Consultation-Liason

Question 1

Halmark sign of refeeding syndrome? By what mechanism does this occur

Answer 1

Hypophosphatemia –> during starvation, phosphate stores are depleted - when carbs are re-introduced, insulin is released, which triggers cellular uptake of phosphate (low serum phosphate)

Question 2

Clinical signs of re-feeding syndrome

Answer 2

Hypophosphatemia (hallmark), peripheral edema, congestive heart failure (CHF), hypokalemia, vitamin defficiences

Question 3

Most common cause of fatalities from re-feeding syndrome

Answer 3

Cardiac complications such as CHF

Question 4

How does purging by vomiting affect serum electrolytes?

Answer 4

• Sodium: Varies
• Potassium: Decreased
• Bicarb: Increased
• Chloride: Decreased
• pH: Increased

Question 5

What are Piaget’s four stages of development and what ages do they pertain to?

Answer 5

1) Sensorimotor (birth to 2 years)
2) Preoperational thought (2 years to 7 years)
3) Concrete thought (7 years to 11 years)
4) Formal operations (11 years through end of adolescence)

Question 6

How do you differentiate PANDAS versus Syndenham’s chorea?

Answer 6

Onset of symptoms –> PANDAS presents early (days to weeks after infection) vs Syndenham’s presents 6-9 months after infection

Question 7

How can you differentiate neurofibromatosis from tuberous sclerosis?

Answer 7

tuberous sclerosis is characterized by BRAIN tumors that cause seizures

Question 8

What are the neuropsychiatric implications of tuberous sclerosis?

Answer 8

Tuberous sclerosis can cause brain tumors that lead to seizures (due to cortical tumors), developmental delays, and frequent psychiatric disorders.

25-50% of individuals with tuberous sclerosis are diagnosed with ASD and 25-50% are diagnosed with ADHD

Question 9

What are the neurocutaneous disorders that can present with co-morbid ASD?

Answer 9

Sturge-Weber (25%) and Tuberous Sclerosis (25-50%)

Question 10

What are examples of genetic syndromes associated with ASD? (6)

Answer 10

Tuberous sclerosis
Fragile X syndrome
Angelman syndrome
Rett syndrome
DiGeorge syndrome
Down syndrome

Question 11

1) What is Sturge-Weber syndrome? 2) What are the more common presenting signs (including skin findings)? 3) What are the neuropsychiatric sequelae?

Answer 11

1) A SPORADIC neurocutaneous syndrome.

2) Port-wine birthmark (facial angioma), leptomengeal angioma, and glaucoma.

3) ASD (25%), epilepsy, and learning difficulties

Question 12

What are the characteristic findings of Neurofibromatosis Type II?

Answer 12

BILATERAL acoustic schwannomas/neuromas, juvenile cataracts, meningiomas,and ependymomas