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Psychiatry > SM_91b: Neurology and Nutrition > Flashcards

SM_91b: Neurology and Nutrition Flashcards

1
Q

____ is critical for function especially in high energy areas

A

Thiamine (B1) is critical for function especially in high energy areas

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2
Q

Thiamine (B1) deficiency causes ____

A

Thiamine (B1) deficiency causes Wernicke-Korsakoff syndrome

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3
Q

Describe Wernicke-Korsakoff syndrome (thiamine/B1 deficiency)

A

Wernicke-Korsakoff syndrome (thiamine/B1 deficiency)

  • Wernicke’s encephalopathy: nystagmus, opthalmoparesis, gait ataxia, confusion
  • Korsakoff’s psychosis: anterograde and retrograde amnesia, difficulty retaining simple facts, no insight, confabulation
  • Peripheral neuropathy
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4
Q

Imaging finding of ____ is pathognomonic for thiamine (B1) deficiency

A

Imaging finding of mamillary body hyperintensity is pathognomonic for thiamine (B1) deficiency

(labs: low thiamine level, normal CSF, imaging: medial thalamic hyperintensity, periaqueductal gray matter hyperintensity)

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5
Q

Treat thiamine (B1) deficiency with ____ and ____

A

Treat thiamine (B1) deficiency with high dose thiamine and glucose concurrently/after

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6
Q

Thiamine (B1) deficiency can cause ____, which is a length-dependent peripheral demyelinating and axonal polyneuropathy

A

Thiamine (B1) deficiency can cause beriberi, which is a length-dependent peripheral demyelinating and axonal polyneuropathy

  • Wet beriberi: with peripheral edema
  • Dry beriberi: without peripheral edema
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7
Q

Beriberi caused by thiamine (B1) deficiency presents as ____, ____, and ____

A

Beriberi caused by thiamine (B1) deficiency presents as burning pain / allodynia (small fiber), weakness / hyporeflexia (large fiber), and muscle tenderness on exam

(may be only noticeable on exam or EMG)

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8
Q

Treat beriberi with ____

A

Treat beriberi with high dose thiamine (B1)

(beriberi is thiamine/B1 deficiency)

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9
Q

____ deficiency (pellagra) occurs in malnourished alcoholic patients or underdeveloped maize-eating populations

A

Niacin (B3) deficiency (pellagra) occurs in malnourished alcoholic patients or underdeveloped maize-eating populations

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10
Q

Niacin (B3) deficiency causes ____

A

Niacin (B3) deficiency causes pellagra

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11
Q

Pellagra due to niacin (B3) deficiency presents with ____, ____, ____, and ____ issues

A

Pellagra due to niacin (B3) deficiency presents with skin, GI, blood, and neurological issues

Dermatitis, dementia, diarrhea

  • Skin: scaly -> dermatitis -> hyperpigmentation
  • Neuropsychiatric symptoms: fatigue, anxiety, depression, irritability, apathy, memory deficits
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12
Q

Dermatitis, dementia, and diarrhea is indicative of _____

A

Dermatitis, dementia, and diarrhea is indicative of pellagra (niacin/B3 deficiency)

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13
Q

Treat pellagra (niacin/B3 deficiency) with ____

A

Treat pellagra (niacin/B3 deficiency) with niacin

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14
Q

____ deficiency occurs due to isoniazid use for TB treatment

A

Pyridoxine (B6) deficiency occurs due to isoniazid use for TB treatment

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15
Q

Pyridoxine (B6) deficiency causes ____

A

Pyridoxine (B6) deficiency causes sensory polyneuropathy

  • Parasthesias
  • Pain
  • Weakness
  • Hyporeflexia
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16
Q

Pyridoxine (B6) deficiency is treated with ____

A

Pyridoxine (B6) deficiency is treated with pyridoxine

17
Q

____ deficiency occurs due to methotrexate use

A

Folate (B9) deficiency occurs due to methotrexate use

18
Q

Folate (B9) deficiency causes ____

A

Folate (B9) deficiency causes peripheral neuropathy

19
Q

____ deficiency in pregnancy is associated with NTDs

A

Folate (B9) deficiency in pregnancy is associated with NTDs

20
Q

Treat folate (B9) deficiency with ____

A

Treat folate (B9) deficiency with folic acid

21
Q

Cobalamin (B12) deficiency leads to ____ and ____

A

Cobalamin (B12) deficiency leads to impairment of DNA synthesis and myelin abnormalities

  • Impairment of DNA synthesis because affects folate cycles
  • Myelin abnormalities b/c even chain fatty acids in membranes rather than odd chain
22
Q

Cobalamain (B12) is released from food in the ____, travels to intestine, binds ____ produced by gastric parietal cells, and is absorbed into the ileum

A

Cobalamin (B12) is released from food in the stomach, travels to intestine, binds intrinsic factor produced by gastric parietal cells, and is absorbed into the ileum

23
Q

Describe causes of malabsorption of cobalamin (B12)

A

Causes of malabsorption of cobalamin (B12)

  • Abscence of intrinsic factor (pernicious anemia, antibodies to intrinsic factor or parietal cells)
  • Atrophic gastritis
  • Gastric or ileal resection
  • Celiac sprue
  • Poor nutrition
  • Metformin, possibly PPIs
24
Q

Classic syndrome of cobalamin (B12) deficiency is ____, affecting the ____ and ____

A

Classic syndrome of cobalamin (B12) deficiency is subacute combined degeneration, affecting the corticospinal tracts and dorsal columns

25
Q

Cobalamin (B12) deficiency symptoms include ____, ____, ____, ____, and ____

A

Cobalamin (B12) deficiency symptoms include mild generalized weakness, parasthesias especially in hands, ataxic paraplegia, irritability / apathy / somnolence, and scotoma

  • Parasthesias are tingling / pins and needles
  • Ataxic paraplegia: gait unsteadiness, stifness and weakness in legs
26
Q

Describe exam findings of cobalamin (B12) deficiency

A

Exam findings of cobalamin (B12) deficiency

  • Loss of vibration and position sense
  • Spasticity, clonus, hyperreflexia, Babinski sign
  • May not have objective findings early in deficiency
27
Q

Describe labs in cobalamin (B12) deficiency

A

Labs in cobalamin (B12) deficiency

  • Serum B12 level: < 100 is usually neurological symptoms, < 200 is should evaluate further even without symptoms, 200-300 is can still be B12 deficient
  • Homocysteine: high indicates intracellular B12 deficiency
  • Methylmalonic acid: high indicates intracellular B12 deficiency
  • Check antibody to intrinsic factor and parietal cells
  • Megaloblastic anemia
28
Q

MRI finding in cobalamin (B12) deficiency is _____

A

MRI finding in cobalamin (B12) deficiency is symmetrically abnormally increased T2 signal intensity, commonly confined to posterior ± lateral columns in cervical and thoracic spinal cord

29
Q

Treatment for cobalamin (B12) deficiency is ____

A

Treatment for cobalamin (B12) deficiency is cobalamin

30
Q

Give thiamine ____ glucose

A

Give thiamine before/concurrent with glucose

Psychiatry (37 decks)

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