Medicine

Question 1

RANSON criteria (24hours)

Answer 1

• Glucose >200
• Ast > 250
• LDH > 300
• Age > 55 yo
• WCC > 16,000

Question 2

RANSON ( 48 hours)

Answer 2

• Calcium < 8
• Hct > 10%
• Oxygen RA < 60mmHg
• Base deficit > 4
• BUN > incr 5
• Sequestration fluid > 6L

Question 3

Causes CN3 palsies

• motor - ptosis, eye in down and out position, inability to elevate, depress or turn medially
• pupillary - mydriasis, absent direct light reflex, absent accomodation reflex

Answer 3

• Extrinsic compression
• aneurysm (10%)
• tumours - nasopharyngeal CA
• raised ICP
• Intrinsic disease
• diabetes
• arteritis
• MS
• GBS - Miller Fisher syndrome
• botulism
• diphtheria

Question 4

CN6 lesions

• paralysis of abduction
• convergent strabismus

Answer 4

• raised ICP
• Wernicke’s encephalopathy
• most commonly post viral in children
• tumours
• mono neuritis multiplex
• MS
• GBS
• botulism
• Diphtheria

Question 5

CN 4 palsies

• extrusion of eye ie up + out
• weak downward gaze
• vertical diplopia

Answer 5

# isolated (uncommon)
- idiopathic
- head trauma - usually severe + LOC
- microvasculopathy - DM, atherosclerosis, HTN
- congenital
# with other CN lesions (common)
- raised ICP
- Wernicke's
- Mono neuritis multiplex
- MS
- GBS
- botulism
- diphtheria

Question 6

Causes binocular diplopia

Answer 6

- ocular nerve palsies 
# III, IV, VI 
- impairment of normal globe movement
# ocular muscle entrapment - blow out fracture orbital floor
# thyroid eye disease (Inferior rectus)
# masses
# Swelling
- Gaze palsies 
# nuclear - oculomotor reflex redcued
# supra nuclear - oculomotor reflex intact
- peripheral vertigo (ocular skew)
- NM disease - MG
- occipital cortisol disease 
# homonymous hemianopia