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Peds neuro boards, V2 > Nutritional / Neurotox > Flashcards

Nutritional / Neurotox Flashcards

1
Q

Symptoms (5) and treatment (4) for TCA overdose

A
  1. Symptoms
    1. widened QRS
    2. Hypotension
    3. anticholinergic effects
    4. SIADH
    5. Serotonin syndrome (if combined with other drugs)
  2. Treatment
    1. IV sodium bicarbonate
    2. Intubate if unresponsive
    3. IV fluids
    4. Activated charcoal if <2 hours since ingestion
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2
Q

Mechanism of PCP intoxication

A

Antagonism of NMDA receptors

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3
Q

Symptoms (5) and treatment of Arsenic Poisoing

A

Symptoms

  1. Stocking glove sensorimotor neuropathy
  2. diffuse hyperpigmentation
  3. GI disturbance
  4. “garlicky” odor
  5. Mees’ lines in nails (also seen with chronic renal failure and other heavy metal poisining

Treatment

  1. chelation with dimercaptopurol or dimercaptosuccininc acid (DMSA)
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4
Q

Symptoms of n-Hexane inhalation (5)

A
  1. CNS depression
  2. progressive, symmetric, ascenting sensorimotor peripheral axonopathy (“glue-sniffer neuropathy”)
  3. Facial numbness
  4. maculopathy
  5. optic neuropathy
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5
Q

Symptoms associated with Lead toxicity

Child (acute) - 5

Child (Chronic) - 2

Adult - 3

A
  1. Children (acute) = Lead encephalopathy
    1. Mental status changes
    2. Seizures
    3. Papilledema
    4. Cerebral edema
    5. Death
  2. Children (Chronic)
    1. Developmental / behavioral problems
    2. Low intelligence / school performance
  3. Adults = PNS toxicity
    1. Subacute motor > sensory axonopathy
    2. wrist / finger extension weakness is classic
    3. May be more nonspecific distal sensorimotor neuropathy
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6
Q

Symptoms of Mercury Poisoining:

  1. Common to all
  2. Organic (7)
  3. Elemental (6)
  4. Inorganic (13)
A
  1. Common to all
    1. Behvioral changes
  2. Organic (seafood ingestion)
    1. tremors / ataxia (floppy like a fish)
    2. visual field defects (think “fish can’t see in front of them”)
    3. Hearing loss (think “hard to hear underwater”)
    4. circumoral / acral parasthesias / neuropathy (think “gaping fish mouth)
    5. GI
    6. coma / death
  3. Elemental mercury (dental fillings, thermometers)
    1. “erethism”
      1. Gingivitis
      2. tremor (Danbury shakes)
      3. hallucinations
      4. memory loss / depression
      5. fatigue / somnolence
  4. Inorganic (industrial toxin) (think johnny depp’s mad hatter, though hatters typically get elemental poisoning)
    1. “pink disease”
      1. painful, red, swollen fingers and toes (think mad hatter’s fingers in Alice in wonderland)
      2. desquamation of hands and feet
      3. psychiatric changes (“mad as a hatter”)
      4. loss of appetitie (only drinks tea)
      5. sweating
      6. salivation
      7. rash
      8. hair loss (no way that was Depp’s real hair)
      9. pruritiis
      10. photophobia
      11. GI
      12. Cardiac disturbances
      13. acute tubular necrosis / nephrotic disease
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7
Q

Symptoms (5) and treatment (1) of Thallium Poisining

A
  1. rapid onset painful sensory neuropathy
  2. alopecia (helps differentiate it from arsenic)
  3. (less commonly)
    1. cranial neuorpathies
    2. encephalopathy
    3. GI / Cardiac effects

Treatment = prussian blue

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8
Q

Diagnosis of arsenic poisioning

Acute

Chronic

A

Acute = Urine

Chronic = Hair (beware of incidental / non-toxic slight elevations!)

