ID, Tox, nutritional

Question 1

Whipple’s disease sx, tx

Answer 1

Oculomasticatory myorhythmia
ocular dysfxn (esp vertical gaze palsy)
GI sx, systemic non-spec, + arthritis
Dementia, gait ataxia,

Tx w/ ceftriaxone

Question 2

JC virus path

Answer 2

Glassy intranuclear inclusions in oligodendrocytes

Question 3

CMV path

Answer 3

Lg inflammatory cells (“Galac”

Lg intranuclear inclusions

Question 4

Rabies path

Answer 4

Intracytoplasmic “negri bodies”
Round, bright pink
Commonly in purkinje cells

Question 5

Cryptococcal meningitis path, tx

Answer 5

encapsulated yeast
+ india ink, round + cup shaped, variable size

Tx - acute amphoterocin and flucytosine, long term fluconazole

Question 6

Toxoplasmosis path, teratogenicity

Answer 6

Path - bradyzooites (lg mottled blue/pink circle)

Hydrocephalus, intracranial calcifications, chorioretinitis

Question 7

Aspergillosis path

Answer 7

90 dgree branching hyphae

Question 8

Rituximab neuro tox

Answer 8

PML

Question 9

Bevacizumab neuro tox

Answer 9

Intracerebral hemorrhage

Question 10

5-fluorouracil neuro tox

Answer 10

Pancerebellar syndrome (less than cytarabine)

Question 11

Cytarabine neuro tox

Answer 11

Subacute pancerebellar syndrome (10-20%)

Poss aseptic meningitis

Question 12

Methotrexate neuro tox

Answer 12

Leukoencephalopathy

Aseptic meningitis

Question 13

Pyridoxine deficiency sx

Answer 13

Angular chelitis, glossitis, stomatitis, poor appetite
Generalized axonal sensorimotor neuropathy
BL distal numb –> distal parasthesias, sensory ataxia, weakness

Question 14

Lead toxicity - acute severe sx

Answer 14

Encephalopathy with brain edema –> dead

Question 15

Lead toxicity adults sx, tx

Answer 15

Subacute motor > sensory peripheral neuropathy
Classic - wrist and finger extension weakness

Tx w/ EDTA

Question 16

Carbon monoxide tox MRI findings

Answer 16

T2 bright or necrosis globus pallidus. 
Diffuse leukoencephalopathy (not as bright)

Question 17

Organophosphate toxicity sx

Answer 17

Salivation, lacrimation, sweat
Miosis
n/v, diarrhea, abd cramps
Flaccid paralysis with fasciculations

Question 18

Thallium toxicity source

Answer 18

Previously rat and insect killers. Now - herbal products

Question 19

Thallium toxicity sx

Answer 19

Rapid onset painful sensory neuropathy

Alopecia

Question 20

Thallium toxicity tx

Answer 20

prussian blue

Question 21

Manganese tox source

Answer 21

TPN, chronic liver disease

Question 22

Manganese tox sx

Answer 22

Parkinsonian sx, dystonia, HA

hallucinations, psychosis, aggressive

Question 23

Manganese tox MRI

Answer 23

Increased T1 signal globus pallidus

Question 24

Mercury tox source, sx

Answer 24

Miner, dentist. After weeks-months exposure

Ataxia, intention tremor, dysarthria, parasthesias
Cognitive and behavioral changes
Constricted visual fields, deafness
Oral - inflamed tender gums, increased salivation, swollen salivary glands

Question 25

Cyanide tox source, sx

Answer 25

Industrial

Ha, anxiety, encephalopathy, vertigo, sz
Bright red skin, abnl (almond) taste
Cardiac - Tachycardia + HTN –> bradycardia and hypotension, AV block, arrhythmia

Question 26

Arsenic tox acute, subacute, chronic

Answer 26

Acute: GI/cardiac sx, encephalopathy, garlic breath
Subacute: GBS like
Chronic: ascending sensorimotor peripheral neuropathy, skin hyperpigmentation/macular rash, scaling palms/soles

Question 27

Vitamin E deficiency

Answer 27

Ataxia, areflexia, dysarthria

Lg fiber sensory loss

Question 28

Copper deficiency

Answer 28

B12 like Myelopathy with spastic paraparesis
Peripheral neuropathy with axonal loss
loss proprioception & vibration
Pancytopenia

primarily seen in cervical region

Question 29

Lithium teratogenicity

Answer 29

Ebstein’s anomaly (malformed tricuspid valve)

Question 30

VPA teratogenicity

Answer 30

Neural tube defects

Craniofacial (cleft), cardiac

Question 31

Carbamazepine teratogenicity

Answer 31

Dysmorphic face - Craniofacial (incl cleft), doll-like facies, long philtrum, short palpebral fissures
Neural Tube Defects, developmental delay
Fingernail hypoplasia
Hip dislocation, inguinal hernia

Question 32

Wernicke vs. Korsakoff

Answer 32

Wernicke - reversible, acute, has motor sx + cognitive
Encephalopathy + confusion, nystagmus + ataxis

Korsakoff - chronic, irreversible, just cognitive
Confabulation
amnesia (anterograde > retrograde)
Personality change
Hallucinations

Question 33

Trichinosis sx, path, tx

Answer 33

Acute-subacute onset
Puffy eyelids, dysphagia, myalgia. Prox > distal weak
Little circles in biopsy
Tx with thiobendazole and steroids

Question 34

Nitrous oxide toxicity mechanism, sx

Answer 34

NO –> irreversible oxidation of B12, most acute with underlying B12 deficiency