CHIR20001 Practical Assessment

Steven Chang s0288064

Pathophysiology:

Alcoholism is a chronic condition and is a risk factor for many chronic diseases.4
Alcohol addiction is a multifactorial issue where personality structure, individual state
of mind and social influences are in constant interaction with brain neurobiology and
pathophysiology.3 It is associated with factors like environmental influences and peer
interaction, genetic factor, the level of cognitive functioning, and certain existing
personality disorders.2
It is among the most common psychiatric disorders in the general population, and even
though the incidence of alcoholism is still more common in men, but it has been
increasing in women.2 And excessive alcohol use is responsible for more
than 95,000 deaths in the United States each year.1

Working Diagnosis:

For patients who diagnosed with Wernicke’s encephalopathy, they might have
shown acute altered mental status, ophthalmoplegia with 3rd and 6th nerve palsy,
impaired coordination such as truncal ataxic gait abnormalities, delirium, and
hypotension. As the result, physical examination may include a complete neurological
exam with cerebellar testing.

Differential Diagnosis:

Twenty-five chronic disease and condition codes in the international Classification of

Disease (iCD)-10 are entirely attributable to alcohol.5 Alcohol also plays a risk factor
in certain cancers, other tumours, neuropsychiatric conditions, and numerous
cardiovascular and digestive diseases.5 Furthermore, alcohol has both beneficial and
detrimental impacts on diabetes, ischemic stroke, and ischemic heart disease.5

Differential Diagnosis include:

• Amnestic-confabulatory syndrome
• peripheral neuropathy
• cerebellar degeneration
• Wernicke-Korsakorff syndrome,
• Delirium tremens
• Hallucinations
• Tremulousness.

Prognosis:

• Cirrhosis
• Oral cancer
• Esophageal, liver and breast cancer
• Cardiovascular disease such as Hemorrhagic stroke or heart attack
• Koraskoff’s syndrome

1
CHIR20001 Practical Assessment
Steven Chang s0288064

• Wernicke’s encephalopathy (WE)

Neurological Assessment (Neurologic exam with Cerebellar Examination)

Step 1- Wash your hands.

Step 2- Introduce yourself and confirm patient’ detail. Explain the examination.

Step 3- Explain the examination

Step 4- Assess Speech

(https://news.ucsc.edu/2019/03/speech-therapy-game.html)

2
CHIR20001 Practical Assessment
Steven Chang s0288064

Step 5- Assess for Nystagmus

(https://www.flintrehab.com/dizziness-after-head-injury/)

Step 6- Inspect Patient’s Posture (Sitting down Position)

(https://geekymedics.com/cerebellar-examination-osce-guide/)

3
CHIR20001 Practical Assessment
Steven Chang s0288064

Step 7- Finger-To-Nose Test (Intention tremor)

(https://neupsykey.com/gait-coordination-and-abnormal-movements//)

Step 8- Assess for Rebound Phenomenon

(https://www.youtube.com/watch?v=mawBzDjbzfo)

4
CHIR20001 Practical Assessment
Steven Chang s0288064

Step 9- Dysdiadochokinesia

(https://geekymedics.com/cerebellar-examination-osce-guide/)

Step 10- Knee Reflex

(https://www.huffpost.com/entry/your-doctors-kneejerk-ref_b_5695290)

5
CHIR20001 Practical Assessment
Steven Chang s0288064

Step 11- Gait Assessment

(https://masnad.com.au/treatment-options/gait-analysis/)

Step 12- Assess Tone

(https://www.youtube.com/watch?v=AuNgCHgfDag)

6
CHIR20001 Practical Assessment
Steven Chang s0288064

Reference

1. Fama R, Le Berre AP, Hardcastle C, Sassoon SA, Pfefferbaum A, Sullivan

EV, et al. Neurological, nutritional and alcohol consumption factors underlie
cognitive and motor deficits in chronic alcoholism. Addict Biol.
2019;24(2):290-302.

2. Mary-Anne Enoch DG. Problem Drinking and Alcoholism: Diagnosis and

Treatment. National Institute on Alcohol Abuse and Alcoholism.
2002;1(65):411-49.

3. Nehring SM, Freeman AM. Alcohol Use Disorder. [Updated 2020 Nov 18].
In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021
Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK436003/

4. Shield KD, Parry C, Rehm J. Chronic diseases and conditions related to

alcohol use. Alcohol Res. 2013;35(2):155-73.

5. Shield KD, Parry C, Rehm J. Chronic diseases and conditions related to

alcohol use. Alcohol Res. 2013;35(2):155-71.