Systemic and Metabolic disorders (incl intoxications and deficiencies)

Question 1

Thiamine deficiency (B1)

Answer 1

confusion and encephalopathy, eye movement abnormalities. peripheral neuropathy. Think about this in alcoholics. Give thiamine before glucose when in doubt. Suspect in any combination of confusion and eye movement abnormalities.

Question 2

niacin deficency

Answer 2

confusion and encephalopathy, dementia, seizures, ataxia, myelopathy and peripheral neuropathy

Question 3

b12 deficiency

Answer 3

dementia, myelopathy, and peripheral neuropathy (parasthesias)

Question 4

folate deficiency

Answer 4

dementia

Question 5

Vitamin E deficiency

Answer 5

ataxia, peripheral neuropathy. Think about this in someone a broad based ataxic gait and absent reflexes/diminished proprioception in the distal lower extremities. (Spinal and cerebellar signs)

Question 6

B6 (pyridoxine) deficiency

Answer 6

Numbness and tingling in the legs, diminished proprioception and vibration to the mid calf with absent DTRs. Seizures and peripheral neuropathies. Assc’d with isoniazid for TB.

Question 7

Wernicke’s encepholopathy

Answer 7

characterized by the triad of confusion, ataxia and ophthalmoplegia.

Subacute combined degeneration of the spinal cord refers to the damaging effects of B12 deficiency on the posterior and lateral columns of the spinal cord.

Question 8

organophosphate intoxication

Answer 8

Inhibits acetocholynesterase, so you get cholinergic effects. Very lethal. Think nerve gasses like Sarin.

This is nausea, vomiting, diaphresis, diffuse muscle weakness, pinpoint pupils (miosis), dyspnea.

Treat with atropine and pralidoxime. Avoid contact with the person’s clothing.

Question 9

PCP intoxication

Answer 9

think agitated, garrulous, with widely dilated pupils.

Question 10

Vitamin A excess

Answer 10

Can cause psuedotumor cerebri– think about this in acne medications. Look out for daily headaches and bilateral papilledema.

Question 11

Carbon monoxide exposure

Answer 11

Think about this in seasons that are low in infections, esp when people report others in the household have not been feeling well.

Can cause forgetfulness, headache, nausea. Lots of exposure can cause globus pallidus necrosis.

Question 12

lead poisoning

Answer 12

autonomic symptoms (abdominal pain, constipation, etc) and predominance of extensor muscle weakness. (think about this in someone with bilateral wrist/foot drop). Can also cause microcytic anemia.

Question 13

phenytoin or carbamazepine excess

Answer 13

cerebellar signs, like ataxia, slurred speech, dysmmetria, nystagmus.

Question 14

manganese intoxication

Answer 14

Think about this in the setting of total parenteral nutrition. Can cause parkinson-like symptoms like tremor, cogwheeling and limb stiffness. Manganese in basal ganglia manifests as increased signal on T1. This can be seen in cirrhosis of many etiologies as well as in excess of manganese ingestion.

Question 15

hyponatremia

Answer 15

if you see AMS and seizure, think about this. It is the most common electrolyte abnormality in essentially any CNS process.

Question 16

arsenic poisoining

Answer 16

total body rash, nausea, vomiting, tinnitis. Oval patches, increased pigmentation around axillae. Decreased sensation to pinprick over the feet. Grayish lines on the nails.