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NBME 20 Answers

nbme20/Block 4/Question#6

A 51-year-old man develops diaphoresis, ...

Alcohol withdrawal

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submitted by neonem(319),

Alcohol withdrawal leads to a sympathetic-hyperactivity-like syndrome with tremors, HTN, insomnia, GI upset, diaphoresis, and mild agitation 3-36 hours after the last drink. There is a similar, but usually slightly later, overlap of withdrawal seizures 6-48 hours after the last drink.

katsu  Alcohol withdrawal sx (p. 554 FA 2018) Time from last drink: 3–36 hr: tremors, insomnia, GI upset, diaphoresis, mild agitation 6–48 hr: withdrawal seizures 12–48 hr: alcoholic hallucinosis (usually visual) 48–96 hr: delirium tremens (DTs) Treatment: benzodiazepine +  

For those curious why it's not D, the way I reasoned it out was that 1. they were referring to opioids, so 2. withdrawal would be

Diarrhea (opposite of constipation that they feel) + nausea Mydriasis (opposite of the miosis) Piloerection Seizures are rare, and they're more associated with alcohol (and also benzos) You may get mild hypertension