Wernicke's Encephalopathy — MRCPsych Paper B MCQ
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Correct answer: B — Wernicke's encephalopathy
The correct answer is B, Wernicke's encephalopathy. Acute confusion, oculomotor abnormalities such as nystagmus or ophthalmoplegia, and ataxia in a person with alcohol dependence are the characteristic features. It is a medical emergency requiring immediate hospital treatment with parenteral thiamine; treatment should not await confirmatory investigations. Delirium tremens is an alcohol-withdrawal delirium usually accompanied by prominent tremor, autonomic hyperactivity and perceptual disturbance, rather than focal ophthalmoplegia. Korsakoff syndrome is predominantly a chronic amnestic syndrome. Hepatic encephalopathy would require supporting evidence of significant liver dysfunction and does not explain the ocular findings. Alcoholic cerebellar degeneration causes a more chronic gait or truncal ataxia without acute confusion and ophthalmoplegia.
Reference: Department of Health and Social Care, Clinical guidelines for alcohol treatment, Chapter 16: Alcohol care in acute hospitals, sections 16.9.3–16.9.4, updated 17 April 2026. https://www.gov.uk/guidance/clinical-guidelines-for-alcohol-treatment/16-alcohol-care-in-acute-hospitals