In the United Kingdom, one unit of alcohol is equivalent to which of the following?
C. In the United Kingdom, a unit is 8 grams of pure alcohol, equivalent to half a pint of ordinary beer, a small glass of wine (9% strength), or one measure of spirits. In the USA a single drink is usually considered to contain about 12 grams of ethanol, which is the content of 12 ounces of beer, one 4-ounce glass of non-fortified wine, or 1–1.5 ounces of 40% ethanol liquor (e.g. whiskey or gin). Using moderate sizes of drinks, clinicians estimate that a single ‘drink’ (1.5 units) increases the blood alcohol level of a 150-pound man by 15–20 mg/dL, which is about the concentration of alcohol that an average person can metabolize in 1 hour.
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Which of the following is incorrect with regard to the pharmacokinetics of alcohol?
C. Nearly 90% of alcohol is absorbed from small intestine, with the remaining 10% absorbed from the stomach. Alcohol reaches peak blood concentration approximately 45–60 minutes after consumption. Absorption is enhanced by an empty stomach whereas food delays absorption. When the alcohol concentration in the stomach becomes too high, gastric mucus secretion increases, leading to closure of the pyloric valve. This pylorospasm slows down the absorption and protects from rapid intoxication but can lead to vomiting and nausea in drinkers.
The intoxicating effects are greater when the blood alcohol concentration is rising than when it is falling; this is called the Mellanby effect. As a result, the rate of absorption directly affects the intoxication response. Nearly 90% of absorbed alcohol is metabolized through oxidation in the liver; the remainder is excreted unchanged by the kidneys and lungs. The rate of oxidation by the liver is constant (15 mg/dL per hour) and independent of plasma alcohol levels; thus alcohol follows zero-order elimination kinetics. Women have a tendency to become more intoxicated than men after drinking the same amount of alcohol; this may be due to differences in absorption kinetics and a lower level of metabolic enzymes such as alcohol dehydrogenase (ADH) in women.
Which of the following has been found to be the best screening method for hazardous drinking in primary care settings?
A. AUDIT is a 10-item questionnaire, covering quantity, frequency, inability to control drinking, withdrawal relief, loss of memory, injury, and concern by others. A score of 8 or more indicates that the person is drinking to a degree that is harmful or hazardous, whereas a score of 13 or more in women and 15 or more in men is indicative of dependent drinking. It is a very useful and widely used scale. The CAGE questionnaire is a simple, easily administered instrument that has only four items. A positive answer should raise suspicion of an alcohol problem, and a score of 2 is highly suggestive of one. It takes 30–120 seconds to administer. Aertgeerts et al studied alcohol screening instruments used in general practice. They found that CAGE was an insufficient screening instrument for detecting alcohol misuse or dependence among primary care patients with only 62% sensitivity for males and 54% for females. AUDIT was found to be more effective, with a sensitivity of 83% among males and 65% among females. However, this was using a cut off-point of 5 rather than the usual 8. The study also found that conventional laboratory tests are of no use for detecting alcohol abuse or dependence in a primary care setting. MAST is the Michigan alcohol screening test and the other options in the question are laboratory-based blood tests.
Which of the following is true with regard to alcoholic blackouts?
A. Alcohol-related blackouts are similar to episodes of transient global amnesia; they occur as discrete episodes of anterograde amnesia in association with alcohol intoxication. Despite a specific short-term memory deficit (inability to recall events that happened in the previous 5–10 minutes) during the blackouts and significant subjective distress that follows, patients have relatively intact remote memory and can perform complicated tasks during a blackout. Thus they appear completely normal to casual observers. It is thought that alcohol blocks the consolidation of new memories into old memories via its action on medial temporal structures. Binge drinkers may be particularly prone to alcoholic blackouts due to repeated intoxications. Although amnesia may accompany withdrawal or intoxication-related generalized seizures, not all blackouts are associated with epileptic activity in EEG.
Which of the following is least likely to be a presenting physical feature of a child with foetal alcohol syndrome (FAS)?
A. Children with FAS commonly present with microcephaly rather than macrocephaly. It is well documented that alcohol and its metabolite acetaldehyde can have serious effects on the developing foetus. Currently, the estimated incidence of FAS is between 1 and 3 cases per 1000 live births. It is one of the most frequent causes of birth defects associated with learning disability, and the most common of non-hereditary causes of birth defects. Clinical features of FAS include prenatal and postnatal growth retardation, central nervous system abnormalities, usually with learning disability (up to severe), a characteristic facial dysmorphism (e.g., absent philtrum, flattened nasal bridge, short palpebral fissures, epicanthic folds, and maxillary hypoplasia), and an array of other birth defects such as microcephaly, altered palmar creases, short stature, syndactyly, atrial septal defect and other heart abnormalities. Full-blown foetal alcohol syndrome is seen in the offspring of approximately one-third of alcoholic women drinking the equivalent of 10–15 units daily. It is also more common in women who binge drink.
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