Acquired Metabolic Disorder Flashcards
1
Q
Causes of HONK
A
hemoconcentration and prerenal azotemia
2
Q
Pathogenesis of Dialysis Dementia Encephalopathy
A
Aluminum Toxicity
3
Q
Extrapontine sites of osmotic demyelination
A
Internal capsule deep white matter corpus callosum thalamus subthalamus amygdaloid Lateral geniculate
4
Q
This condition would manifest as paresthesia, tetany, seizure and papilledema due to increased intracranial pressure
A
Hypocalcemia
5
Q
What is the compensatory mechanism would result in response to reduction in cerebral perfusion
A
Vasodilation of resistance vessel
6
Q
Pathological feature of CPM
A
destruction of myelinated sheath sparing the axons (severe at the center of pons)
7
Q
Most common manifestation of DDS
A
Headache 70%
8
Q
This substance accumulates in globus pallidus in the presence of hepatic disease
A
Manganese
9
Q
This condition is characterized by rapid changes in water balance to osmotic demyelination
A
Sepsis and Burns encephalopathy
10
Q
Treatment for chronic altitude sickness
A
alcohol elevation of PCO2 acclimatization 2-4 days
11
Q
How to correct sodium
A
([target Na - starting Na] x 0.6) x weight (kg) = infused Na load (mEq)
12
Q
What is universal to hyperthyroidism
A
Action tremor
13
Q
Ischemic-Hypoxic Encephalopathy usually result from
A
Lack of O2 and Blood flow to brain
14
Q
Complication of uremic encephalopathy
A
- ICH/Subdural 2. Infection - meningitis
15
Q
When does CT scan findings of carbon monoxide may present
A
1-4 weeks
16
Q
This result to depletion of ATP in midbrain reticular nuclei
A
Elevated level of ammonia
17
Q
Cyclosporine causes following condition
A
Edema of cerebral white matter PRES
18
Q
Seizure is common in what acquired metabolic disorder
A
Hyponatremia Hyperosmolar
19
Q
What are the antibody and serves as a markers in celiac disease
A
antiTransglutaminase antiEndomysium
20
Q
What parameters should be measured in uremic encephalopathy
A
Calcium Manganese
21
Q
This is the most reliable indicator of impending coma during the early phase of disorder
A
EEG
22
Q
This is associated with alcoholism with clinical ataxia of gait
A
Cerebellar ataxia with myxedema
23
Q
EEG findings of Brain Death
A
Isoelectric
24
Q
Normal Serum Osmolarity
A
270 - 290
25
This is characterized by progression of initial neurologic symptoms with additional weakness, shuffling of gait and spasticity
Delayed Post-Anoxic Encephalopathy
26
Characteristic of Alzheimer Type II Astrocyte
1. Swelling of terminal process 2. Folds in basement membrane 3. Increased number of mitochondria 4. Increased enzyme that metabolize mitochondria
27
In the presence of low CHON what level of Ca where neurological symptoms is evident
10mg/dl
28
2 Types of Congenital hypothyroidism
1. Sporadic 2. Endemic
29
Convulsion in hypoglycemic encephalopathy results from
altered neuronal integrity due to elevation of NH3 and decreased GABA and lactate
30
This condition is characterized by myoclonic twitching of muscle, arrhythmic, asynchronous that occur during sleep and wakefulness
Uremic Twitching Convulsion Syndrome
31
EEG findings of hypercapneic pulmonary disease
Delta and theta
32
Reye Syndrome associated viral infection
Influenza B Varicella Infection
33
This condition may result to hypernatremia by retraction of cerebral cortex from the dura
subdural hematoma
34
Correction of Na should not be \_\_\_\_\_
\> 10 mmol/L in 24 hour
35
In chronic acquired hepatocerebral degeneration, all liver enzymes are elevated but neurological status correlates with
Ammonia
36
The following condition would result to hypercapneic pulmonary disease
COPD Emphysema Fibrous lung disease Neuromuscular disease
37
Age predilection of CPM
M=F
38
This is secondary to circulatory arrest due to severe degree of hypoxia
Brain Death Syndrome
39
Histopathologic findings in congenital hypothyroidism
Low number of nerve cells especially at the 5th cortical layer
40
Symptoms of hypercalcemia
diffuse myoclonus and rigidity
41
what is directed against gluten compound that causes neurologic symptoms
Antigliaden
42
Types of endemic congenital hypothyrodism depends on:
Timing, duration and severity of iodine deficiency
43
This condition would result to increase tolerance to hypoxia
Hypothermia
44
Pathologic findings in Reye Syndrome
Cerebral edema with infiltration of hepatocytes with fat droplets
45
Post-hypoxic neurological syndrome (in order)
Persistent coma Dementia Extrapyramidal Syndrome Choreathetosis Cerebellar ataxia Intense Myoclonus Amnesic state
