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Bulbar-Onset MND — RACP Adult Medicine MCQ

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HardNeurologyBulbar-Onset MNDRACP Adult Medicine

A man with alcohol dependence is 48 hours from his last drink. Despite repeated oral diazepam he is agitated, disoriented, diaphoretic and hallucinating, with pulse 132/min and temperature 38.1°C. What is the immediate management priority?

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Reveal the answer and explanation

Correct answer: E — Escalate monitored benzodiazepines and administer parenteral thiamine

Explanation lettering: E = shown as C · C = shown as E

C is correct. This is severe alcohol withdrawal with delirium: monitored benzodiazepine escalation and parenteral thiamine are priorities. D may be an adjunct for dangerous agitation but does not treat withdrawal physiology. E risks precipitating Wernicke injury and withholds treatment. A controls adrenergic signs without preventing seizures. B is unsafe during the peak-risk period.

Reference: NSW Health, Clinical guidance for withdrawal from alcohol and other drugs: https://www.health.nsw.gov.au/aod/professionals/Publications/managing-withdrawal.pdf