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9
Q

Symptoms / MRI findings of Manganese toxicity (5 + 2)

A
  1. Tremor
  2. parkinsonism
  3. dystonia
  4. cognitive
  5. T1 brightness in globus pallidus
  6. Possible association with parkinsonism and liver cirrhosis
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10
Q

Symptoms of Zinc Toxicity (4)

A
  1. copper deficiency
  2. myelopathy
  3. myeloneuropathy
  4. anemia with leukopenia
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11
Q

Treatment for benzodiazepine overdose

A
  1. Supportive vs flumazenil
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12
Q

Onset and symptoms (7) of Delirium Tremens

A
  1. Onset 48-96 hours after last drink
  2. Symptoms
    1. Hyperventilation > respiratory alkalosis
    2. cerebral blood restriction
    3. hyperthermia
    4. autonomic instability
    5. arrythmia
    6. disorientation
    7. delirium
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13
Q

Chronic neurologic effects of alcohol abuse (6)

A
  1. Korsakoff psychosis (after Wernicke’s)
  2. alcoholic cerebellar degeneration (vermian atrophy w/ gait ataxia)
  3. cerebral atrophy, cognitive impairment
  4. peripheral neuropathy
  5. myopathy
  6. Marchiafava-bignami disease (necrosis of CC in malnourished alcoholics)
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14
Q

Mechanism and Treatment for Organophosphate Poisoning

A

Mechanism

  1. binds to acetylcholinesterase in neurons and NMJ (flaccid paralysis w/ fasciculations) > buildup of acetylcholine

Treatment

  1. Atropine
  2. pralidoxime
  3. seizures mgmt w/ benzos
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15
Q

Carbon Monoxide Poisoning

Early (3) and late (4) effects

A

Early = non-specific

  1. headache, diziness, diminished concentration
  2. dyspnea
  3. chest pain

Late, can start up to 1 month later

  1. movement d/o
    1. parkinsonism-like features (shuffling gait, retropulsion)
    2. sometimes hyperkinetic
  2. Behavioral changes
    1. slowed cognition
    2. abulia
    3. mutism
  3. Cortical blindness
  4. incontinence
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16
Q

MRI abnormalities in Carbon monoxide poisining

A
  1. T2 hyperintensities or necrosis in pallidum / Basal ganglia
  2. Leukoencephalopathy
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17
Q

Vitamin A

  1. Symptoms of defiency (1)
  2. Symptoms of toxicity
    1. Acute (4)
    2. Chronic (6)
    3. other (1)
A

Vitamin A (retinol)

Symptoms of Deficiency

  1. Blindness
  2. poor bone growth
  3. hyperkeratosis

Toxicity

  1. Acute
    1. nausea / vomiting
    2. headache
    3. altered mental status
    4. anorexia
  2. Chronic
    1. osteoporisis / fractures
    2. hair loss
    3. dry skin
    4. insomnia
    5. fatigue
    6. Pseudotumor cerebri
  3. Also birth defects
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18
Q

Vitamin D

Symptoms of Deficiency (4)

Symptoms of Toxicity (2)

A

Deficiency

  1. rickets (children)
  2. osteomalacia (adults)
  3. hypocalcemic tetany
  4. predisposition to MS, Parkinsons, and Alzheimers

Toxicity

  1. Hypercalcemia
  2. Pancreatitis (from hypercalcemia)
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19
Q

Vitamin E

  1. Function
  2. Deficiency
  3. Toxicity
A

Function

  1. antioxidant, exact function is debated

Deficiency

  1. spinocerebellar ataxia 2/2 poor nerve conduction
  2. myopathy
  3. vision changes / night blindness
  4. hemolytic anemia

Toxicity

  1. Not necessarily toxicity, but supplementation may predispose to hemorrhagic stroke
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20
Q

Vitamin K

  1. Symptoms of deficiency
A
  1. Deficiency
    1. Prolonged PT and PTT
    2. no effect on bleeding time and platelet count
21
Q

