Neurological disorders

Question 1

Outline the treatment approach for status epilepticus.

Answer 1

1. Maintain airway
2. Obtain IV access, give NS
3. STAT labs: BG, Na, Ca, serum & urine drug screen, anticonvulsant drug levels
4. Thiamine 100 mg IV
5. Dextrose 50 g IV push
6. Lorazepam or diazepam
7. Phenytoin

…..

If not working:

1. Phenobarbital
2. General anesthesia (midazolam, pentobarbital, propofol)

Question 2

Review the Glasgow Coma Scale.

Answer 2

Question 3

How is the GCS score interpreted?

Answer 3

13+: mild brain injury

9-12: moderate injury

< 8: severe brain injury

UpToDate

Question 4

What are the clinical manifestations of pheochromocytoma?

Answer 4

HA, sweating, tachycardia

pallor, HTN

purple book 7-10

Question 5

What are the diagnostic studies used to confirm pheochromocytoma?

Answer 5

1. 24 hr urinary metanephrine & catecholamine measurement
2. Plasma free metanephrines
3. Adrenal CT/MRI
   * purple book 7-10*

Question 6

How is pheochromocytoma treated?

Answer 6

1. alpha blockade - pheoxybenzamine
2. beta blockade - propranolol
3. adrenalectomy
   * purple book 7-10*

Question 7

What are some causes of delirium?

Answer 7

D Dementia
E Electrolyte disorders
L Lung, liver, heart, kidney, brain
I Infection
R Rx Drugs
I Injury, Pain, Stress
U Unfamiliar enviroment
M Metabolic

Question 8

What is the clinical manifestation of delirium?

Answer 8

• Acute onset (hours/days) and a fluctuating course
• Inattention or distraction
• Disorganized thinking or an altered level of consciousness

Question 9

Compare delirium and dementia.

Answer 9