AECME online module questions (without answers)

1. Factors that influence the development of alcohol dependence include

A Psychological factors
B Social factors
C Environmental factors
D All of the above
2. What are the clinical symptoms and signs of alcohol dependence?
A tolerance development, withdrawal symptoms, impaired control over drinking
B Repeated alcohol consumption that is related to legal problems or when it is
physically dangerous (i.e. driving a car)
C Alcohol consumption that results in an inability to fulfill home, school, or work
obligations
D Preoccupation with location of alcohol consumption
3. What is considered to be moderate drinking?
A No more than one drink a day for women and two drinks a day for men
B No more than two drinking a day for men and women
C No more than one drink a day for men and two drinks a day for women
D No more than one drink a day for women and three drinks a day for men
4. Which of the following is considered one serving of alcohol?
A 8 oz beer, 4 oz wine, 1 oz 80-proof distilled spirits
B 8 oz beer, 5 oz wine, 1.5 oz 80-proof distilled spirits
C 12 oz beer, 4 oz wine, 1 oz 80-proof distilled spirits
D 12 oz beer, 5 oz wine, 1.5 oz 80-proof distilled spirits
5. What is a good intervention - one that can significantly reduce the amount of
alcohol consumed and the number of binge drinking episodes - for a patient a
physician feels has a developing drinking problem?
A One 30-minute session immediately following the visit that led to evidence of a
problem
B Two 20-minute sessions with a physician two months apart
C Two 15-minute sessions with a physician one month apart
D. An immediate referral to Alcoholic Anonymous
6. What is the most likely group to binge drink (consume 5 or more drinks on the
same occasion)?
A. Those 18-25
B Those 25-40
C Those 40-65
D Those 65 and over
7. At what blood alcohol level can death occur?
A 250mgm % (.25%)
B 300mgm% (.30%)
C 400mgm% (.40%)
D 550mgm% (.55%)

8. What physical clues help in diagnosing alcoholism?

A Nausea
B Irritability
C Impotence
D All of the above
9. Light to moderate drinking
A Is not common in many cultures
B Increases the risk of developing cardiovascular disease
C May reduce "all-cause" mortality
D Has an effect mediated by LDL cholesterol
10. What three highly recognizable behaviors do professionals focus on when
making a diagnosis of alcoholism?
A Distortions in thinking, impaired control over drinking, withdrawal symptoms
B Presence of tolerance, preoccupation with obtaining or consuming alcohol,
thoughts of denial
C Impaired control over drinking, preoccupations with obtaining or consuming
alcohol, continued use of alcohol despite adverse consequences
D Withdrawal symptoms, presence of tolerance, thoughts of denial
1. How does chronic alcohol intake affect sleeping?
A Induces sleep disorders
B Decreases daytime fatigue and sleepiness
C Aids with the second half of the sleep period
D Cures insomnia
2. What is the most common rhythm disorder associated with alcohol use?
A Atrial fibrillation
B Holiday heart syndrome
C Nonischemic cardiomyopathy
D Supraventricular tachyarrhythmias
3. What percent carbohydrate deficient transferrin indicated hazardous drinking, i.e.
more than 40 grams of alcohol per day?
A 1.2%
B 2.6%
C 4.1%
D 5.7%
4. What tests are useful for assessing less recent alcohol use?
A Liver function and red blood cell index tests
B Percent carbohydrate deficient transferrin and hemoglobin or whole blood
acetaldehyde adducts tests C MAST and CAGE tests
D Aspartate aminotransferase and alanine aminotransferase tests
5. Appropriate animal models for alcoholism meet all these criteria, except:
A Self administration of alcohol

B Chronic consumption leading to tolerance and dependence

C Symptoms of Wernicke-Korsakoff syndrome
D Relapse
6. Alcohol is broken down in the body first to _________ and then to _________
A Acetylcholine and then to acetate
B Acetaldehyde and then to acetate
C Acetate and then to acetaldehyde
D Aldehyde and then to acetone
7. Which of the following are associated with aggression, impulsivity, isolation, and
impaired social interaction?
A High tryptophan
B Low 2-HT
C Low AVC
D Low serotonin
8. Alcohol effects which of the following neurotransmitters/receptors?
A GABA
B NMDA
C Serotonin, opioid, GABA, NMDA, dopamine and cholinergic
D Dopamine
9. What percent of alcoholics carry another psychiatric disorder at some point
during their drug dependence?
A 40%
B 20%
C 16%
D 60%
10. What condition is found almost universally across heavy drinkers?
A Fatty liver
B Cirrhosis
C Alcoholic hepatitis
D Liver cancer
1. Which of the following is least likely to increase the risk of alcoholism?
A A history of alcoholism in the person's biologic father.
B A history of alcoholism in the person's stepfather.
C A history of alcoholism in the person's brother.
D Ability to drink large quantities of alcohol without feeling drunk
E Consumption of 4 drinks/day or more.
2. All of the following are true EXCEPT:
A Alcohol dependence is a physical disease and is caused and sustained by a
combination of biological, psychological, and sociological factors.
B Alcoholics tend to follow a predictable pattern of behavior as they become
alcoholics.
C The overwhelming majority of social users do not become alcoholics
D Alcohol abuse is a habit under considerable volitional control

