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Whaba notes 1 Flashcards

Brain death criteria Vit B12 deficiency Horner's syndrome Bac meningitis

1
Q

5 major brain death criteria?

A
  1. Clinical/neuroimaging evidence of acute CNS problem c/w brain death
  2. Exclusion of confounders
  3. No intoxication or poisoning
  4. Core temp >36 (90)
  5. Cardinal findings (next card)
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2
Q

5 major brain death criteria?

A
  1. Clinical/neuroimaging evidence of acute CNS problem c/w brain death
  2. Exclusion of confounders
  3. No intoxication or poisoning
  4. Core temp >36 (90)
  5. Cardinal findings (next card)
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3
Q

Cardinal findings of brian death?

A

Coma: no cerebral motor response to pain
Absent BS reflexes (pupils, EOM, facial sensation/motor response, pharyngeal/tracheal reflexes)
Apnea testing

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4
Q

4 requirements to do apnea testing?

A

Core temp 36.5
SBP 90 (UTD says 100)
Euvolemic
Normal arterial PO2

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5
Q

5 scenarios for which confirmatory tests for brain death are recommended?

A
  • Severe facial trauma
  • Preexisting pupillary abnormality
  • toxic levels of any sedating drug
  • sleep apnea
  • severe pulm dz
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6
Q

When to perform repeat exams for brain death in the following groups?

A
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7
Q

Name 5 possible confirmatory tests for brain death

A
  1. Conventional angiography
  2. EEG
  3. TCDUS
  4. Technetium-99m hexamethlpropylene amineoxime brain scan
  5. Somatosensory evoked potentials
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8
Q

Essential clinical pic for dx of B12 deficiency

A

Gradual onset, distal symmetric sensory loss + weakness (late complication)

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9
Q

Cardinal findings of brian death?

A

Coma: no cerebral motor response to pain
Absent BS reflexes (pupils, EOM, facial sensation/motor response, pharyngeal/tracheal reflexes)
Apnea testing

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10
Q

4 requirements to do apnea testing?

A

Core temp 36.5
SBP 90 (UTD says 100)
Euvolemic
Normal arterial PO2

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11
Q

5 scenarios for which confirmatory tests for brain death are recommended?

A
  • Severe facial trauma
  • Preexisting pupillary abnormality
  • toxic levels of any sedating drug
  • sleep apnea
  • severe pulm dz
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12
Q

When to perform repeat exams for brain death in the following groups?

A
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13
Q

Who gets confirmatory tests for brain death, by age group:

1 yo

A

1 yo: optional

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14
Q

Name 5 possible confirmatory tests for brain death

A
  1. Conventional angiography
  2. EEG
  3. TCDUS
  4. Technetium-99m hexamethlpropylene amineoxime brain scan
  5. Somatosensory evoked potentials
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15
Q

Essential clinical pic for dx of B12 deficiency

A

Gradual onset, distal symmetric sensory loss + weakness (late complication)

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16
Q

Why can B12 deficiency occur w/ UMN signs?

A

Concurrent myelopathy

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17
Q

Dx of B12 deficiency?

A

Borderline to low levels of B12 + increased homocysteine and MMA
-if B12 if borderline (150-200 pg/mL), HC and MMC should still be incr

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18
Q

Name 5 major neurologic features of B12 deficiency

A
  1. Myeloneuropathy (subacute combined degeneration)
  2. Cognitive impairment
  3. Optic neuropathy (atrophy is less common)
  4. Isolated cerebellar ataxia
  5. Dementia is less common
19
Q

2 complications of untreated B12 deficiency?

A

Gait instability and muscular atrophy

20
Q

Physical exam findings for B12 deficiency?

A

Decreased proprioception and vibration
Distal weakness
+/- decreased DTRs at ankle w/ Babinski 2/2 subacute combined degeneration

21
Q

2 MC presenting features of B12 deficiency?

A

Myeloneuropathy

Megaloblastic anemia

22
Q

5 major causes of B12 deficiency?

A
  1. Gastric DOs (MC type)
  2. Dietary- rare, only in strict vegetarians
  3. Surgery
  4. IBS
  5. Nitrous oxide abuse
23
Q

Tx of B12 deficiency?

A

1 mg IM cyanocobalamin QD x7d –> IM Qwk x 3mo –> maintenance IM Qmonth or q3mo

24
Q

Describe the myelopathy of B12 deficiency

A

Subacute combined degeneration of corticospinal and dorsal columns

25
B12 myelopathy + peripheral neuropathy: 4 major features
Areflexia Sensory ataxia Paraparesis Extensor plantar response
26
What are folate levels like in B12 deficiency?
Normal
27
Fill in the blank: the SNS fibers to the eye exit the spinal cord with _______ --> enter the ______________--> attaches to the _____
T1 Cervical sympathetic chain ICA
28
What can nerve conduction studies reveal in B12 deficiency?
Peripheral neuropathy
29
Name the 2 major auto-Abs a/w pernicious anemia and the percentage of patients with each
Anti-IF (70%) | Anti-parietal cell (90%)
30
BP lesion only affecting the hand and splitting the ring finger is what nerve?
Ulnar
31
Which portion of the ANS supplies part of the muscles for elevating the eyelid: psNS or SNS?
SNS
32
3 clinical findings with lesion of the superior part of the SNS?
Miosis Enophthalmos Anhidrosis
33
SNS to the eye originates in which part of the brain?
Hypothalamus
34
Fill in the blank: the SNS fibers exit the spinal cord with _______ --> enter the ______________--> attaches to the _____
T1 Cervical sympathetic chain ICA
35
A tumor in the chest will affect which BP cord first?
Medial
36
When discussing BP lesions, any tingling or numbness above the wrist is due to lesion of which 2 possible types of structures?
Root or cord
37
BP lesion only affecting the hand and splitting the ring finger is what nerve?
Ulnar
38
Name 3 brainstem causes of horners syndrome
1. Glioma 2. Infarct 3. Syringobulbia
39
Name 2 cervical cord causes of horners syndrome
1. Glioma | 2. Syringomyelia
40
Name 2 T1 root causes of horners syndrome
1. Neurofibroma | 2. BP lesion
41
Name 2 ICA causes of horners syndrome
1. Occlusion | 2. Dissection
42
Name 2 causes of horners syndrome not specifically localized to brainstem, cervical cord, T1 root, or ICA
1. Cluster HA | 2. Pancoast tumor
43
2 Abx that can be used in Ppx of meningococcal and H flu meningitis?
RIF | Cipro

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