Archive Of Standardized Exam Questions: Wernicke Encephalopathy


This page is dedicated to organizing various examples of standardized exam questions whose answer is Wernicke encephalopathy. While this may seem a odd practice, it is useful to see multiple examples of how Wernicke encephalopathy will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a tradition question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.


When it comes to standardized exams, each topic has its own “code” marked by key buzzwords, lab findings, clues, etc. If you are well versed in this code you will be able to more quickly identify the condition that is being discussed, and get the right answer on the exam you are taking. Below is the “code” for Wernicke encephalopathy

  • Alcoholic patient is the classic presentation on exams.
  • The following triad of symptoms is essentially diagnosis for this condition (on exams):
    1. Mental status changes
    2. Eye issues: this can be nystagmus and/or ophthalmoplegia 
    3. Ataxia: the patient will almost always have altered gait/difficulty walking 

Question # 1

A 35 year old man is brought to the emergency department by police after he was found sitting in the street unaware of his surroundings. The patient cannot remember his name, his date of birth, or his age. His vital signs are unremarkable. Physical exam shows bruises around the face and extremities. Right later gaze is significantly restricted. On left lateral gaze nystagmus is noted. He has mild gynecomastia and palmar erythema. Abdominal exam reveals tenderness in the right upper quadrant. His liver edge is palpated 4 cm below the right costal margin. His muscle strength appears normal, but he is unable to stand or walk. His deep tender reflexes are absent. What is the most likely explanation for this patient’s findings?

Explanation # 1

Mental status changes + nystagmus/ophthalmoplegia + ataxia = Wernicke encephalopathy

Question # 2

A 50 year old man comes to the hospital because he was found in the street confused and visibly drowsy. He is unsure of where he is. A physical exam reveals a lateral gaze defect and also a wide based ataxic gait. His blood alcohol level is now 0.07 mg/dL in the emergency room. What diagnosis may this patient have?

Explanation # 2

Confusion + ophthalmoplegia + ataxia = Wernicke encephalopathy


Many questions on standardized exams go beyond simply recognizing the underlying topic. Often there are specific testable facts regarding some aspect of the topic’s pathophysiology/management/clinical implications that are commonly asked. Some of these are listed below:

  • What causes it: deficiency of 
  • What area of the brain is classically damaged: in this condition the mamillary bodies are classically damaged (they are a foci of hemorrhage and necrosis). 
  • How do you treat? FIRST you administer thiamine THEN you administer glucose. Thiamine is a cofactor for enzymes responsible for glucose metabolism, so glucose admisntration (in the absence of thiamine) will exacerbate this condition. 


Page Updated: 09.18.2016