E A diagnosis of Alcohol dependence is based on having three or more of the DSM-IV

criteria in a one-year period.
3. Ethanol is a small molecule that is soluble in water and lipids, enabling it to pass
easily through cell membranes. All of the following are true except:
A It distributes throughout tissues and cells in proportion to their respective water
content
B Vascular organs can equilibrate quickly with arterial blood and have an increased
rate of alcohol distribution.
C The brain achieves a higher ethanol concentration, more rapidly than other
organs.
D It does not pass through the blood-brain barrier
4. The rate of metabolism of ethanol by the body
A Rises until the dehydrogenase system is saturated and then remains constant
B Is constant until the threshold for the dehydrogenase system is reached and
thereafter rises with increasing blood levels.
C Rises steadily with increasing blood concentrations
D Decreases with increasing blood concentrations
E Is constant at all blood concentrations
5. Ethanol absorption is highest in the
A Mouth
B Stomach
C Jejunum
D Ileum
E Cecum
6. With chronic ethanol ingestion, the most sensitive and first test (among liver
enzymes) to change is like to be
A Alanine aminotransferase (ALT)
B Gamma glutamyltransferase (GGT)
C Lactate Dehydrogenate (LDH)
D Asparte aminotransferase (AST)
E Alkaline phosphatase (AST)
7. Choose the best answer: For a given amount of ingested alcohol, women:
A Achieve higher blood alcohol levels
B Have a smaller body size and higher fat content
C Have smaller volume of distribution for alcohol
D Have less gastric-ADH.
E Experience a delay in gastric emptying during the luteal phase of the menstrual
cycle.
F All of the above
8. All of the following are true EXCEPT:

A Shakespeare referred to the sexual consequences in Macbeth, Act2, Scene 2: "It

provokes and unprovokes; it provokes the desire, but it takes away from the
performance.
B At BAL levels over 100 mg/dL, alcohol pharmacologically enhances sexual arousal
C At BAL levels over 100 mg/dL, erection and ejaculatory competence are inhibited
or eliminated.
D Before prescribing Viagra for impotence, a thorough history of alcohol and drug
use should be taken.
E After drinking a moderate amount of alcohol, women have a decreasing
physiological sexual response with increasing alcohol consumption
9. A standard drink is generally defined as:
A 8 ounces of beer, 4 ounces of wine, and 1 ounce of 80-proof distilled spirits
B 8 ounces of beer, 4 ounces of wine, and 1.5 ounces of 80-proof distilled spirits
C 12 ounces of beer, 4 ounces of wine, and 1 ounce of 80-proof distilled spirits
D 12 ounces of beer, 5 ounces of wine, and 1.5 ounces of 80-proof distilled spirits
10. Choose the best answer for Blood Alcohol Level (BAL):
A Is expressed as the percentage of alcohol in deciliters of blood in the field of
traffic safety
B A 160-pound man will have a BAL of approximately 0.04 percent 1 hour after
consuming two 12-ounce beers or two other standard drinks on an empty stomach
C Of .05 percent or more may cause consistent impairment in eye movements.
D Eating before drinking has a significant effect on BAC by slowing absorption.
E All of the above
11. Moderate drinking is defined by the Dietary Guidelines for Americans as:
A No more than two drinks a day for women
B No more than three drinks a day for men
C One drink a day for men and women
D No more than one drink a day for women and two drinks a day for men.
E None of the above
12. Traffic-related fatalities
A Result in the death of approximately 140,000 lives per year, three-fourths of
which are alcohol related. B Cost the public about $100 million per year.
C Have shown that intoxicated driving does not increase the risk of a fatal crash.
D Involving alcohol account for 38% of all driving fatalities.
13. All of the following are true EXCEPT:
A Light to moderate alcohol intake from beer, wine or spirits is associated with a
reduction in all-cause mortality.
B Light to moderate alcohol ingestion reduces all cause mortality primarily due to its
ability to decrease cardiovascular diseases, most especially coronary artery disease
C Just as small amounts of alcohol have protective effects on coronary vascular
disease and total mortality, it also has a positive effect on hemorrhagic stroke.
D The effect of alcohol on ischemic stroke is represented by a 'J' curve
14. Which factor is not a protective factor for beginning substance abuse?

