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

C. Alcohol-induced psychiatric symptoms

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. Months sober, then weeks-long binges

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

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

B. Drinking nonbeverage alcohol

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

B. 0.08–0.10 g/dL 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

C. Significant pharmacodynamic tolerance

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

A. Alcohol-related blackout episode

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

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

A. With perceptual disturbances

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

C. Tremulousness

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

B. Miosis

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

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

A. Generalized tonic–clonic

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

A. Mammillary bodies

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

B. Less than 3% 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

D. CNS infection

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

C. Hypomagnesemia

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

A. Become assaultive or suicidal

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

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

C. Alcohol withdrawal delirium

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

A. 30s–40s after years heavy use

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

B. Concurrent hepatitis or pancreatitis

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

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

C. Vomiting

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

A. Improve after a year abstinent

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

B. Younger than 35

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

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

C. Ataxia, confusion, ocular signs

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

A. Anterograde amnesia in alert patient

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

B. Heavy drinking limited to weekends

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

C. Intoxicated all day, at least two days

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

B. Withdrawal tremor

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

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

B. Insomnia and anxiety

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

C. Autonomic hyperactivity with mydriasis

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

A. Alert but startle easily

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

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

B. Continuous tremor over eight hertz

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

C. Burst tremor slower than eight hertz

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

A. Within one week after stopping

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

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

C. Act on delusions as real threats

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

B. Pneumonia

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

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

A. Thirties or forties

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

C. Rare in good physical health

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

B. Half of affected patients

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

A. Fifty to seventy percent

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

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

C. Bilateral but not symmetric

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

B. Clear spontaneously or progress

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

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

A. Malabsorption problems

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

C. Several critical 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

B. Axonal conduction and synaptic transmission

del

del

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

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

C. Intact remote memory

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

B. Prior five to ten minutes

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

A. Almost all neurochemical systems

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

B. Tolerance development

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

C. Withdrawal syndromes

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

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. Mammillary bodies

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

C. Arrest for intoxicated behavior

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

D. Interpersonal impairment

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

A. Fatigue

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

B. Depression

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

C. Physical illness

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

D. Cessation after heavy prolonged use

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

A. Insomnia

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

B. Irritability

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

D. More than one seizure

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

A. Hyponatremia

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

B. Head injuries

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

C. CNS neoplasms

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

D. Cerebrovascular disease

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

A. Alcohol delirium

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

B. 20%

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

C. Heart failure

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

D. Delusions

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

A. Disorientation

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

B. Fever

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

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

A. Alcohol use disorder

“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

C. Fifth of spirits in one sitting

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

B. Alcohol use disorder

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

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

A. Severe functional deterioration

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

B. More severe withdrawal symptoms

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

B. Disorganized thought process

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

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

B. Disoriented to time

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

C. Disoriented to place

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

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

A. Driving-impairment risk standard

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

B. Maladaptive behavior plus physiologic sign

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

C. Daily prolonged drinking pattern

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

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

A. Poorly studied

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

B. Improves; some permanent deficits

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

B. Autoimmune encephalopathy

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

A. Craving

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

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

B. Withdrawal tremor relieved by alcohol

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

C. Vomiting

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

D. Alcohol withdrawal tremor spectrum

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

A. Tongue and eyelids

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

B. Delirium tremens

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

C. Minimization/poor insight

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

A. Tactile hallucinations