Smoking Alcohol Substance1. A man with COPD still smokes. What is the NICE NG209 very brief advice sequence?A. Ask, advise, act (offer combined behavioural support and pharmacotherapy)B. Ask only if he brings it up, then stopC. Advise that stopping is pointless after COPD is diagnosedD. Act by starting varenicline in the first trimester of a partner's pregnancy as the couple's planCheck
Smoking Alcohol Substance2. When is varenicline typically started relative to the quit date (BNF/NICE)? The most appropriate action is: Start before the quit date (usually 1–2 weeks) while still smoking, then quitTRUE. TrueFALSE. FalseCheck
Smoking Alcohol Substance3. UK guidance on nicotine e-cigarettes for smokers who will not use other licensed treatments. What is a fair statement? The most appropriate action is: They can be used as a harm-reduction option with a plan to stop smoking tobacco; they are not risk-freeTRUE. TrueFALSE. FalseCheck
Smoking Alcohol Substance4. What is AUDIT-C used for in general practice?A. Diagnosing Wernicke encephalopathyB. Brief screening for hazardous and harmful drinkingC. Replacing CIWA-Ar in delirium tremensD. A mandatory test before any NRTCheck
Smoking Alcohol Substance5. AUDIT-C is above the local cut-off. What is the most appropriate next questionnaire step? Select TWO correct statements.Select all that apply.A. Most appropriate: Complete the full AUDIT to stratify risk/dependenceB. The following is not the most appropriate next step: No further alcohol history is allowedC. Most appropriate: Start disulfiram immediately in receptionD. Most appropriate: Assume the score is always a lab errorCheck
Smoking Alcohol Substance6. Raised GGT in isolation. What is the correct interpretation? The most appropriate action is: Not diagnostic of alcohol dependence on its ownTRUE. TrueFALSE. FalseCheck
Smoking Alcohol Substance7. Which patient is the poorest candidate for community assisted alcohol withdrawal? Select TWO correct statements.Select all that apply.A. Most appropriate: Previous delirium tremens and seizures, living alone, no supervisionB. The following is not the most appropriate next step: Mild dependence, good support, daily monitoring available, no seizure historyC. Most appropriate: Willing, lower SADQ, no Wernicke featuresD. Most appropriate: Stable housing and a reducing chlordiazepoxide plan with follow-upCheck
Smoking Alcohol Substance8. Confusion, ataxia, and ophthalmoplegia in a dependent drinker. What is the most appropriate action?A. Emergency admission for suspected Wernicke encephalopathy and parenteral thiamine (Pabrinex)B. Oral thiamine only and review in 6 weeksC. Community chlordiazepoxide as the only treatmentD. Reassure as 'just drunk'Check
Smoking Alcohol Substance9. In hospital teaching, why is thiamine given to at-risk drinkers around glucose administration?A. Thiamine treats hypoglycaemia better than glucoseB. Glucose can precipitate Wernicke in thiamine-deficient patientsC. Thiamine reverses opioid comaD. Thiamine is an alternative to chlordiazepoxide for seizuresCheck
Smoking Alcohol Substance10. Dependent drinker in the community, not currently Wernicke. What B vitamin plan is typical?A. No thiamine unless jaundicedB. Folic acid instead of thiamine alwaysC. Oral thiamine (BNF doses) and consider parenteral if malnourished/attending EDD. Vitamin D as the Wernicke treatmentCheck