Emergency and critical care: alcohol withdrawal delirium: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Emergency and critical care: alcohol withdrawal delirium

Sample item

A chronic heavy drinker is admitted after a fall. Three days after his last drink he becomes agitated, disoriented, has coarse tremor, sweating, tachycardia and vivid visual hallucinations. What is the diagnosis and first-line drug?

AAlcoholic hallucinosis treated with phenytoinBWernicke encephalopathy treated with haloperidolCDelirium tremens treated with a benzodiazepineDHepatic encephalopathy treated with lactulose alone

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Delirium tremens treated with a benzodiazepine

Delirium tremens appears 48 to 96 hours after the last drink, with autonomic hyperactivity, tremor and hallucinations. Benzodiazepines are first line, with thiamine given before glucose.

Option by option

A. Alcoholic hallucinosis treated with phenytoin
Alcoholic hallucinosis occurs with clear consciousness and no autonomic storm.
B. Wernicke encephalopathy treated with haloperidol
Wernicke encephalopathy features ophthalmoplegia and ataxia, and antipsychotics lower the seizure threshold.
C. Delirium tremens treated with a benzodiazepine (correct)
Correct. Benzodiazepines treat withdrawal and prevent seizures.
D. Hepatic encephalopathy treated with lactulose alone
Hepatic encephalopathy does not explain the autonomic storm after abstinence.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Delirium tremens treated with a benzodiazepine. Delirium tremens appears 48 to 96 hours after the last drink, with autonomic hyperactivity, tremor and hallucinations.

Why is "Alcoholic hallucinosis treated with phenytoin" not the answer?

Alcoholic hallucinosis occurs with clear consciousness and no autonomic storm.

Why is "Wernicke encephalopathy treated with haloperidol" not the answer?

Wernicke encephalopathy features ophthalmoplegia and ataxia, and antipsychotics lower the seizure threshold.

Why is "Hepatic encephalopathy treated with lactulose alone" not the answer?

Hepatic encephalopathy does not explain the autonomic storm after abstinence.

What concept does this question test?

It tests Emergency and critical care: alcohol withdrawal delirium in General Medicine. Benzodiazepines are first line, with thiamine given before glucose.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Emergency and critical care: alcohol withdrawal delirium?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.