A Strong family bonds

B High IQ test scores
C Good academic grades
D Participation in extracurricular school activities E Routinely eating dinner together
as a family
15. Cardiovascular complications of alcoholism include all of the following EXCEPT
A Cardiomegaly
B Atrial arrhythmias
C Hypertension
D Coronary artery disease
E Ventricular arrhythmias
16. In minor withdrawal from alcohol the earliest symptom would most likely be
A Tremor of hands
B Diarrhea
C Convulsions
D Hallucinations
E Fever 102
F p.o.
17. All of the following are typical findings in acute alcoholic myopathy, EXCEPT
A Weakness
B Fever
Proximal muscle involvement Elevated serum creatine kinase
Asymmetric swelling
18. Wernicke's encephalopathy is an acute, life threatening condition which may
cause death from brainstem hemorrhages. It requires emergency treatment with
A Clorpromazine (Thorazine)
B Magnesium Sulfate
C Diazepam (Valium)
D Phenytoin (Dilantin)
E Thiamine (Vitamin B-1)
19. Scientific evidence has shown (select the single best answer):
A An inverse association between moderate levels of alcohol consumption and
cardiovascular mortality
B The decrease in CAD mortality may be due to increased plasma levels of HDL
cholesterol
C Excessive alcohol consumption increases cardiovascular risk factors and mortality
D All of the above
20. Alcohol-related birth defects include all of the following EXCEPT
A Microcephaly
B Small palpebral fissures
C Small ears
D Flat nasal bridge
21. Physicians in an office setting can utilize brief intervention:

A After determining whether a patient is a moderate drinker, alcohol abuser, or

alcohol dependent
B To provide advice on alcohol intake and also treatment options tailored to the
patient's learning style, motivational level, and the services available
C Most effectively when the physician has an established cooperative alliance with
the patient
D According to WHO and several academic studies, brief intervention is an effective
tool in reducing high risk drinking
E All of the above
22. Certain questions are useful in screening to determine presence of ethanol
dependence. One set of questions known as the 'CAGE' questionnaire. This acronym
stands for
A Chloral hydrate (noctec), alcohol, glutethimide (doriden), ethclorvynol (Placidyl)
B Cut down, annoyed, guilty, eye-opener
C Confusion, agitation, S3 gallop, edema
D Un-Controllable urge to drink, un-Able to limit intake, un-Grateful for help to stop
drinking, un- Excited about treatment
23. All of these statements about Alcoholics Anonymous are generally true EXCEPT
A There are no dues
B Anyone can become a member
C No one can contribute more than $300 per year
D Current research has shown this approach to be ineffective
E Members help each other
24. The 'rule of thumb' in referring substance-abusing patients is:
A Initiate treatment utilizing the least restrictive environment possible.
B Always place patients in a detox unit
C Inpatient treatment is the best choice for all patients with a diagnosis of addiction
D AA is never an option for young adults
E None of the above
25. When educating college students regarding alcohol, it is important to stress:
A For them to call 911 if they suspect someone has alcohol poisoning.
B That coffee or a shower will not help someone with alcohol poisoning
C That a person with alcohol poisoning should be placed on their side to avoid
aspiration
D All of the above
1.What percentage of patients in a primary care setting drink at levels that may
place them at
risk for developing alcohol-related problems.
a. less than 10 percent
b. almost 20 percent
c. close to 40 percent
d. over 50 percent

2. Brief Intervention is generally used with patients

a. who are severely alcohol dependent
b. who are not yet alcohol dependent
c. who dont have time for counseling
d. none of the above
3.Which of the following is not a common element of brief intervention
a. feedback on personal risk
b. responsibility of the patient
c. advice to cut down/quit
d. pharmacotherapy
4. Brief intervention is associated with
a. decreased alcohol consumption
b. decreased health care utilization
c. decreased motor vehicle events
d. all of the above
5. The Stage Model of the Process of Change occurs in the following sequence
a. Precontemplation, Contemplation, Preparation, Action, Maintenance
b. Precontemplation, Preparation, Contemplation, Maintenance, Action
c. Preparation, Precontemplation, Action, Contemplation, Maintenance
d. Maintenance, Precontemplation, Action, Contemplation, Preparation
1. What is the most common co-morbid psychiatric diagnosis in alcoholics?
a. Suicide
b. Depression
c. Anti-social Personality Disorder d. Generalized Anxiety Disorder
2. As many as 80% of alcohol dependent patients complain of depressive
symptoms,
these symptoms include all of the following except
a. reduced appetite
b. decreased energy
c. increased energy
d. insomnia
3. There is a J-shaped relationship between alcohol exposure and near lethal
attempts for
a. frequency of drinking
b. drinking within 3 hours of a suicide attempt
c. alcoholism
d. binge drinking
e. all of the above
4. Depressed alcoholics should always be
a. screened for depression
b. screened for suicide risk
c. referred to a psychiatrist if needed
d. all of the above

