Intoxications and Deficiencies

Question 1

45 year old man taking isoniazid for TB prophylaxis.Develops numbness and tingling in his legs and diminished proprioception and vibration to the med calf with absent deep tendon reflexes.

Answer 1

decreased pyridoxine (B6) since INZ causes B6 depletion.

Question 2

Farm worker with nausea and vomiting. He is diaphoretic and diffusely weak with pinpoint pupils.

Answer 2

Organophosphate intoxication

Tx: Atropine for mACh effects. Pralidoxime for nicotinic effects. Sx include muscle weakness, dyspnea, miosis, headache, blurred vision. Serum ACh-esterase is decreased. MRI abnonrmalities in insular cortex and hippocampus

Question 3

Vitamin A excess

Answer 3

Pseudotumor cerebri (MRI shows normal or small, slit-like ventricles.) Do LP.

Question 4

Carbon monoxide poisoning

Answer 4

long term effects: forgetfulness, depression, confusion

Globus pallidus necrosis

Question 5

Thiamine deficiency

Answer 5

Suspect with any combination of confusion with eye movement abnormalities.
Give thiamine before glucose!

Question 6

Vitamin E deficiency

Answer 6

Spinal and Cerebellar signs

Question 7

Lead Poisoning

Answer 7

Autonomic sx (Abdominal pain + constipation) and extensor muscle weakness. Microcytic anemia.

Question 8

Phenytoin and CBZ excess

Answer 8

Cerebellar signs: ataxia, horizontal nystagmus, limb dysmetric, slurred speech
with seizure disorder

Question 9

B12 deficiency

Answer 9

Subacute combined degeneration of spinal cord (Dorsal and lateral column degeneration). Paresthesias in hands and feet, atrophic gastritis, bilateral babinskis signs and hyporeflexia in upper and lower limbs. Vibration and positions sense are diminished in hands and feet.

Question 10

Manganese Toxicity

Answer 10

in basal ganglia. movement stuff– parkinson’s like

Question 11

Ethylene glycol intox

Answer 11

peripheral nerve and cranial nerve dysfunction (almost locked-in)