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The Prediction of Alcohol Withdrawl Severity Scale (PAWSS): Systematic literature review and pilot study of a new scale for the prediction of complicated alcohol withdrawal syndrome by Jose R. Moldanado, et. al., Journal of Alcohol, Volume 48, 2014 (pages 375-390)
[Answer 11 of 15 questions correctly to receive
3 hours of Continuing Education credit.]
1. Hospital physicians quickly identify most patients who have Alcohol Use Disorder (AUD).
a. True
b. False

2. Most patients with AUD experience only uncomplicated (mild) withdrawal symptoms that do not require medical intervention and that usually disappear within 2-7 days of the last drink.
a. True
b. False

3. The incidence of Alcohol Withdrawal Syndrome (AWS), among alcohol-dependent subjects admitted to a general medical hospital severe enough to require pharmacological treatment, is between
a. 5 and 20%.
b. 10 and 20%
c. 20 and 30%
d. 30 and 40%.

4. Which is TRUE regarding Alcohol Withdrawal Syndrome (AWS)?
a. It can cause human neuronal damage 24 hours after it starts.
b. It can lead to brain damage.
c. Each episode of withdrawal worsens the severity and consequences of the next one, leading to a vicious cycle.
d. All of the above.

5. The purpose for the authors developing the Prediction of Alcohol Withdrawal Severity Scale (PAWSS) was to identify patients at risk for complicated alcohol withdrawal so they might benefit from pharmacological intervention, preventing further morbidity and mortality.
a. True
b. False

6. Which is NOT one of the ten questions on the Prediction of Alcohol Withdrawal Severity Scale (PAWSS)?
a. Have you consumed any amount of alcohol within the last 30 days?
b. Have you ever experienced previous episodes of alcohol withdrawal?
c. Have you ever experienced alcohol withdrawal seizures?
d. Has a family member expressed concern for your drinking in the past 30 days?
e. Have you ever experienced delirium tremens (DTs)?
f. Have you ever undergone alcohol rehabilitation treatment? (in-patient or out-patient treatment programs or Alcoholics Anonymous attendance)
g. Have you ever experienced blackouts?
h. Have you combined alcohol with other "downers" like benzodiazepines or barbiturates during the last 90 days?
i. Have you combined alcohol with any other substance of abuse during the last 90 days?
j. Was the patient's Blood Alcohol Level (BAL) on presentation > 200?
k. Is there evidence of increased automatic activity? (Heart rate > 200 bpm, tremor, sweating, agitation,
nausea)

7. The strongest predictor that a person is going to have alcohol withdrawal syndrome is whether or not he or she
a. has consumed any alcohol in the past 30 days.
b. has a personal or family history of alcohol withdrawal or delirium tremens.
c. has ever been in an alcoholic treatment center.
d. has combined alcohol with any other substance of abuse in the past 90 days..

8. The "kindling hypothesis" says that
a. one drink leads to another.
b. abusing alcohol leads to abusing other illegal substances.
c. the longer a person abuses alcohol, the more he has to drink to in order to experience the same effects.
d. the more years a person abuses alcohol, the more severe his withdrawal symptoms become.

9. The most likely predictor that someone is going to experience Delirium Tremens (DT) is someone who has already experienced it.
a. True
b. False

10. People who have never spent time in an alcoholic treatment center are LESS likely to experience alcohol and withdrawal seizures (AWS) and delirium tremens (DT) than those who have received rehabilitation treatment.
a. True
b. False

11. Which is NOT true about blackouts?
a. A blackout is a transient episode of amnesia.
b. People momentarily lose consciousness during a blackout.
c. People have to have a high blood alcohol level (BAL) to have a blackout.
d. The more severe the alcoholism, the more likely blackouts are to occur.
e. Blackouts increase in frequency with the amount of alcohol consumed.

12. Those who abuse alcohol and barbiturates will experience greater withdrawal symptoms than those who just abuse alcohol.
a. True
b. False

13. In a large retrospective study among motor vehicle trauma victims, patients admitted to the hospital with a Blood Alcohol Level ______ had a 30-fold risk of alcohol withdrawal and those with a BAL < 100 mg/dL had a 12-fold risk of alcohol withdrawal.
a. BAL > 100 mg/dL
b. BAL > 125 mg/dL
c. BAL > 150 mg/dL
d. BAL > 200 mg/dL

14. Alcohol-dependent patients who had elevations in ______ were more likely to experience delirium tremens (DT).
a. body temperature
b. heart rate
c. blood pressure
d. All of the above

15. The Prediction of Alcohol Withdrawal Severity Scale (PAWSS) takes less than one minute to be administered.
a. True
b. False