Cardinal Manifestations

Question 1

It affects elderly people; presents with stooped posture, shuffling gait, and decreased arm swing. What is the diagnosis

Answer 1

Parkinson’s disease

Question 2

Give two drugs that can be used to treat Parkinson’s disease

Answer 2

1. rivastigmine
2. Donepezil

Question 3

What is the MOA of rivastigmine and donepezil

Answer 3

Cholinesterase inhibitors

Question 4

what is the characteristic tremor noted in Parkinson’s disease

Answer 4

Pill rolling tremor

Question 5

wide-based gait, Shuffling, freezing gait, with difficulty initiating the gait. What type of gait disorder?

Answer 5

Frontal gait disorder

Question 6

At what level of hypothermia is enough to cause coma?

Temperature level

Answer 6

T < 31 celsius

Question 7

Sodium of < ___ mmol/L is associated with coma or convulsions

Answer 7

Sodium < 119 mmol/L

Question 8

Sodium of < ___ mmol/L is associated with confusion

Answer 8

Sodium < 125 mmol/L

Question 9

What will you suspect in a comatose patient with reddish skin?

Answer 9

Carbon monoxide poisoning

Question 10

What type of herniation syndrome do you suspect in a patient with ipsilateral pupillary dilation, Babinski sign and ipsilateral hemiparesis?

Answer 10

Uncal herniation

Question 11

What type of herniation syndrome will you suspect in a patient with miotic pupils and drowsiness

Answer 11

Central transtentorial herniation

Question 12

What level of ethanol (mmol/L or mg/dL) will cause inebriation?

Answer 12

Ethanol > 43 mmol/L or > 0.2 mg/dL

Question 13

What level of ethanol (mmol/L or mg/dL) will cause coma?

Answer 13

Ethanol > 65 mmol/L or > 0.3 mg/dL

Question 14

A normal CT scan in a comatose patient is not enough to exclude?
Note: 8 ddx

Answer 14

1. early infarct
2. acute brainstem infarct
3. meningitis
4. encephalitis
5. mechanical shearing of axons in a closed head traum
6. sagittal sinus thrombosis
7. hypoxic injury
8. subdural hematoma

Question 15

What imaging test will you order if you suspect a posterior circulatory stroke?

Answer 15

Brain MRI or a CT angiography

Question 16

What are the next steps if you have a comatose patient with fever and meningismus or neck rigidity?

Answer 16

1. Get blood cultures, then give IV Vancomycin + IV 3rd generation cephalosporin + dexamethasone
2. rule out intracerebral mass via imaging
3. if intracerebral mass is negative, proceed with LP

Question 17

what will you suspect in a patient who develops sudden onset headache, vomiting and eventually becomes comatose?

Answer 17

subarachnoid hemorrhage

Question 18

How do you do and interpret apnea testing?

Answer 18

1. preoxygenate patient to 100% O2
2. remove the ventilator
3. Apnea test is confirmatory if there is no respiratory effort after sufficiently high PCO2
   CO2 tension rises by 2-3 mmHg/min with apnea

Question 19

What type of dementia presents early on with episodic memory loss, then later by aphasia, executive dysfunction, or navigational problems?

Answer 19

Alzheimer’s disease

Question 20

What type of dementia presents early on with difficulties in mood, judgement, movement and behaviour, or personality change?

Answer 20

Frontotemporal dementia

Question 21

What type of dementia presents with visual hallucinations, parkinsonism, Capgras syndrome and prone to delirium?

Answer 21

Lewy body disease

Question 22

What is Capgras syndrome?

Answer 22

the delusion that a familiar person is replaced by an impostor

Question 23

What is pulsus paradoxus?

Answer 23

It is when the SBP rises by > 10 mmmHg during inspiration

Question 24

What does pulsus paradoxus suggest?

Answer 24

It is suggestive of COPD, Asthma, or pericardial disease

Question 25

What are signs suggestive of elevated right atrial pressure?

Answer 25

NVD, leg edema, accentuated P2 over P1