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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
Q

B12 myelopathy + peripheral neuropathy: 4 major features

A

Areflexia
Sensory ataxia
Paraparesis
Extensor plantar response

26
Q

What are folate levels like in B12 deficiency?

A

Normal

27
Q

Fill in the blank: the SNS fibers to the eye exit the spinal cord with _______ –> enter the ______________–> attaches to the _____

A

T1
Cervical sympathetic chain
ICA

28
Q

What can nerve conduction studies reveal in B12 deficiency?

A

Peripheral neuropathy

29
Q

Name the 2 major auto-Abs a/w pernicious anemia and the percentage of patients with each

A

Anti-IF (70%)

Anti-parietal cell (90%)

30
Q

BP lesion only affecting the hand and splitting the ring finger is what nerve?

A

Ulnar

31
Q

Which portion of the ANS supplies part of the muscles for elevating the eyelid: psNS or SNS?

A

SNS

32
Q

3 clinical findings with lesion of the superior part of the SNS?

A

Miosis
Enophthalmos
Anhidrosis

33
Q

SNS to the eye originates in which part of the brain?

A

Hypothalamus

34
Q

Fill in the blank: the SNS fibers exit the spinal cord with _______ –> enter the ______________–> attaches to the _____

A

T1
Cervical sympathetic chain
ICA

35
Q

A tumor in the chest will affect which BP cord first?

A

Medial

36
Q

When discussing BP lesions, any tingling or numbness above the wrist is due to lesion of which 2 possible types of structures?

A

Root or cord

37
Q

BP lesion only affecting the hand and splitting the ring finger is what nerve?

A

Ulnar

38
Q

Name 3 brainstem causes of horners syndrome

A
  1. Glioma
  2. Infarct
  3. Syringobulbia
39
Q

Name 2 cervical cord causes of horners syndrome

A
  1. Glioma

2. Syringomyelia

40
Q

Name 2 T1 root causes of horners syndrome

A
  1. Neurofibroma

2. BP lesion

41
Q

Name 2 ICA causes of horners syndrome

A
  1. Occlusion

2. Dissection

42
Q

Name 2 causes of horners syndrome not specifically localized to brainstem, cervical cord, T1 root, or ICA

A
  1. Cluster HA

2. Pancoast tumor

43
Q

2 Abx that can be used in Ppx of meningococcal and H flu meningitis?

A

RIF

Cipro

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