46
What level of potassium where there will be generalized body weakness
\<2.0
47
2 forms of hyperglycemia
Hyperglycemia with ketoacidosis HONK
48
This is due to acute cell death secondary to massive swelling of neuron and non-neuronal structure
Cytotoxic Edema
49
This condition is characterized by confusion, stupor and coma that is precipitated by infection and stress
Addison Disease
50
What is the mortality rate of Reye Syndrome if ammonia is elevated at \>500mg/dl
60%
51
Etiology of hypercalcemia in: a. young b. elderly
a. hyperparathyroidism b. osteolytic bone tumor multiple myeloma vit D intoxication hyperthyroidim Sarcoidosis Decreased urinary Ca
52
Pathological findings of Chronic acquired hepatocerebral degeneration
Concentrated at the vascular border zone sparing hippocampus, pallidum and deep folia hyperplasia of protoplasmic astrocytes (+) opalski cells
53
What glucose level would present as confusional state and seizure occurence
30mg/dl
54
Glucose reserve may sustain up to \_\_\_\_
30 minutes
55
ECG findings in congenital hypothyroidism
Low voltage QRS
56
What is the reason for symptoms of DDS
Rapid lowering of urea leaving the brain with higher concentration of serum urea resulting to shift of water into the brain to equalize osmotic gradient "REVERSE UREA SYNDROME"
57
Ischemia would result to
arrest of aerobic metabolism
58
Good prognosis of metabolic disorder
intact brainstem function
59
EEG findings of hepatic encephalopathy
Paroxysm of bilaterally synchronous slowing or TRIPHASIC wave in delta background seen in frontal region interposed with alpha activity
60
This is characterized by dehydration, fatigue, weakness and abdominal pain with blood glucose \> 400mg and ph \<7.2
DM ketoacidosis
61
Imaging findings of DM ketoacidosis
Cerebral edema
62
This is characterized by confusion, delirium and comatose due to elevation of NH3 but not to degree to cause encephalopathy
fulminant hepatic failure
63
This is characterized by neurological symptoms occuring during or following dialysis
Dialysis Disequilibrium Syndrome (DDS)
64
Pathological findings of Cerebellar ataxia with myxedema
loss of purkinje cells and gliosis of molecular later especially pyramids
65
Etiology of CPM
Rapid correction of Na
66
Histologic findings of hepatic encephalopathy
Increase number and size of protoplasmic astrocytes (+) alzheimer type II astrocytes
67
In the presence of normal CHON a level of calcium at this level will produce neurological deficit
\> 12mg/dl
68
This occurs after anesthesia where Na fell markedly
POST-operative hyponatremia
69
What is the characteristic feature of Dialysis Dementia Encephalopathy
Transient improvement in speech after IV diazepam
70
Earliest CT-Scan findings in encephalopathy
loss of gray and white matter distribution
71
This condition is characterized by dissolution of sheath of myelinarted fibers and sparing of neurons
Osmotic demyelination
72
This results to dissolution of membrane
Free Radicals
73
Treatment of carbon monoxide poisoning
Hyperbaric O2 at 2-3 atm
74
Opalski cells are associated in what disease
Wilson Disease
75
What amino acid has an altered metabolism in the setting of burns and sepsis
Phenylalanine
76
Blood flow will increase by 400% in what level of oxgenation
25mmHg PO2
77
This is characterized by mental function derangement following administration of ACTH
Iatrogenic psychosis
78
Seizure in hypoxic ischemia can be ameliorated by
Midazolam and Propofil
79
This is non-ischemic hepatic encephalopathy preceded for several days to week by fever
Reye Syndrome
80
Associated with peripheral neuropathy m polymyoclonus and ataxia of gait and limbs
Cerebellar syndrome with celiac disease
81
The level of glucose that would result to coma and irreparable brain injury
10mg/dl`
82
Carboxyhemoglobin at 50-60% would result to:
Coma Blindness Decortication Seizure
83
This contribute to rapid destruction of neurons under anoxia and ischemia
Glutamate
84
What condition is similar to uremic encephalopathy
tetany
85
If seizure is uncontrollable what medication can be given
Clonazepam 8-12mg daily
86
What is the most common cause of SIADH
Hypotonic Isovolemic Hypernatremia
87
a.k.a Monge Disease
Chronic high altitude sickness
88
Differential diagnosis of celiac disease
Paraneoplastic cerebellar degeneration CJD Vitamin E deficiency
89
Confusional state combined with state of sustained muscle contraction
