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alcohol use disorder

Practice targeted AMC-style multiple-choice questions on alcohol use disorder.

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A 45-year-old man presents to the emergency department with severe epigastric pain radiating to the back. He has a history of alcohol use disorder and has been drinking heavily over the past week. On examination, he is febrile, tachycardic, and has abdominal tenderness. Laboratory tests reveal elevated serum lipase and amylase levels. What is the most appropriate initial management for this patient?

A. Oral antibiotics
B. Intravenous fluid resuscitation
C. Nasogastric tube insertion
D. Endoscopic retrograde cholangiopancreatography (ERCP)
E. Immediate surgical consultation
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Contrast-enhanced ultrasound of encephaloid hepatocellular carcinoma
Image by R. Badea, Simona Ioanitescu CC BY 3.0 · Source

A 70-year-old male with cirrhosis secondary to alcohol abuse presents with new-onset ascites and a palpable liver mass. His AFP is markedly elevated. A contrast-enhanced ultrasound is performed, as shown. What is the MOST appropriate next diagnostic step?

A. Quadruple-phase CT scan of the abdomen
B. Initiate systemic chemotherapy
C. Repeat ultrasound in 3 months
D. MRI of the abdomen with hepatobiliary contrast
E. Liver biopsy
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CT scan of hepatocellular carcinoma, without and with IV contrast
Image by Zhenyu Pan, Guozi Yang, Tingting Yuan, Lihua Dong, Lihua Dong CC BY 4.0 · Source

A 58-year-old male with cirrhosis secondary to alcohol abuse presents with new-onset ascites and RUQ pain. His AFP is markedly elevated. A CT abdomen with IV contrast is performed, as shown. What is the MOST appropriate next step in confirming the suspected diagnosis?

A. Initiate systemic chemotherapy
B. Referral for liver transplantation evaluation
C. Repeat CT scan in 3 months
D. MRI of the abdomen with hepatobiliary contrast
E. Liver biopsy
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Contrast-enhanced ultrasound of encephaloid hepatocellular carcinoma
Image by R. Badea, Simona Ioanitescu CC BY 3.0 · Source

A 58-year-old male with cirrhosis secondary to alcohol abuse presents for routine surveillance. His AFP is 25 ng/mL. A contrast-enhanced ultrasound is performed, as shown. What is the MOST appropriate next step in management?

A. MRI of the abdomen with contrast
B. Repeat AFP in 3 months
C. CT of the abdomen with contrast
D. Liver biopsy
E. Initiate sorafenib
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Contrast-enhanced ultrasound of encephaloid hepatocellular carcinoma
Image by R. Badea, Simona Ioanitescu CC BY 3.0 · Source

A 62-year-old male with cirrhosis secondary to alcohol abuse presents with new-onset ascites and a palpable liver mass. His AFP is 600 ng/mL. A contrast-enhanced ultrasound is performed. What is the MOST appropriate next step in confirming the diagnosis and guiding management?

A. Repeat AFP in 3 months
B. Initiate sorafenib therapy
C. Liver biopsy
D. Administer systemic chemotherapy
E. Perform a diagnostic paracentesis
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Contrast-enhanced ultrasound of encephaloid hepatocellular carcinoma
Image by R. Badea, Simona Ioanitescu CC BY 3.0 · Source

A 65-year-old male with known alcoholic cirrhosis undergoes surveillance. The provided contrast-enhanced ultrasound was obtained. What is the MOST appropriate next step?

A. Repeat ultrasound in 3 months
B. Liver biopsy
C. Initiate sorafenib
D. Ablation therapy
E. Triphasic CT or MRI
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A 43-year-old is unconscious with low blood glucose (1.8 mmol/L), has a history of insulin use and alcohol intake. What is the next step?

A. 16G IV + 10% glucose, 150-200 ml over 15 minutes.
B. Give oral glucose.
C. Give 1 mg of glucagon intramuscularly.
D. Give IV 50% glucose.
E. Give subcutaneous insulin.
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A 45-year-old Aboriginal man from a remote community presents to the clinic for a routine health check. He has a history of smoking (20 pack-years) and reports drinking alcohol occasionally (3-4 standard drinks per week). He denies any chronic medical conditions. His blood pressure is 145/95 mmHg. BMI is 32 kg/m2. Fasting blood glucose is 6.5 mmol/L. Which of the following is the MOST appropriate initial management strategy, considering the principles of culturally safe care?

A. Prescribe an antihypertensive medication (e.g., ACE inhibitor) and metformin to address the elevated blood pressure and glucose levels immediately.
B. Initiate lifestyle modification counseling, including smoking cessation, dietary advice, and encourage increased physical activity, while also arranging a follow-up appointment to reassess blood pressure and glucose levels.
C. Provide him with written information about hypertension and diabetes and instruct him to follow up with the clinic if he develops any symptoms.
D. Refer him to a specialist physician for further evaluation and management of his hypertension and pre-diabetes.
E. Advise him to reduce his alcohol consumption and schedule a follow-up appointment in six months to monitor his blood pressure and glucose levels.
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CT scan of hepatocellular carcinoma, without and with IV contrast
Image by Zhenyu Pan, Guozi Yang, Tingting Yuan, Lihua Dong, Lihua Dong CC BY 4.0 · Source

A 68-year-old man with known alcoholic cirrhosis presents for routine surveillance. He reports mild fatigue. Liver function tests are within his baseline (Child-Pugh A). Alpha-fetoprotein is 150 ng/mL. The provided images are obtained. Considering the clinical context and the findings demonstrated in the images, which of the following treatment modalities is most likely to be considered first for this patient?

A. Transarterial chemoembolisation (TACE)
B. Surgical resection
C. Palliative care
D. Systemic targeted therapy (e.g., Sorafenib)
E. Liver transplantation assessment
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A 58-year-old man presents to the emergency department with severe epigastric pain radiating to the back, which started suddenly 6 hours ago. He has a history of alcohol use disorder and has been consuming large amounts of alcohol daily for the past 10 years. On examination, he is diaphoretic and in distress, with a blood pressure of 100/60 mmHg, heart rate of 120 bpm, and respiratory rate of 22 breaths per minute. Abdominal examination reveals tenderness in the epigastric region with guarding. Laboratory tests show elevated serum amylase and lipase levels. Which of the following is the most appropriate initial management step?

A. Intravenous fluid resuscitation
B. Immediate surgical consultation
C. Administration of proton pump inhibitors
D. Initiation of broad-spectrum antibiotics
E. Nasogastric tube insertion
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A 45-year-old man presents to the emergency department with severe epigastric pain radiating to his back, which started suddenly a few hours ago. He has a history of alcohol use disorder and has been drinking heavily over the past week. On examination, he is diaphoretic and in distress. His vital signs show a blood pressure of 100/60 mmHg, heart rate of 110 bpm, respiratory rate of 22 breaths per minute, and temperature of 37.8°C. Laboratory tests reveal elevated serum lipase and amylase levels. An abdominal ultrasound shows no gallstones. Which of the following is the most appropriate initial management step for this patient?

A. Nasogastric tube insertion
B. Intravenous fluid resuscitation
C. Initiation of broad-spectrum antibiotics
D. Immediate surgical consultation
E. Oral rehydration therapy
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