Alcohol use disorder

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Alcohol use disorder

Psychological disorders

Psychological disorders

Psychological disorders


Alcohol use disorder


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USMLE® Step 1 questions

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High Yield Notes

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Alcohol use disorder

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USMLE® Step 1 style questions USMLE

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A 40-year-old man is brought to the emergency department following a head-on motor vehicle collision. Trauma workup demonstrates a fracture of the right femur and tibia for which the patient is admitted and scheduled for surgical repair the next day. Twelve hours after admission, the patient becomes agitated, hypervigilant, and paranoid. He repeatedly tells the nurse that he hears voices calling out his name and someone is planning to kill him. He frequently attempts to remove his morphine PCA pump. Past medical history is significant for alcohol use disorder, opioid use disorder, and moderate marijuana use. Temperature is 37.5°C (99.5°F), a pulse is 88/min, respirations are 17/min, and blood pressure is 135/87 mmHg. Physical examination shows an alert and oriented male with tremulousness and diaphoresis. Which of the following is the most likely etiology of this patient’s condition?  

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alcoholism p. 595, 726

Alcoholism p. 595

anemia p. 428

in anemia taxonomy p. 425

cardiomyopathy p. 317

cataracts and p. 554

cirrhosis and p. 398

common organisms affecting p. 176

esophageal cancer p. 387

ethanol metabolism and p. 70

folate deficiency p. 428

gastritis in p. 388

hepatitis p. 376

hypertension and p. 306

ketone bodies in p. 88

Klebsiella in p. 143

Korsakoff syndrome p. 581

liver serum markers in p. 399

lung abscesses and p. 710

magnesium levels in p. 336

Mallory-Weiss syndrome in p. 386

osteonecrosis in p. 473

osteoporosis and p. 472

pancreatitis p. 250, 406

porphyria p. 432

sideroblastic anemia p. 427

subdural hematomas p. 532

treatment p. 726

vitamin B1 deficiency p. 64

vitamin BNaN deficiency p. 66

wet beriberi p. 714

Alcohol-related disorders

readmissions with p. 277

Aspiration pneumonia

alcoholics p. 176

Bacteroides spp.

alcoholism p. 176


alcoholism p. 726

alcoholism treatment p. 595

Fusobacterium spp.

alcoholism p. 176


alcoholism p. 595

Klebsiella spp. p. 143

alcoholism p. 176


alcoholism p. 595, 726

Pancreatitis p. 406

alcoholism p. 595

Peptostreptococcus spp.

alcoholism p. 176

Peripheral neuropathy

alcoholism p. 595

Testicular atrophy

alcoholism p. 595


Alcohol is one of the most widely used psychoactive substances in the world, and has been a part of different cultures for hundreds of years.

Drinking alcohol can have serious harmful consequences, it’s been linked to various cancers, gastrointestinal diseases, and metabolic problems.

Over time, regular use of alcohol can lead to alcohol dependence and bouts of withdrawal, and this can take a serious physical and emotional toll on a person’s life.

Alcoholic drinks contain the chemical ethanol, which is a tiny molecule that reduces the activity of various inhibitory and excitatory neurotransmitter pathways in the brain.

Inhibitory neurotransmitters make neurons in the central nervous system less likely to fire an action potential, and the brain’s major inhibitory neurotransmitter—gamma-aminobutyric acid or GABA—acts as an “off” switch and restricts brain activity.

Ethanol is a GABA agonist, so when it binds to GABA receptors it makes that inhibitory signal even stronger.

Ethanol also activates opioid receptors and induces the release of endogenous morphine—known as endorphins.

The opioids then bind to receptors on dopaminergic neurons in the nucleus accumbens, which trigger the release of dopamine and serotonin in that part of the brain.

Ethanol also acts as a glutamate antagonist.

In other words, ethanol blocks glutamate, which is an excitatory neurotransmitter, from binding to glutamate receptors, making it less likely that those neurons will fire.

The combined effect that ethanol has on these neurotransmitters varies by the location in the brain.

For example, in the nucleus accumbens and the amygdala, which are the reward centers of the brain, ethanol produces pleasant or rewarding feelings like euphoria.

This is important because if a person believes that drinking leads to euphoria, they are more likely to drink again.

In the cerebral cortex, the thought-processing center of the brain, ethanol slows everything down, making it difficult to think and speak clearly.


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