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Whaba notes 2 Flashcards

1
Q

Why can someone with MG p/w cholinergic crisis?

A

They’re on anti-AchEs

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2
Q

Presenting features of a cholinergic crisis in MG?

A 
Increased salivation
Increased lacrimatin
Vomiting
Abdominal pain
Diarrhea
Sweating 
Pupillary constriction
Fasiculation
Worsening weakness (in extreme cases)
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3
Q

3 major features of Wernicke syndrome?

A 
Acute global confusional state
Abnormal eye movements
Ataxic gait (mostly truncal)
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4
Q

Timeline of Wernicke synd?

A

Evolves over days-wks

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5
Q

5 major cognitive features of Wernicke syndrome?

A 
Inattentiveness
Indifference
Decreased spontaneous speech
Impaired memory
Lethargy
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6
Q

Serious complication of wernicke synd?

A

Progression to coma

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7
Q

2 major ANS signs a/w Wernicke synd?

A

Tachycardia, orthostatic hypoTN

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8
Q

Loss of pupillary reactivity common or uncommon w/ Wernicke syndrome?

A

Uncommon

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9
Q

Describe the basics of Korsakoff syndrome

A

Chronic amnestic disorder, anterograde and retrograde

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10
Q

What are 3 important cognitive features preserved in Korsakoff?

A

Alertness
Attentiveness
Behavior

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11
Q

Which responds to tx- Wernicke or Korsakoff?

A

Wernicke

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12
Q

Underlying etiology of W-K syndrome?

A

Thiamine deficiency

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13
Q

Name 3 things other than alcoholism that can lead to W-K syndrome

A

Chronic hemodialysis
Drugs for obesity
HyperTH

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14
Q

3 features of tx of W-K synd?

A

Thiamine 50-100 mg daily
MVI
Bed rest (2/2 ANS sx)

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15
Q

In Wernicke-Korsakoff syndrome, you’ll see lesions in which 4 areas?

A

Medial thalamus
Hypothalamus
PAG of MB
Mammillary bodies

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16
Q

Describe the 5 features essential to Dx of botulism

A
  1. Hx ingestion home-canned foods or honey (infants)
  2. Rapid onset of ocular symptoms (diplopia, ptosis, blurry vision)
  3. Bulbar sx (dysarthria, dysphagia)
  4. Descending pattern of weakness
  5. Dilated pupils (no psNS)
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17
Q

Describe pathophys of botulism poisoning

A

Ingest toxin–> blood
Toxin irreversible binds to presynaptis nerve endings of PNS and CNS–> internalization of toxin–> blocks Ach release by cleaving polypeptides essential for docking of vesicles

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18
Q

In food borne botulism, what do you ingest that causes Sx?

A

Preformed toxin

19
Q

Describe Sx of food-borne botulism

A 
N/V/D w/in 2-26 hr of ingestion
Constipation (once neuro sx present)
Early neuro: oculobulbar Sx
Respiratory weakness
Unreactive pupils
Areflexia
20
Q

Describe the oculobulbar Sx of botulism (6)

A 
Dry mouth
Blurry vision
Diplopia
Dysarthria
Dysphagia
Dysphonia
21
Q

3 general (non-neuro) s/s of infantile botulism

A

Constipation (early in dz course)
Weak cry
Poor feeding

22
Q

As infantile botulism progresses, what Sx appear following constipation/weak cry/poor feeding? (5)

A 
Progressive weakness
Poor suck
Loss of head control
Hypotonia
Decreased movement
23
Q

3 ANS features of infantile botulism?

A

HypoTN
Tachycardia
Dry mouth

24
Q

For diagnosis of botulism, what can you test for in blood? Stool?

A

Blood: Toxin
Stool: Toxin and C. botulinium

25
What do you see on electrodiagnostic testing in botulism?
Small CMAP in response to supramaximal stimulus
26
Botulism can present very similarly to MG. However, which one has much blurrier vision?
Botulism
27
What may you need to do to control respiratory weakness in botulism?
Intubate
28
Beside supportive care, what are 2 drugs you can give in botulism?
Trivalent botulinium antitoxin | Guanidine HCl
29
Trivalent botulinium antitoxin: when should you give it, what are its benefits, and what's its major ADE?
Must give early while toxin is still in blood It decreases severity of disease and overall mortality Anaphylaxis
30
What is the role of anti-Ach drugs in botulism?
Controversial
31
What is a literal paraphasia?
Substitution of one letter for another (wife vs wafe)
32
What is a semantic paraphasia?
Substitution of one word for another (wife vs mom)
33
What type of aphasia is caused by a lesion of the arcuate faciculus of the supramarginal gyrus?
Conduction aphasia
34
Describe fluency, comprehension, and repetition in conduction aphasia
Fluent (w/ paraphesias) Good comprehension Loss of repetition
35
Conduction aphasia: how are writing, naming, and reading? How common is hemiparesis?
Writing- poor Naming and reading- variable Hemiparesis- infrequent
36
What sort of repetitions can you see in conduction aphasia?
Repetitions of substitutions
37
For Wernicke's aphasia, name the: - Broadmann's area: - Location in the brain: - Arterial supply
- BA 22 - Posterior superior temporal lobe on dominant (left) side - Posterior division of MCA
38
Wernicke's aphasia: describe fluency, comprehension, naming, repetition, writing, reading, frequency of hemiparesis
Fluent, paraphesic Poor: comprehension, naming, repetition, writing Variable reading Infrequent hemiparesis
39
Do you see repetitions of substitutions in Wernickes or Broca's aphasia?
Wernickes
40
Broca's aphasia, name the: - Broadmann's area: - Location in the brain: - Arterial supply
- BA 44 - Inferior frontal gyrus - Anterior division of MCA on dominant (left) side
41
Describe speech in Broca's aphasia
Initially mute, then will start saying short sentences
42
Under what circumstances can people with Broca's aphasia read?
If they avoid the hemianopic part of their vision
43
Broca's aphasia: describe fluency, comprehension, naming, repetition, writing, reading, grammar, and frequency of hemiparesis
``` Nonfluent Intact comprehension Poor naming, repetition, writing Variable reading Disordered grammar Hemiparesis common ```

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