Vitamin B1

Symptoms of deficiency (9)

A

Vitamin B1 (thiamine)

  1. “wet beriberi”
    1. Heart failure
    2. edema
  2. “dry beriberi”
    1. pain, parathesias, weakness
    2. Laryngeal involvement is common (weak voice)
  3. weight loss
  4. emotional disturbances
  5. Wernicke’s encephalopathy
  6. irregular heartbeat
  7. (chronic) korsakoff’s syndrome

No real toxicity

22
Q

Vitamin B2

Symptoms of defiency (7) and toxicity

A

B2 (riboflavin)

Deficiency = ariboflavinosis

  1. Photosensitivity
  2. cheilosis (cracked lips)
  3. Glossitis
  4. seborrheic dermatitis / pseudo-syphillis (particularly affecting scrotum/labia majora and mouth)
  5. phayrngitis
  6. hyperemia
  7. edema of pharyngeal and oral mucosa

Excess

  1. too much B2 can generate free radicals in eyes and skin when exposed to sun and light
23
Q

B3

  1. Symptoms of deficiency (5)
  2. Symptoms of toxicity (4)
A

B3 (niacin)

Deficiency = pellagra

  1. Diarrhea
  2. Dermatitis
    1. face, neck, dorsal surfaces of limbs
    2. looks a little like a sunburn
  3. Dementia
  4. weakness
  5. Insomnia

Excess

  1. Flushing
  2. nausea
  3. vomiting
  4. signs / sx of liver toxicity
24
Q

Vitamin B5

Symptoms of deficency (2)

A

Vitamin B5 (pantothenic acid)

Deficiency (rare)

  1. acne
  2. parasthesia

No known toxicity

25
Q

B6

Symtpoms of deficiency (6)

Symptoms of toxicity (2)

A

Pyridoxine

Deficiency

  1. Microcytic anemia
  2. depression
  3. dermatitis
  4. hypertension
  5. water retention
  6. elevated levels of homocysteine
  7. axonal neuropathy

Toxicity

  1. sensory neuronopathy (look for ataxic gait)
  2. dermatological lesions
26
Q

B7

Symptoms of deficiency (2)

A

B7 (Biotin)

Deficiency

  1. Impaired growth and neurologic disorders in infants

No known toxicity

27
Q

B9

  1. Symptoms of deficiency (3)
  2. Symptoms of toxicity (1)
A

B9 (folic acid)

Deficiency

  1. macrocytic anemia
  2. elevated levels of homocysteine
  3. NT defects (in pregnant women)

Toxicity

  1. masks B12 deficiency, which can lead to permanent neurological damage
28
Q

B12

Deficiency (5)

Toxicity (1)

A

B12 (cobalamin)

Deficiency (more common in elderly and in perinicious anemia)

  1. macrocytic anemia
  2. elevated homocysteine
  3. peripheral neuropathy
  4. memory loss / other cognitive defecits
  5. Mania / psychosis

Toxicity

  1. Acne-like rash
29
Q

Vitamin C deficiency

A
  1. scurvy
    1. Bleeding mucus membranes
    2. spongy gums
    3. brown skin spots
30
Q

Symptoms of Psilocybin ingestion (4)

A
  1. Hallucinations
  2. myadriasis
  3. tachycardia
  4. hyperthermia
31
Q

Symptoms of Mescaline ingestion (3)

A
  1. Nausea / vomiting
  2. diaphoresis
  3. Hallucinations
32
Q

Vitamin Deficiencies that lead to increased Homocystine and how to differentiate among them

A
  1. Pyridoxine (B6)
    1. Microcytic anemia
  2. Folic Acid (B9)
    1. Macrocytic anemia
    2. NTD
  3. Cyanocobalamin
    1. Macrocitic anemia
    2. Peripheral neuropathy
    3. Memory loss
33
Q

