Neuromuscular Dz, TBI, Intracranial HTN, Brain death

Question 1

Sx of ALS (Amyotrophic Lateral Sclerosis)?

Answer 1

Ascending paralysis with asymmetric limb involvement over months-years. Tongue fasiculations. Eye movement & sensation are normal.

Question 2

Medical name of Lou Gehrig’s Dz?

Answer 2

ALS (Amyotrophic Lateral Sclerosis)

Question 3

Muscle weakness w/ tongue fasiculations. Dz?

Answer 3

ALS (Amyotrophic Lateral Sclerosis)

Question 4

Other name of Guillain-Barre Dz?

Answer 4

AIDP (Acute Inflammatory Demyelinating Polyneuropathy)

Question 5

Sx of Guillaine-Barre?

Answer 5

Ascending, symmetrical weakness, sensory abnormalities, weeks after diarrhea. Autonomic abnormalities.

Question 6

Muscle weakness w/ autonomic dysfunction. Dz?

Answer 6

Guiallain-Barre Dz

Question 7

Pathophysiologiy of myasthenia gravis?

Answer 7

Post-synatpic AchR antibodies

Question 8

weakness that gets worse with reptition. Dz?

Answer 8

Myasthenia gravis.

Question 9

Thymoma associated with what weakness-causing disease?

Answer 9

myasthenia gravis

Question 10

Muscle weakness w/ occulobulbar weakness. Dz?

Answer 10

Myasthenia gravis.

Question 11

Mimic of myasthenia gravis? Differentiating feature?

Answer 11

Botulism. It has arelexia, dry mouth, ileus.

Question 12

Sx of tick paralysis?

Answer 12

ascending paralysis, preserved sensation, areflexia, opthalmoplegia

Question 13

Sx polio?

Answer 13

asymmetric weakness, legs > arms.

Question 14

Sx Rabies?

Answer 14

Pharyngeal spasms, grimacing encephalitic agitation. Opisthontonos (paraspinal muscle spasms), then paralysis.

Question 15

Paralysis with rash. Dz?

Answer 15

West Nile virus

Question 16

Antibodies (+) in Guillain-Barre?

Answer 16

GM1, GD1a

Question 17

Test of choice for Guillain Barre Dz?

Answer 17

-LP with increased protein & normal WBC. Nerve conduction studies or GM1, GD1a antibodies also plausible.

Question 18

Tx of Guillain-Barre Dz?

Answer 18

Anticholinesterase, IVIG, Plasma exchange. Corticosteroids. Thymectomy.

Question 19

Tests (2) for botulism?

Answer 19

Repetitive nerve stimulation shows presynaptic block. Toxin demonstration in blood, stool, wound.

Question 20

Test for rabies?

Answer 20

PCR from CSF shows viral RNA. Pleocytosis with increased protein.

Question 21

Test for polio?

Answer 21

PCR from CSF. Pleocytosis with increased protein.

Question 22

Mechanism of DAI?

Answer 22

axonal shear at grey/white interface is universal. Axon twisting.

Question 23

Test of choice for DAI?

Answer 23

MRI

Question 24

Indications for seizure ppx after TBI?

Answer 24

GCS<10, abnormal CT (defines moderate-severe)

Question 25

Duration of seizure ppx?

Answer 25

7 days

Question 26

CT definition of “mild” TBI?

Answer 26

Normal CT.

Question 27

CT definition of “moderate” / grade-IITBI?

Answer 27

cisterns open. <5mm shift. Small, high-density lesions.

Question 28

CT definition of “severe” / grade-III TBI?

Answer 28

Cisterns compressed

Question 29

CT definition of “severe” / grade-IV TBI?

Answer 29

Midline shift >5mm.

Question 30

Indications for surgery in SDH?

Answer 30

> 10mm or shift >5mm.

Question 31

Fluid choice in TBI?

Answer 31

isotonic, non-glucose containing fluids. Albumin caused harm. No evidence for/against prophylactic hypertonic saline or PRBCs.

Question 32

Normal intracranial pressure?

Answer 32

<15.

Question 33

Goal CPP (Cerebral perfusion pressure)?

Answer 33

50-70

Question 34

Indications for ICP monitoring in TBI?

Answer 34

Abnormal CT at admission. Normal CT, posturing, >40yo.

Question 35

Target Osm when using mannitol for TBI?

Answer 35

320

Question 36

Toxicity of mannitol?

Answer 36

renal failure

Question 37

Target Na when using hypertonic saline for TBI?

Answer 37

<155

Question 38

Elements of clinical braindeath exam? (6)

Answer 38

1. Unresponsive to pain.
2. No pupil response.
3. Occulocephalic or occulovestibular reflex absent.
4. No cornea reflex.
5. No gag or cough reflex.
6. Apena.

Question 39

Requirements of apnea testing for braindeath exam?

Answer 39

PaCo2 starts normal, then increases >60. No hypoxemia. 10 minute observation.

Question 40

Duration of flat EEG needed for braindeath exam?

Answer 40

30 minutes.