Asterixis
90
What metabolic derangement result to hypercapneic pulmonary disease
Respiratory acidosis
91
What laboratory findings are elevated Reye Syndrome
ALT Coagulation times Blood ammonia
92
Patient who survive hepatic coma will progress to:
Chronic acquired hepatocerebral degeneration (non-wilson)
93
Differential diagnosis of CPM
Basilar artery occlusion Chronic relapsing MS
94
Condition that may predispose to Metaboli Acidosis
Hyperammonemia Isovaleria MSUD Glutaric Aciduria Hyperglycemia
95
Etiology of hypoparathyroidism
Iatrogenic Agenesis of parathyroid Di George Intestinal malabsorption Pancreatic insufficiency
96
Pathogenesis of Hypernatremia
Neuronal shrinkage and synaptic surface of cells
97
Treatment for hypercapneic pulmonary disease
Positive pressure ventilation Phlebotomy for increased viscosity
98
Fluid restriction in SIADH`
if Na is \<120: 500ml for 24 hours if NA is \<130: 1000ml for 24 hours
99
What is the GABA-BDZ theory
This inhibit the binging of endogenous BDZ in the setting of liver disease
100
Imaging findings of uremic encephalopathy
Cerebral shrinkage
101
Cause of cortical blindness
infarction of MCA and PCA
102
MRI findings of Leukoencephalopathy
White matter hyperintensity
103
What is the function of thyroid hormone
axodenritic development and organization
104
How is chronic hydrocephalus causes hypernatremia
Hypothalamic thirst center is inactive leading to hypernatremia then coma
105
CSF findings of hypercapneic pulmonary disease
Increased pressure pCO2 \>75
106
Normal blood glucose in the brain
1-2grams (30mmol/100g of tissue)
107
All metabolic encephalopathy would present slowing of EEG, except?
Hepatic Encephalopathy
108
isolated spastic paraplegia where NH3 is elevated at \>200mg/dl
hepatic myopathy
109
This encephalopathy characterized by agitation, confusion, clouding of consciousness dysarthria and rigidity
Pancreatic Encephalopathy
110
Pattern of breathing in Uremic Encephalopathy
Kussmauls \> Cheyne Stokes \> Death
111
Treatment with HONK
fluid replacement (Isotonic saline)
112
This is characterized by very high blood glucose (\>700mg/dl) without ketosis and osmolality is \>300mosm/l
HONK
113
CT-Scan findings of carbon monoxide poisoning
Decreased accentuation of pallidum
114
Chronic complication of hemodialysis characterized by stuttering speech, focal seizure and behavioral changes
Dialysis Dementia Encephalopathy
115
What form of glucose are found in the brain
glycogen
116
MRI findings of CPM
Batwing lesion of the pons
117
Causes of SIADH
Headtrauma Bacterial meningioma Cerebral infarction SAH Cerebral and systemic neoplasm
118
EEG findings of uremic encephalopathy
Diffusely irregular slow
119
how long of physiologic jaundice in cretinism
up to 3 months
120
Characterized by rhythmic tremor of arms with sustained tremors
Hepatic paraplegia
121
Medullary pupil and deep coma are found in what level of glucose
10mg/dl
122
What is mostly affected structure in the presence of anoxia
Hippocampus Deep folia of cerebellum
123
Formula of Serum Osmolarity
2 x Na +Glucose / 18 + BUN / 3
124
This is characterized by varying form of deafness, dysarthria and proximal limbs rigidity
Neurologic form
125
What is the provocative factor in jejunal bypass operation
overfeeding and fasting
126
Syndrome that became evident as patient awaken from encephalopathy
Visual agnosia Proximal arm and shoulder syndrom
127
Cerebral edema in DM ketoacidosis is a result from
accumulation of fructose and sorbitol \ reversal of osmolality gradient
128
This condition is characterized by fat pads, short stature, microcephaly and psychomotor development
Mxyedema form
129
Management of Cerebellar ataxia with myxedema
Thyroid hormine
130
Medical Condition that lead to encephalopathy
1. Global reduction of cerebral blood flow 2. Hypoxic from suffocation 3. Paralytic due to respiratory failure 4. Carbon Monoxide Poisoning
131
Clinical manifestation of Chronic altitude sickness
pulmonary hypertension Cor pulmonale Secondary polycythemia Papilledema
132
Due to delayed rise of insulin in response to CHO meal
Functional or reactive hypoglycemia
133
Histologic findings of hepatic myopathy
loss of betz cells in frontal region
134
The increase activity of GABA in hepatic disease can be ameliorated by
Flumanezil
135
MRI findings of hepatic myopathy
Hyperintensity of globus pallidus
136
What would result if blood glucose fall
CNS utilize non-glucose substrate (ketoacids, lactates, pyruvare, fructose)
