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Alcohol withdrawal — MCCQE Part 1 MCQ

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EasySubstance UseAlcohol withdrawalMCCQE Part 1

48-year-old man presents with tremor and agitation 18 hours after last drink. He is tachycardic, hypertensive and diaphoretic. Which of the following is the most appropriate next step?

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Correct answer: A — Treat with symptom-triggered benzodiazepines and thiamine before glucose

Treat with symptom-triggered benzodiazepines and thiamine before glucose is best because autonomic hyperactivity after cessation indicates alcohol withdrawal. Provide reassurance only and arrange no follow-up is suboptimal because mental health risk often requires structured follow-up or urgent escalation; Use long-term benzodiazepine monotherapy as default treatment is suboptimal because benzodiazepine monotherapy is rarely an appropriate long-term strategy; Avoid direct risk assessment to preserve rapport is suboptimal because direct assessment of suicide, violence, capacity and substance use is clinically appropriate; Attribute symptoms to personality or culture without assessing illness is suboptimal because diagnostic overshadowing risks missing treatable mental illness. Thiamine prevents Wernicke encephalopathy.

Reference: Canadian guideline for high-risk drinking/AUD