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🧠📖💯 > Acquired Metabolic Disorders > Flashcards

Acquired Metabolic Disorders Flashcards

1
Q

Most common early imaging changes in severe hypoxic injury

A

Loss of distinction between gray and white matter

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2
Q

When does delayed posthypoxic encehalopathy occur?

A

1-4 weeks post ictus

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3
Q

4 clinical signs at day 1 after cardiac arrest that predicts a poor neurologic outcome or death:

A
  1. Corneal reflex absent
  2. Pupils nonreactive
  3. No withdrawal to pain
  4. No motor response
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4
Q

Complications of therapeutic hypothermia (4)

A

Hypotension
Bleeding
Ventricular ectopy
Infection

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5
Q

Predominant symptoms in the delayed category post carbon monoxide poisoning

A) headache
B) papilledema
C) seizures
D) extrapyramidal features

A

D) extrapyramidal features

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6
Q

Characteristic lesions of CO poisoning that had produced coma

A

Early: mild cerebral edema

Late: discrete lesions in the gp > inner putamina

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7
Q

Treatment of CO poisoning

A

Initial: inspired oxygen

Carboxyhgb > 40% or w coma or sz: hyperbaric

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8
Q

In mountain sickness, HA, n/v, weakness, insomnia can be experienced at ____ ft

A

8,000

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9
Q

Which of the following is NOT true of Monge Disease?

A) also called chronic mountain sickness
B) a/w pulmonary hypertension
C) a/w secondary polycythemia
D) a/w daytime headaches
E) a/w mild mental dullness
A

D) a/w daytime HAs

Monge Disease a/w nocturnal headache & papilledema

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10
Q

Which of the following is NOT true of hypercapnic pulmonary disease?

A) Papilledema may be asymmetric
B) a/w myoclonus and asterixis
C) Frequently a/w prolonged coma
D) fast-frequency tremor

A

C) Frequently a/w prolonged coma

Prolonged coma is rare (compared to hypoxic enceph)

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11
Q

Causes of hypercapnic pulmonary disease:

Pulmo (3)
Neurologic (2)

A

Pulmo

  1. COPD
  2. Emphysema
  3. Fibrosing lung disease

Neuro

  1. Neuromuscular weakness
  2. Medullary respiratory center involvement
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12
Q

Which of the following treatment measures for chronic hypercapnic pulmonary disease is NOT true?

A) Use of PPV
B) Phlebotomy
C) Antibiotics
D) Aminophylline may produce high BP and seizures
E) None of the above
A

E) None of the above

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13
Q

At what glucose level do you expect:

a) Confusional state, seizures
b) Coma, irreparable brain injury

A

a) 30mg/dL

b) 10mg/dL

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14
Q

Most common causes (top 3) of hypoglycemic encephalopathy?

A

Insulin/diabetic agent use
Pancreatic tumor
Depletion of liver glycogen

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15
Q

Seizures and focal signs such as a hemiparesis, a hemisensory defect, choreoathetosis, or a homonymous visual field defect are more common in ______ than in any other metabolic encephalopathy and may erroneously suggest the possibility of a stroke.

A

Hyperosmolar nonketotic hyperglycemia

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16
Q

What is a sensitive and reliable indicator of impending coma for hepatic encephalopathy?

a) MRI
b) GCS
c) EEG
d) Serum ammonia

A

c) EEG

Findings:
Paroxysms of bilaterally synchronous slow or triphasic delta waves
Initially frontally
Interspersed with alpha activity

17
Q

MRI findings in hepatic encephalopathy?

Due to?

A

Symmetric T1 hyperintensities in the globus pallidus

2/2 manganese deposition

18
Q

Histologic finding in hepatic encephalopathy?

A

Alzheimer type II astrocytes

19
Q

Mainstay of treatment in hepatic encephalopathy?

A

Oral lactulose

ammonia -> ammonium

20
Q

Main cause of death in patients awaiting liver transplants (neurologic)

A

Cerebral edema

21
Q

5 treatment measures for Reye Syndrome?

A

HHIT Lactulose

Hemodialysis
Hypertonic solutions
Intravenous glucose
Temperature control
Lactulose
22
Q

Which of the following is true regarding Uremic Encephalopathy?

a) Progressive neurologic deterioration
b) Myoclonic twitches disappear during sleep
c) Uremic patients are prone to infections, including meningitis
d) Cerebral edema is evident

A

c) Uremic patients are prone to infections, including meningitis
* Symptoms fluctuate
* Myoclonic twitches are incessant during wakefulness and sleep
* Cerebral edema is notably absent

23
Q

This neurologic symptom occurs in up to 70% of dialysis disequilibrium patients

A

Headache

24
Q

Population of HD patients who present with dialysis disequilibrium (those at risk)

A

Pts undergoing rapid HD

Early stages of dialysis program

3rd-4th hour of HD / 8-48 h after completion

25
Q

Characteristically, dialysis encephalopathy begins with ____

A

Dysarthria (hesitant, stuttering)

Aphasia

26
Q

A characteristic clinical feature of dialysis encephalopathy is transient improvement in speech with _____

A

IV diazepines

27
Q

Pathologic changes in dialysis encephalopathy include microcavitation more severe in _____

A

left frontotemporal operculum

28
Q

Which of the following are considered common symptoms in septic encephalopathy?

a) Asterixis
b) Focal cerebral disorder
c) Myoclonus
d) Paratonia, polyneuropathy

A

d) Paratonia, polyneuropathy

29
Q

Which of the following is NOT a cause of SIADH?

a) Head trauma
b) GBS
c) Cerebral infarction
d) Neoplasm
e) None of the above

A

e) None of the above

Other causes:
Bacterial meningitis
SAH

30
Q

Fluid intake restriction for the following Na levels. Format ___ ml/24h

a) Na < 120 mEq/L
b) Na < 130 mEq/L
c) Na 130 mEq/L

A

a) Na < 120 mEq/L: 500ml/24h
b) Na < 130 mEq/L: 1,000 ml/24h
c) Na 130 mEq/L: 1,500 ml/24h

31
Q

Calcium level that produces neurologic symptoms

A

Ca > 12 mg/dL

32
Q

MCC of hypercalcemic encephalopathy

a) young patient
b) older patients

A

a) young - hyperparathyroidism

b) older - osteolytic bone tumors, mets, MM

33
Q

True or false: delirium and convulsions are common in hypercalcemic encephalopathies

A

False

34
Q

What is the essential pathologic attribute of CPM?

A

Dissolution of sheaths of myelinated fibers and sparing of neurons

35
Q

More than 1/2 of CPM cases occur in the late stages of _____

A

Chronic alcoholism

36
Q

CPM by the numbers:

a) Occurs in rapid correction of pts w/ initial serum Na ___
b) Correct hyponatremia by

___ within 24 h
___ within 48 h

A

a) <130 mEq/L

b)
10 mEq/L x 24h
<21 mEq/L x 48h

37
Q

Non-wilsonian vs. wilsonian hepatocerebral degeneration:

Cirrhosis is more common in?
Cortical lesions are more common in?

A

Both in Acquired / Non-Wilsonian Hepatocerebral Degeneration

38
Q

Hyperthermia severely affects which part of the brain?

A

Cerebellum

39
Q

Most frequent and potentially preventable and correctable metabolic cause of encephalopathy in the world

A

Neonatal Myxedema (Cretinism)

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