e. none of the above

5. The recommended treatment for comorbid depression and alcohol dependence is
to
a. detox the patient and then treat symptoms of Major Depression
b. in-patient care and monitoring
c. treat alcohol dependence, recommend Alcoholics Anonymous attendance (90
meetings in 90 days) along with an adequate trial of both dose and duration of
antidepressant.
d. initiate treatment with an antidepressant and see if symptoms of alcohol
dependence resolve
1. Which of the following statements about alcohol consumption during stages of
pregnancy is NOT true?
a. There are no teratogenic effects of alcohol consumption in the first trimester of
pregnancy.
b. Heavy drinking during the second trimester seems to cause more clinical
features of FAS than at other times during pregnancy.
c. During the third trimester, the hippocampus is greatly affected, which leads to
problems with encoding visual and auditory information (reading and math).
d. Alcohol intake in the third trimester seems to be of far more importance in
relation to pre-term delivery than intake in the second trimester.
2. The diagnosis of Fetal Alcohol Syndrome is based on which criteria?
a. Prenatal Alcohol Exposure (confirmed and unconfirmed)
b. Growth Retardation
c. Facial Characteristics
d. Neurodevelopmental Problems
e. All of the Above
3. Birth Defects related to maternal alcohol abuse include all of the following
EXCEPT:
a. Microcephaly
b. Small Palpebral Fissures
c. Small Ears
d. Flat Nasal Bridge
4. Approximately how many children are born each year with FAS?
a. 500
b. 50
c. 5,000
d. 50,000
5. Which statement best describes the difference between children prenatallyexposed to
alcohol and those diagnosed with ADHD?
a. Children diagnosed with ADHD exhibit impulse control problems, where
prenatally-exposed children do not.

b. Prenatally-exposed children score higher on aptitude test than do those

diagnosed with ADHD.
c. Children with ADHD exhibit difficulty focusing and sustaining attention over time;
In contrast, children who are exposed to alcohol prenatally are able to focus and
maintain, but display difficulty in shifting attention from one task to another.
d. Children with ADHD outgrow their problems while children prenatally exposed to
alcohol do not.
1. All of the following are 12 step programs except
A. Alcoholics Anonymous
B. Overeaters Anonymous
C. Caduceus
D. CHAD
2. The AMA defines an impaired physician as
A. One who is unfit for duty
B. One unable to fulfill professional or personal responsibilities because of
psychiatric illness, alcoholism, or drug dependency
C. One who shows up under-the-influence or with residual effects
D. None of the above
3. What specialties account for the greatest percentages in Florida?s Physician
Resource Recovery Network?
A. Internal Medicine, Orthopedics, Ob/Gyn
B. Psychiatry, Neurology, Surgery
C. Radiology, Orthopedics, Pediatrics
D. Anesthesia, Family Medicine, Emergency Medicine
4. Some of the barriers to treatment for impaired professionals include
A. Denial
B. Self-treatment
C. General distain for anything "psychiatric"
D. All of the above
5. In addition to substance use disorders, all of the following impairments would be
included under the AMA definition of impaired physician, EXCEPT
A. Generalized Anxiety Disorder
B. Depression
C. Blindness
D. All of the above
6. Physicians use tobacco and alcohol
A. Less than age, sex, income-matched controls
B. More than age, sex, income-matched controls
C. About the same as age, sex, income-matched controls
D. At much higher rates than age, sex, income-matched controls
7. Drug use, abuse, overdose, and addiction appears to occur

A. More often among physicians

B. Less often among physicians
C. About the same among physicians as other groups
D. Rarely among medical professionals
8. Which of the following is not as useful for detecting recent drug use
A. Blood
B. Urine
C. Sweat
D. Hair
9. According to Verghese, the measure of the health of our profession is
A. How well we care for our patients
B. How well we care for ourselves
C. How well we care for our patients and ourselves
D. How well we are able to control and conceal substance abuse
10. Which of the following is NOT part of the process that the new JCAHO standards
describe?
A. Providing education about physician health
B. Identifying and acting with swift and severe disciplinary actions against physician
addicts
C. Addressing prevention of physical, psychiatric, or emotional illness
D. Facilitating confidential diagnosis, treatment, and rehabilitation of physicians who
suffer from a potentially impairing condition