137
Notorious medication that causes HONK
Corticosteroids Thiazides Phenytoin
138
Focal symptoms of HONK
hemisensory hemimotor hemianopsia
139
How many minutes of anoxia would permit permanent damage to brain
\> 5 minutes
140
What is the main cause of fulminant hepatic failure
Cerebral edema
141
Important diagnostic feature of hypercapneic pulmonary disease
Papilledema Myoclonus Asterixis
142
What is overexpressed during acute high altitude sickness
VEGF - result to increased vascular permeability
143
Patient with carbon monoxide poisoning would manifest symptoms when carboxyhemoglobin reaches at what level
20-30%
144
What pressure usually would result to decreased cerebral blood flow
60-70mmHg
145
CSF findings in congenital hypothyroidism
Increased CHON
146
EEG findings of Dialysis Dementia Encephalopathy
Periodic sharp waves or spike wave activity with delta and theta activity
147
3 types of hyponatremia
Hypertonic - hyperglycemia & mannitol Hypotonic - common in neurologic problem Isotonic - hyperlipiduria and hyperproteinemia
148
Treatment of Hepatic Encephalopathy
Neomycin and Kanamycin Oral lactulose Rifaximin Branch Chain amino acid
149
How is head trauma implicated in Hypernatremia
damage to the pituitary stalk
150
This occur in developed countries where there is metabolism and disorder of thyroid gland
Sporadic type
151
EEG findings of Reye Syndrome
Diffuse arrhythmia delta progressing to ECS
152
Cretinism is associated with what defect
defect in thyroxin synthesis
153
Delayed neurologic deterioration in carbon monoxide poisoning occurs when
1-3 weeks
154
Cardiac arrest and generalized weakness occurs in the seeting of hyperkalemia at what level
\>7meq
155
This is common in goitrous region characterized severe intrauterine hypothyroidism
Cretinism and neonatal myxedema
156
Glucose utilization of the brain
60-80mg/min
157
This condition is characterized by derangement of consciousness, mental slowing and confusion with hyperactive followed by progressive drowsiness
Hepatic coma
158
Temperature to maintain using hypothermic protocol
33 degrees celsius for 24 hour
159
Treatment of sporadic congenital hypothyroidism
Thyroid hormone
160
EEG findings of Metabolic acidosis
High voltage slow activity
161
Presence of antithyroid antibody against thyroid peroxidase and thyroglobulin in brain and csf
Hashimoto Encephalopathy
162
Complication of Renal Transplantation
Primary Lymphoma of the brain Progressive Multifocal Leukoencephalopathy (PMLE) Wernicke Korsakoff Central Pontine Myelinosis Bleeding Diasthesis
163
Large dose of hypoglycemia is more dangerous, because
enzymatic exhaustion
164
Brain swelling in Reye syndrome is secondary to
fatty infiltration of viscera
165
These drugs should be taken cautiously in the presence of uremia
Furoseminde INH Nitrofurantoin Aminoglycoside Hydralazine
166
Histologic findings in encephalopathy associated with burns and sepsis
Brain Purpura Pericapillary hemorrhages and necrosis
167
What is the problem in SIADH
Urine is hypertonic in relation to plasma
168
This is characterized by irreversible mild dementia and extrapyramidal syndrome
Chronic acquired hepatocerebral degeneration
169
2 Forms of endemic hypothyroidsim
a. Myxedema b. neurologic
170
MRI findings of Cerebellar ataxia with celiac disease
Lymphocytic infiltration and perivascular cuffing in cerebellar cortex and peripheral nerves
171
This is due to islet cell tumor sometimes mistaken from episodic confusional psychosis
Recurrent hypoglycemia
172
This is an exogenous toxin that produce delayed neurologic deterioration
Carbon monoxide
173
What is the pathogenesis of hypercapneic pulmonary disease
Direct CO2 narcosis and acidosis of CSF
174
Pathogenesis of hepatic encephalopathy
Abnormality in nitrogen metabolism result to urea accumulation
175
Diagnosis of cretinism occurs
6th-12th month of life
176
The dangerous level of Na in SIADH
100mg/l
177
Hypercalcemia is considered as elevation of serum calcium at what level
\>10.5mg/dl
178
What causes glutamate release
Massive Ca influx
179
Most important cause of confusion, stupor and coma
Hypoglycemic encephalopathy
180
Indication of poor neurologic outcome in encephalopathy
Absent corneals Absent pupillary No withdrawal to pain Absent motor response
181
Iron and Ca deposits in blood vessel of lenticular and dentate
Fahr Disease
182
Treatment for Hashimoto encephalopathy
Respond to steroids Plasma exchange