Symptoms of Chronic Selenium Poisoning

A
34
Q

Differntiate between two toxic exposures resulting in “garlicky breath”

A
  1. Arsenic
    1. “Mees lines” on nails
  2. Selenium
    1. Sloughing of nails
    2. hair loss

Both have

  1. Gi disturbance
  2. irritability / neurologic impairment
35
Q

Medical Causes for thyrotoxicosis

A
  1. exogenous thyroid replacement (duh)
  2. amiodarone
  3. litium
36
Q

Adverse effects of Amiodarone

A
  1. hyperthyroidism / thryrotoxicosis
  2. hypothyroidism
  3. corneal deposits
  4. optic neuropathy
  5. non-arteritic anterior ischemic optic neuropathy (N-AION)
  6. peripheral neuropathy
37
Q

Mechanism behind tetrodotoxin

A

AKA pufferfish toxin

  1. sodium channel blockade
38
Q

What is this?

A

basophillic stipping (lead poisoning)

39
Q

Occupational exposure table

A
40
Q

What are people with organophosphate poisoning at risk for years later

A

Delayed peripheral neuropathy

41
Q

Ciguatera toxicity

Where is it found?
symptoms

  • GI (3)
  • GU (1)
  • neuro (5)
  • psych (2)
  • derm (2)
A
  1. found in tropical reef fish
  2. Symptoms
    1. GI
      1. abdominal pain
      2. hypersalivation
      3. vomiting / diarrhea
    2. GU
      1. Pain
    3. Neuro
      1. Dysasthesias
      2. burning mouth
      3. “sensory inversion” (hot is cold, cold is hot)
      4. cranial neuropathies
      5. meningeal signs / symptoms
    4. Psych
      1. hysteria / delirium
      2. depression
    5. Derm
      1. rash
      2. hair/nail loss
42
Q

Patient with urinary tract infection is going in for surgery

What herbal supplement would you want to make sure she isn’t taking?

What herbal supplements could result in the opposite effect of the one above?

A

Nettle (taken for UTI’s) can be assocaited with decreased bleeding

Ginko Baloba and Kava Kava can be associated with increased bleeding time.

43
Q

Name herbal supplements that can cause:

Increased Bleeding (2)
Decreased bleeding (1)
Hepatotoxicity (2)
Hallucinations / Psychosis (2)
Serotonin Syndrome (1)

A
  • Increased bleeding
    • Kava Kava
    • Ginko Baloba
  • Decreased bleeding
    • Nettle
  • Hepatotoxicity
    • Kava Kava
    • Black Cohosh
  • Hallucinations / psychosis
    • Kava Kava
    • Yohimbine
  • Serotonin syndrome
    • St. John’s wort
44
Q

Patient is admitted with anorexia nervosa (purging type)

Name 8 conditions you should be worried about

A

Hypochloremia

Alkalosis

Elevated serum bicarbonate

Leukopenia

arrythmia (due to extreme hypokalemia)

hypomagnesemia

hypophosphatemia

hypocalcemia

45
Q

Unique Symptoms of Vitamin Deficiencies:

Seizures (1)
Spinocerebellar Degeneration (1)
Myelopathy (2)

A

Seizures: B6 (pyridoxine)

Spinocerebellar ataxia: Vitamin E

Myelopathy:
Vitamin E
Vitamin D

46
Q

Add-on treatment for hypoglycemia in patients taking metformin

A

Octreotide

47
Q

Conditions that can increase risk for pernicious anemia

A

History of hashimotos thyroiditis

Type 1 diabetes

(i.e. autoimmune conditions)

48
Q

Anti-abuse medications: Mechanism of action

Methadone
Buprenorphine
Naltrexone

A

Methadone: full opiod agonist

buprenorphine: partial opioid agonist

Naltrexone: mu-opioid receptor ANTagonist

Peds neuro boards, V2 (29 decks)

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