Uncovered High-Yield Topics Flashcards
What does a normal CSF study look like?
- Opening pressure 5-20 cm water
- Glucose 50-80 mg/dL (or ~2/3 of serum glucose)
- Protein 15-40 mg/dL
- WBC < 3 (<30 in neonates)
- RBC < 5
AIP vs Wilson’s disease
AIP is acute in onset while Wilson’s is gradual
AIP is associated with neuropathic sensations (abdominal pain w/o tenderness, tingling sensations) while Wilson’s is assocaited with movement disorders.
Five P’s of AIP
- Painful abdomen (often confused for acute abdomen, leading to a belly full of scars)
- Purple urine (urine is colorless initially, but exposure to light causes PBG in urine to oxidize and gives urine its color).
- Peripheral neuropathy (patchy numbness and paresthesias)
- Psychological disturbances (anxiety, confusion, psychosis, dementia)
- Precipitated by drugs or dietary changes (drugs that enhance cytochrome P-450 activity, sulfa drugs, barbiturates, some antipsychotics, alcohol)
Myotonic dystrophy
Myotonia
Delayed muscle relaxation
Should make you think of myotonic dystrophy
In whom should you use amitryptaline with caution?
- Patients over age 65 (it has anticholinergic activity)
- Patients on multiple other drugs that can cause serotonin syndrome
Steroid psychosis
People on high dose steroids can have steroid-induced psychosis!
Little is known about underlying risk factors, but if someone develops new psychosis on high-dose steroids you should trial holding the steroids.
Classic onset of ALS
- Dysphagia
- Dysarthria
- Tongue fasciculations
- Paradoxical breathing (expansion of abdomen on expiration rather than inspiration, caused by diaphragmatic weakness)
Things that mess with anterior horn cells
- Heritable syndromes (spinal muscular atrophy)
- Lead poisoning
- Polio myelitis
- West Nile Virus myelitis
Treatment of PCP intoxication
- Involves treatment of agitation and aggression
- Benzodiazepines
Really, most parotid gland masses are benign. But, if they grow to involve ___, they are probably malignant.
Really, most parotid gland masses are benign. But, if they grow to involve the facial nerve, they are probably malignant.
What diseases does a negative ANA likely exclude?
- SLE
- Scleroderma
-
MCTD
- The sensitivity for these diseases is quite high (>90%), but still not entirely perfect. Other diseases you really shouldn’t take a negative ANA into much consideration since it is closer to ~50% positivity
Wilson’s disease pathophysiology
- Autosomal recessive disorder
- Mutation in ATP7B, a transport protein
- It is genetic!! Not just copper toxicity
- Characterized by the reduced excretion of copper into the bile secondary to a transport abnormality, leading to the pathologic accumulation of copper in the liver and other tissues, particularly the brain
Copper chelators
- Penicillamine – pee out copper
- Trientine – poop out copper
Delayed facial nerve palsy
Sometimes occurs after trauma to the head
Basically, the facial palsy does not develop until ~24-48 hours later, when the edema becomes more significant
When this occurs, it will be a complete facial nerve palsy, not an isolated lower facial nerve palsy. The latter should be concerning for epidural hemorrhage.
Connection of the frontal eye field to the cranial nerves
Chiari malformation
Type I: Cerebellum into the spinal cord
Type II: More cerebellum into the spinal cord, and a myelomeningocele
COAT RACK for Wernicke’s and Korsakoff’s
A lesion above the red nucleus leads to resting ___.
A lesion below the red nucleus leads to resting ___.
A lesion above the red nucleus leads to resting flexion.
A lesion below the red nucleus leads to resting extension.
Basically think of the red nucleus as sending out a default “extend” signal to the body, which is overridden by cortical input.
Sign of diffuse axonal injury on CT
“Blurring of white-gray junction”
Various temporal lobe functions
Causes of Kluver-Bucy syndrome
Presentation/Features of Kluver-Bucy syndrome
What do the superior colliculi regulate?
What commonly damages them?
They regulate vertical gaze (superior/inferior)
They are commonly damaged in Parinaud syndrome
Quick rule of thumb for HIV infections and CD4s
Mnemonic for normal pressure hydrocephalus
“Wet, wild, wacky”
Wet – urinary incontinence
Wild – gait unsteadiness
Wacky – dementia
Whipple’s disease
- Mostly in males over age 40
- Intracellular gram + bacteria that stains on PAS
- Clinical features:
- Malabsorption + abd pain + diarrhea
- Arthritis
- Movement symptoms (ataxia, myoclonia, ophthalmoparesis)
- Diagnosis: Small intestine biopsy with PAS staining (if GI symptoms present). PCR testing also available for GI or CSF samples.
- Treatment: IV ceftriaxone or penicillin for 2-4 weeks, then batrim for 1 year.
Transient global amnesia
- Presentation: Abrupt onset, transient memory loss following psychological stress or vigorous exercise
- Amnesia is anterograde, sometimes with partial retrograde
- By definition, takes < 24 hours to resolve, and resolution is complete
- Diagnosis: Clinical, but EEG and MRI have associated findings and can rule out other etiologies
- EEG: rule out epilepsy/simple partial seizure
- MRI: Shows focal hyperintensities in the hippocampi
- Treatment: None. Self-resolving. Sometimes may monitor for 24 hours if the diagnosis is in question.
Two types of infection from Taenia sollium
- If acquired from ingestion of larva in raw pork: Intestinal taeniasis
- May be asymptomatic
- May present with GI upset or malabsorption (similar to trichinellosis or ascariasis)
- If acquired from eggs in human faeces (ie, in someone who was infected with intestinal taeniasis): Cysticercosis
- May manifest in several tissues
- Neurocysticercosis: Headache, elevated ICP, FNDs, seizures. MRI w/ multiple ring-enhancing lesions (early stage). LP w/ eosinophilia.
- Ocular cysticercosis: Subretinal cysts on ophthalmologic exam
Waterhouse-Friderichsen syndrom
- An endotoxin-triggered coaguolpathy that may be induced by Neisseria meningitidis
- Characterized by the purple, spotty purpura of N. meingitidis and acute adrenal insufficiency or adrenal hemorrhage.
Treatment for cryptococcal meningitis
- Induction therapy with amphotericin B + flucytosine
- Maintenance with 8 weeks of fluconazole
Uncal herniation syndrome (Garret)
Ipsilateral CN 3 palsy
Contralateral paralysis
Risk of ipsilateral PCA strokes
– The medial temporal lobe is squished against the midbrain
Diffuse cerebral edema in cardiac collapse
Due to hypoxic injury
Metabolic encephalopathies may precipitate ___
Metabolic encephalopathies may precipitate diffuse cerebral edema
ICP ladder
- Head of bed at 30 degrees
- Hyperventilation
- Hypertonic saline / mannitol
- Skull decompression
- Therapeutic hypothermia
Prophylactic hemicraniectomy
- If you have a patient with a large territory infarct, this may result in cerebral edema that can be life threatening
- Hemicraniectomy may be performed to prevent life threatening herniation
Right MCA language changes
- Prosody changes
- Anomia
- Paraphasic errors
Treatment for neurocysticercosis
Praziquantel and Albendazole
Area postrema syndrome
Subtype of neuromyelitis optica (NMO), hence anti-AQP4 will be present.
Characterized by episodes of intractable nausea, vomiting, and/or hiccups
MRI shows enhancement of just the area postrema, which is in the dorsal medulla just inferior to the cerebellum.
