To Screen or Intervene?
It's Complicated
EtOH Withdrawal
Treatment & Recovery
Primary Care Grab Bag
100
Name the four questions of the C.A.G.E. screen.
1. Have you ever felt you needed to Cut down on your drinking? 2. Have people Annoyed you by criticizing your drinking? 3. Have you ever felt Guilty about drinking? 4. Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?
100
Pt. presents to review labs, which show microcytic, iron-deficiency anemia. He has a history of chronic alcohol abuse and you suspect a GI bleed. These are 2 possible causes.
What is peptic ulcer, esophageal varices, Mallory-Weiss tears, Boerhaeve syndrome, hemorrhagic pancreatitis, or bleeding hemorrhoids.
100
Name two clinical features of alcohol withdrawal.
What is anxiety, tremors, nausea, vomiting, tachycardia and hallucinations.
100
This fellowship, founded in 1935, helps individuals achieve sobriety through mutual aid and a 12-step program.
Alcoholics Anonymous
100
This skin condition is the most common skin neoplasm, it is usually located on the face, or the back of the hands and metastasis is rare.
What is basal cell carcinoma
200
This screening tool is brief and easy to perform, but less sensitive for detecting binge drinking.
What is C.A.G.E. screen?
200
Pt.'s wife brings him into the office unexpectedly because he has grown increasingly confused. You notice an ataxic gait, he smells of alcohol, and has a horizontal nystagmus on physical exam. He is oriented to person and place, and remembers your name. Name this disorder.
What is Wernicke encephalopathy? (not Wernicke-Korsakoff)
200
This syndrome involves confabulations in which the patient invents stories to fill in memory gaps
What is Wernicke-Korsakoff syndrome
200
In 1977, Prochaska developed the stages of change model with these five components.
1. Pre-contemplation 2. Contemplation 3. Preparation 4. Action 5. Maintenance
200
Name 2 classes of drugs (or examples from 2 classes of drugs) that require monitoring of LFTs and are commonly prescribed in the primary care setting.
What are statins, fibrates, thiazolidinodiones, and niacin (and probably many more)?
300
Name two appropriate goals to establish with a patient during a brief intervention.
What are abstinence or entry into a treatment program for alcohol-dependent patient, or moderate drinking for non-dependent patient.
300
Alcoholic couple present for annual physical. He has gynecomastia, testicular atrophy, and complains of decreased libido and impotence. She has palmar erythema, spider nevi, and complains of irregular periods. Their signs signs and symptoms share this common etiology.
What is decreased liver metabolism of estrogen and suppressed testosterone production?
300
What treatment is usually administered to treat nutritional deficiencies?
What is the "banana bag," thiamine, folate, and multivitamin.
300
44 y.o male with hx of alcohol abuse and dependence presents is seeking a non-faith based organization to aid in detoxing and maintaining his sobriety. Name two options available for him.
What is SMART Recovery, Outpatient centers
300
The goals for blood pressure and LDL cholesterol in a diabetic patient.
What are 130/80 and <100?
400
A 20 yo F college student presents to your office with a superficial head laceration after "partying too hard" the night before. This is the second time she has presented to student health with an alcohol-related injury. She is a good student and denies drinking during the week. Name the screening test that is most appropriate for this patient.
What is AUDIT to distinguish hazardous drinking, harmful drinking and dependence.
400
Pt. calls and schedules an emergency visit. She has a temperature of 101 degrees, icteric sclera, and a distended abdomen with tender hepatomegaly on exam. Fingerstick glucose is 55mg/dL, and STAT labs show elevated LFTs with an AST:ALT ratio >2. She admits to frequent episodes of binge drinking. She is suffering from this condition.
What is alcoholic hepatitis? (not cirrhosis--would probably not see hepatomegaly and would probably have low LFTs)
400
Delerium Tremens may include what other clinical symptoms (name two) in addition to delirium?
Fever, gross tremor, autonomic instability, visual hallucinations, fluctuating levels of psychomotor activity.
400
A pt with a past hx of significant EtOH dependence now sober for 7 years, tells you that he is worried about the upcoming holiday season because old friends with which he used to drink have invited him to a New Years Eve party. These "worries" are formally known as what?
Relapse Triggers
400
This condition can result from severe hypertriglyceridemia.
What is pancreatitis?
500
"No one can make you change or make you decide to change. What you do about your drinking is up to you." Name the component of the FRAMES intervention model that this statement represents.
What is Responsibility of the patient.
500
The full name of the surgical procedure for treating refractory ascites.
What is Transjugular Intrahepatic Portosystemic Shunt (TIPS)?
500
This class of drugs can be used to treat patients who experience vivid and unpleasant auditory hallucinations, usually after 48 hours of drinking cessation.
What are antipsychotics (haloperidol and risperidone)
500
While examining your patient, you notice a very large tattoo on her back stating a date. State how you might use this finding to probe a conversation regarding her social history and what technique/intervention might you use at that point.
"That's a nice tattoo. Does it have a particular meaning to you?" --> (Sobriety Tattoo?) --> Probe EtOH use --> PRAISE progress and assess maintenance of goals.
500
A 53 y.o female presents to clinic for a Health Maintenance Exam. She has a hx of obesity, HTN, HLP and DM II. Name routine parts of her health maintenance that are specific for her at this visit.
Vacc: Tdap, Influenza, Pneumovax CA Screen: Colon, Cervical, Breast Labs: Lipids, CMP, A1C, microalbumin (UA)
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