Alcohol

Question 1

Which vitamin deficiency leads to peripheral neuropathy (pain, tingling, other limb abnormalities)?

Answer 1

Vitamin B12 (cobalamin)

Question 2

Which vitamin deficiency causes Wernnicke’s?

Answer 2

Vitamin B1 (thiamine)

Question 3

Physical exam of someone with alcohol use disorder and limb weakness (or other neurological sign)

Answer 3

GASTRO

General appearance:

• kempt/unkempt
• restlessness
• level of alertness

Hand examination:

• koilonychia: spoon shaped nails related to chronic iron-deficiency anemia
• clubbing: can be a sign of chronic systemic disease of the heart, lung or liver
• palmar erythema: estrogen excess
• dupuytren’s contracture: cirrhosis

Extend hands:
-asterixis/hepatic flap: metabolic encephalopathy in advanced liver disease

Eyes:

• jaundice
• conjunctival pallor

Mouth:

• angular stomatitis: deficiency in iron and B-vitamins
• red and swollen: B12 deficiency

Chest:

• spider naevi
• loss of hair
• gynaecomastia

Abdomen:

• ascites
• capit medusa
• hepatomegaly
• spenomegaly

NEURO

Eyes:

• test eye movements
• nystagmus and opthalmoplegia

Co-ordination (cerebellar):

• nose-to-finger
• heel-to-shin
• dysdiadokinesia

UL:
-hand power and sensation ‘grip my fingers as hard as you can’ ‘can you feel that?’: peripheral neuropathy

LL:
-stand up with arms crossed: proximal myopathy

GAIT:

• walk normally: look for wide-based, ataxic gait
• heel-toe: balance
• heel walk: foot dorsiflexion weakness
• toe walk: foot plantarflexion weakness