Neuro CIS Case 1

Question 1

causes of syncope

Answer 1

neuro-cardiogenic
vasomotor syncope
cardiac syncope
other

Question 2

neuro-cardiogenic causes of syncope

Answer 2

vasovagal
carotid sinus syndrome
micturition
valsalva syncopes

Question 3

vasomotor syncope (think of inability to maintain peripheral tone)

Answer 3

orthostatic hypotension
medication induced
ans or pns neuropathies
peripheral vascular disease

Question 4

cardiac syncope

Answer 4

arrhythmias (mostly tachy), heart block, outflow obstruction, asystole

Question 5

other causes of syncope

Answer 5

seizure disorder, TIA, psychogenic

Question 6

partial seizure

Answer 6

altered consciousness but wakefulnes is retained

Question 7

generalized seizure

Answer 7

characterized by complete loss of consciousness

Question 8

what drugs lower the seizure threshold

Answer 8

tramadol and buproprion

Question 9

potential causes of seizure

Answer 9

metabolic
drug induced
withdrawal
cns pathology (CVA) trauma, infection
endocrine
systemic conditions

Question 10

drug withdrawal of what can cause seizures

Answer 10

alcohol and benzodiazepines

Question 11

systemic conditions associated with seizure

Answer 11

SLE, eclampsia, high grade fevere, HTN encephalopathy

Question 12

endocrine and seizures

Answer 12

hypo/hyperthyroidism

Question 13

CD4 count under 200 infection

Answer 13

P jirovecci

Question 14

CD4 count under 100 infection

Answer 14

toxoplasmosis

Question 15

CD4 count under 50 infection

and drug

Answer 15

mycobacterium avium

azithromycin

Question 16

TST > 5mm

and drug

Answer 16

tuberculosis (isoniazid)

Question 17

obligate intracellular parasites (protozoan)

Answer 17

toxoplasma gondii

Question 18

acquiring infection of toxo

Answer 18

cats excrete it in oocysts in feces and humans acquire through ingestion

fecal oral route

Question 19

symptoms of toxo infection

Answer 19

altered mental status
fever
HA
possible siezures
focal neuro deficits

Question 20

diagnosis of toxo infection

Answer 20

clinical symptoms
IgG anti-toxoplasma
MRI ring enhanced lesions

Question 21

treatment for toxo

Answer 21

sulfadizine + pyrimethamine +leucovorin

Question 22

long term use of methadone with someone taking HIV meds

Answer 22

greatly increased risk of long QTC syndrome and at risk for torsade de pointes and sudden onset syncope or cardiac death

increased when used in conjunction with any other 3A4 substrate meds like many of the anitvirals for HIV/AIDS

Question 23

goal of cerebral edema treatment is to get direct pressure under ____ mmHg

Answer 23

20

Question 24

treatment for cerebral edema

Answer 24

osmotic diuretics (furosemide)

IV mannitol

induced hyperventilation (by means of mechanical respiration) goal is to obtain PCO2 of 26-30 mmHg, creates resp alkalosis to buffer post injurious acidosis

head elevation
deompressvie craniotomy, ventriulostomy

Question 25

iv mannitol and cerebral edema caution

Answer 25

continue to assess pts Na levels and renal function as it can induce hypernatremia nad acute tubular necrosis

Question 26

what do you order in an altered mental status pt

Answer 26

urine drug screen

Question 27

CSF interpretation

open pressure: >300mmHg
WBC: >1000/mm3
%PMN >80%
glucose: <40
proteinj>200mg/dL
cytology (-)

Answer 27

bacterial

Question 28

CSF interpretation

open pressure: <300mmHg
WBC: <1000/mm3
%PMN >1-50%
glucose: >40
protein <200mg/dL
cytology (-)

Answer 28

viral

Question 29

CSF interpretation

open pressure: <200mmHg
WBC: <500/mm3
%PMN >1-50%
glucose: <40
protein >200mg/dL
cytology positive

Answer 29

neoplastic

Question 30

CSF interpretation

open pressure: 300mmHg
WBC: <500/mm3
%PMN >1-50%
glucose: <40
protein >200mg/dL
cytology (positive)

Answer 30

fungal