1. True or False. Primary effect of ethanol (ETOH) on the central nervous system (CNS) is

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a. depression in neuronal excitability

true

b. depression in impulse conduction

true

c. depression in neurotransmitter release

true

2. Complete the following concerning neurotoxicology:

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a. Describe the Mellanby effect with respect to ETOH. The severity of intoxication is greater when blood alcohol level is_____.

rising

b. What is the effect of a blood alcohol level of

     i. 25 mg/dL?

mild intoxication, impaired cognition

     ii. 100 mg/dL?

vestibular/cerebellar dysfunction

     iii. 500 mg/dL?

usually fatal—respiratory depression

3. Legal intoxication is a blood alcohol level of _____ mg/dL.

100 (80)

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4. As ETOH levels fall, hyperactivity may occur as compensation for the _____ effects of ETOH.

CNS depressant

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5. True or False. Regarding delirium tremens:

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a. occurs within 4 days of ETOH withdrawal

true

b. agitation, confusion, autonomic instability

true

c. mortality 5 to 10% if untreated

true

d. benzodiazepine as first-line drug

true

6. True or False. Delirium tremens can be suppressed by

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a. benzodiazepines

true

b. resumption of drinking

true

c. beta-adrenergic antagonists

true

d. A2 agonists

true

7. What is the treatment for alcohol withdrawal syndrome?

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a. Mainstay of treatment are the_____.

benzodiazepines

b. They reduce a_____ h_____

autonomic hyperactivity

c. and may prevent s_____

seizures

d. and/or_____ _____.

delirium tremens

e.

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     i. Also use_____

100mg/day

     ii. for _____days

3 to 5

f.

     i. and_____ for seizures.

Dilantin

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     ii. Load with _____mg/kg.

18

8. True or False. Delirium tremens usually begins within _____ days of the onset of ETOH withdrawal.

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a. 4

true

b. 5

false

c. 6

false

d. 7

false

9. Complete the following about ethanol:

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a. True of False. The classic triad of Wernicke encephalopathy is

     i. encephalopathy, ophthalmoplegia, and ataxia

true

     ii. apraxia, ophthalmoplegia, and encephalopathy

false

     iii. ophthalmoplegia, ataxia, and myelopathy

false

b. Eye signs occur in _____%.

96%

c. Gait disturbance occurs in _____%.

87%

d. Memory disturbance is called_____ _____ and occurs in _____%.

Korsakoff syndrome; 80%

10. True or False. Wernicke encephalopathy is associated with

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a. thiamine deficiency

true

b. vitamin B₁₂ deficiency

false

c. folic acid deficiency

false

d. vitamin C deficiency

false

11. Complete the following about Wernicke encephalopathy (WE):

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a. Is there a unique MRI picture in WE?

yes

b.

     i. There is a _____signal

high

     ii. on_____ Wl

T2

     iii. in the _____ thalamus

medial

     iv. the _____ of the fourth ventricle and

floor

     v. the p _____gray

periaqueductal

     vi. of the_____.

midbrain

c. What changes occur in the mammillary bodies?

atrophy

12. Complete the following about Wernicke encephalopathy (WE):

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a. What common treatment can precipitate acute WE?

IV glucose

b. What should be given first: IV glucose or thiamine?

thiamine

c. WE eye signs improve within_____.

days

d. However residue of

     i. K _____s_____

Korsakoff syndrome

     ii. occurs in _____% in the form of

80%

     iii. h_____ n_____

horizontal nystagmus

     iv. and a_____.

amnesia

13. True or False. Reversal of opioid toxicity is achieved with

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a. naloxone

true

b. methadone

false

c. Catapres

false

d. Romazicon

false

14. Heroin, an opioid, causes small pupils called_____.

miosis

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15. Complete the following about amphetamines:

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a. Toxicity is similar to_____.

cocaine

b. Their use can result in CVA due to_____.

vasculitis

16. What are the features of carbon monoxide?

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a. The largest source of poisoning in the United States is from_____.

CO

b. It harms by binding to_____.

Hb

c. It has an affinity for it _____ times that of O₂.

250

d. Cells need _____ mL O₂/100mL blood.

5

e. Blood normally contains _____ mL O₂/100mL.

20

f. The “cherry red” color of blood occurs in only _____%.

6%

17. In severe CO intoxication, CT scan may show

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a. l_____ a_____ in the

low attenuation

b. g_____ p_____.

globus pallidus

18. True or False. Outcome

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a. is more closely correlated with CO Hb levels

false

b. is more closely correlated with hypotension

true

c.

     i. _____% die

40%

     ii. _____% have persistent sequelae

30 to 40%

     iii. _____% make a full recovery

30 to 40%