A. Alcohol delirium
front 79 Untreated delirium tremens mortality is about: A. 2% B. 20% C. 50% D. 80%	back 79 B. 20%
front 80 A named intercurrent cause of DT mortality is: A. Otitis media B. Appendicitis C. Heart failure D. Nephrolithiasis	back 80 C. Heart failure

front 81 A symptom explicitly listed for delirium tremens is: A. Fixed phobia B. Persistent euphoria C. Catatonic stupor D. Delusions	back 81 D. Delusions
front 82 A core delirium tremens feature is: A. Disorientation B. Hyperphagia C. Polydipsia D. Hemiparesis	back 82 A. Disorientation
front 83 An autonomic sign listed for delirium tremens is: A. Hypothermia B. Fever C. Miosis D. Bradycardia	back 83 B. Fever
front 84 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	back 84 D. Follow substance-use template

front 85 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	back 85 A. Alcohol use disorder
front 86 “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	back 86 C. Fifth of spirits in one sitting
front 87 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	back 87 B. Alcohol use disorder
front 88 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	back 88 D. Alcohol-related symptom effects

front 89 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	back 89 A. Severe functional deterioration
front 90 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	back 90 B. More severe withdrawal symptoms
front 91 Rambling, unfocused, continuous speech most indicates: A. Expressive aphasia B. Disorganized thought process C. Catatonic mutism D. Pure motor tremor	back 91 B. Disorganized thought process
front 92 Intermittently mistaking the interviewer for a relative suggests: A. Intact orientation B. Stable recognition C. Pure remote amnesia D. Fluctuating recognition	back 92 D. Fluctuating recognition

front 93 Unable to state the correct date/time is: A. Disoriented to person B. Disoriented to time C. Depersonalization D. Normal stress response	back 93 B. Disoriented to time
front 94 Believing the hospital is a parking lot is: A. Confabulation only B. Intact orientation C. Disoriented to place D. Language disturbance	back 94 C. Disoriented to place
front 95 A gross tremor visible at rest is best termed: A. Dystonia B. Chorea C. Rigidity D. Resting tremor	back 95 D. Resting tremor
front 96 Legal intoxication thresholds primarily reflect: A. Driving-impairment risk standard B. Dementia diagnosis cutoff C. Withdrawal severity predictor D. Thiamine deficiency marker	back 96 A. Driving-impairment risk standard

front 97 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	back 97 B. Maladaptive behavior plus physiologic sign
front 98 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	back 98 C. Daily prolonged drinking pattern
front 99 A factor that can aggravate withdrawal is: A. Mild eczema B. High fitness level C. Nearsightedness D. Depression	back 99 D. Depression
front 100 Alcohol-induced persisting dementia is described as: A. Poorly studied B. Uniform well-defined syndrome C. Not linked to alcohol D. Always fully reversible	back 100 A. Poorly studied

front 101 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	back 101 B. Improves; some permanent deficits
front 102 Wernicke encephalopathy is also called: A. Viral encephalopathy B. Autoimmune encephalopathy C. Alcoholic encephalopathy D. Hepatic encephalopathy	back 102 B. Autoimmune encephalopathy
front 103 Intense urge to drink on awakening is best termed: A. Craving B. Delusion C. Confabulation D. Dissociation	back 103 A. Craving
front 104 Drinking alcohol “instead of meals” most suggests: A. Normal appetite variation B. Primary anorexia nervosa C. Pure financial limitation D. Alcohol replaces nutrition	back 104 D. Alcohol replaces nutrition

front 105 Tremor that briefly improves after alcohol most supports: A. Stroke recovery pattern B. Withdrawal tremor C. Parkinson progression D. Essential tremor confirmation	back 105 B. Withdrawal tremor relieved by alcohol
front 106 In a patient trying to keep drinking, the symptom that prevents intake is: A. Rash B. Aphasia C. Vomiting limits intake D. Chest pain	back 106 C. Vomiting
front 107 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	back 107 D. Alcohol withdrawal tremor spectrum
front 108 Withdrawal tremulousness may prominently involve: A. Tongue and eyelids B. Ankles C. Jaw D. Fingers	back 108 A. Tongue and eyelids

front 109 Tremor with tachycardia but no confusion most argues against: A. Alcohol withdrawal B. Delirium tremens C. Autonomic hyperactivity D. Withdrawal tremor	back 109 B. Delirium tremens
front 110 "Alcohol never affected work” despite job loss best reflects: A. Confirmed sobriety B. Accurate insight C. Minimization/poor insight D. Full sustained remission	back 110 C. Minimization/poor insight
front 111 Picking at “bugs” during severe withdrawal most suggests: A. Tactile hallucinations B. Simple insomnia only C. Isolated essential tremor D. Normal startle response	back 111 A. Tactile hallucinations