Case #3 Questions:

  1. What differential diagnoses are you contemplating at this point in the examination? What clues do you identify in this scenario? Answer
  2. Describe what additional details in the history you might want to know to determine if alcohol withdrawal is a major concern in this patient? Describe how you might ask the questions; be selective, she's already irritated. Answer
  3. What medical complications might you anticipate? What are the potential medical complications of Alcohol Withdrawal Syndrome?  Answer
  4. What are the potential medical complications of alcoholism on the:
  1. gastrointestinal system
  2. hematopoietic system
  3. cardiovascular system

Answer

  1. What do you recommend to her physician planning to discharge her in the morning? What is the appropriate treatment for uncomplicated alcohol withdrawal syndrome?  Answer
  2. Describe your treatment plan for delirium tremens.  Answer

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Three months later, you notice she has made an appointment to see you in the office. You are nervous about addressing the issue of alcohol dependence with this colleague who frequently refers patients to you. You decide it's time to better understand treatment options for alcoholism. You discuss this concern with a substance abuse expert who recommends you attend an open AA meeting.

You find out that there actually are AA meetings held at your hospital every Wednesday evening, so you decide to attend the following week. You learn a lot about AA from attending the AA meeting. The AA speaker discussed the role alcohol has had in his life and described his life in recovery. He mentions several times how he interacted with physicians who were oblivious to his drinking problem.

On your visit with Dr. Tried, she admits to still drinking "a few" Gin & Tonics at night, but can't seem to quit. She wonders if she had a stroke perioperatively because she's experienced problems with recent memory. She's distraught that at times she forgets appointments and loses things.

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Questions for Discussion:

  1. Discuss how you would address the issue of treatment options for alcoholism. What would you recommend? Be specific. Answer
  2. What are the 12 suggested steps of AA?  Answer

  3. What is the differential diagnosis of her memory loss? Are there available treatment options for any of these?  Answer

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