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EDIC Part (1) Course Notes > Neuro & Metabolic > Flashcards

Neuro & Metabolic Flashcards

1
Q

Herpes simplex virus? Types? (HSV)

A
  • type 1 & 2
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2
Q

Herpes simplex virus type 2 ? Common on what age group?

A

In Young children

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3
Q

Herpes simplex virus type (1)? Common in which age group?

A

Older adults

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4
Q

signs & symptoms of HSV infection?

A

Fever
Malaise
Headache
Confusion
Seizures

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5
Q

Investigation for HSV?

A
  • CT not sensitive for temporal lobe changes
  • CSF - Lymphocytosis & Elevated proteins
  • HSV PCR highly specific
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6
Q

Treatment of HSV?

A

Acyclovir

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7
Q

Prognosis for HSV encephalitis ?

A
  • Untreated mortality > 70%
  • Treated mortality < 20%
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8
Q

Complications post-SAH endovascular intervention?

A
  • Re-bleeding (unlikely after successful procedure)
  • Hydrocephalus
  • Delayed cerebral ischaemia (common: Day 4-21)
  • Seizures
  • Neurogenic pulmonary oedema
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9
Q

Types of hydrocephalus ?

A
  • Acute
  • Chronic / delayed onset
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10
Q

Mechanism of acute hydrocephalus?

A

Blockage in the flow of CSF within the ventricles due to intraventricular blood

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11
Q

Mechanism of chronic / delayed onset hydrocephalus?

A

Reduced absorption of CSF by the arachnoid villi due to fibrosis or inflammation

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12
Q

Mechanism of delayed cerebral ischaemia?

Note: May cause new neurological deficit or reduced GCS

A
  • Due to breakdown of blood products causing vasoconstriction
  • High risk day 7-10 post-bleed
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13
Q

Management of delayed cerebral ischaemia?

A
  • Nimodipine
  • Endovascular intervention
  • Hypertension
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14
Q

Management of Hydrocephalus?

A
  • Extra-ventricular drain
  • Shunt (chronically)
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15
Q

Indication for intubation in myasthenia gravis?

A
  • Decline in spirometry
  • Hypercapnia
  • Respiratory failure
  • Inability to clear secretions
  • Bulbar dysfunction
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16
Q

Whats is myasthenia gravis?

A

Disorder of the nuro-muscular junction (AchR antibodies) where autoantibodies block the nicotinic acetylcholine receptor and respiratory failure occurs.

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17
Q

Treatment of Myasthenia gravis?

A
  • Steriods
  • Plasma exchange (vs) IVIg
18
Q

Neuro-protectibve measures in traumatic brain inury ?

A
  • ICU admission
  • Intubation
  • Serial examination of neuro & pupil
  • Head elevation 30-45 degrees
  • Analgesia & Sedation
  • Temperature management
  • Anti-seizure medication
  • CPP > 60mmHg
19
Q

What is central diabetes insipidus?

A

Deficiency of vasopressin (ADH) due to dysfunction of posterior pituitary or hypothalamus. Inability to absorb water in the collecting duct

20
Q

Signs & symptoms of Central Diabetes Insipidus?

A
  • Inability to concentrate urine
  • Hypernatraemia
  • High serum osmolality / Low urinary osmolality
21
Q

Pathophysiology of DKA?

A
  • Insulin deficiency
  • Hyperglycaemia
  • Osmotic diuresis
  • Hypovolaemia
  • Inability to utilise glucose
  • Ketosis & acidosis
22
Q

What is the normal anion gap?

A

8-12

23
Q

How do you calculate anion gap?

A

(Na + K) - (HCO + Cl) =

24
Q

Causes of NAG metabolic acidosis?

Note: Normally loss of HCO & Na - Tx - NaHCO3

A
  • Hyperchloraemia
  • Ileal-conduit
  • Diarrhoea, ileostomy & fistula
  • Renal tubular acidosis
  • Addison’s disease
25
Q

SGLT2 inhibitors? (Dapagliflozin)

A
  • Associated with HAG metabolic acidosis
  • Normal blood sugar (Euglycaemic DKA)
  • ## Prevents re-absorption of glucose in the PCT (Blocks SGLT2 proteins)
26
Q

SGLT2 inhibitors? (Dapagliflozin)

A
  • Associated with HAG metabolic acidosis
  • Normal blood sugar (Euglycaemic DKA)
  • Prevents re-absorption of glucose in the PCT (Blocks SGLT2 proteins)
  • Decreases insulin production & increases glucagon production
  • Increases urinary glucose excretion
  • Promotes shift from glucose to fat metabolism
27
Q

Diagnosis & management of hyponatraemia?

A

See picture attached
Rapid correction requires 1.8% Normal Saline.

28
Q

Reasons for weakness needing ICU admission?

A
  • Malnutrition / Sepsis
  • Myasthenia gravis / Guillain-Barre Syndrome / Botulism / Tetanus
  • Respiratory muscles weakness / Weak swallowing
29
Q

Common causes of weakness?

A
  • Guillain-Barre Syndrom
  • Myasthenia Gravis
  • Botulism
  • Acquired critical illness neuropathy
30
Q

Differential diagnosis of NM weakness?

A
  • Brainstem
  • Spinal cord transverse myelitis
  • GBS
  • Myasthenia gravis
  • Botulism
  • Lambert-Eaton Syndrome (lung cancer)
  • Steroid myopathy
  • Polio
  • Periodic paralysis associated with low potassium
  • Porphyria
  • MND
31
Q

Clinical signs of bulbar involvement ?

A
  • Reduced cough strength
  • Difficulty in swallowing
  • Deviation of the tongue on protrusion
  • Changes in voice
32
Q

How to measure the strength of respiratory muscles ?

A
  • Maximal Inspiratory Pressure (manual occlusion of circuit)
  • Maximal expiratory pressure
  • Forced vital capacity (Spirometry)
33
Q

How to measure weakness?

A
  • MRC sum score (48 cut-off score)
34
Q

Components tested in MRC sum score?

A
  • Shoulder forward flexion
  • Forearm flexion
  • Writst flexion
  • Thigh flexion
  • Leg extension
  • Foot flexion
35
Q

What is GBS?

A
  • Ascending paralysis
  • Associated with Campylobacter diarrhoea (stool)
  • It can be immunilogically mediated
  • Raised proteins in CSF
  • Bulbar palsy + Peripheral weakness
  • Associated with Anti-GM1 & Anti-GQ1b
  • Loss of reflexes
36
Q

Management of GBS?

A
  • Consider IVIG
  • Plasma exchange
  • Supportive care
37
Q

Signs & symptoms of Miller-Fisher Syndrome?

A
  • Ophthalmoplegia
  • Sensory ataxia
  • Areflexia
38
Q

Drugs exacerbating myasthenia gravis ?

A
  • Gentamicin/ Streptomycin
  • Tetracycline
  • Quinine
  • Lignocaine
  • Muscle relaxant
39
Q

What is botulism?

A
  • Associated with drug users
  • Visual disturbance
  • Diplopia
  • Muscle weakness
  • Droopy eye-lids
  • Pre-synaptic disorder of NMJ
40
Q

Diagnosis of GBS and other neurological conditions?

A
  • Neurophysiological studies

EDIC Part (1) Course Notes (8 decks)

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