Acquired Metabolic Disorders

Question 1

Most common early imaging changes in severe hypoxic injury

Answer 1

Loss of distinction between gray and white matter

Question 2

When does delayed posthypoxic encehalopathy occur?

Answer 2

1-4 weeks post ictus

Question 3

4 clinical signs at day 1 after cardiac arrest that predicts a poor neurologic outcome or death:

Answer 3

1. Corneal reflex absent
2. Pupils nonreactive
3. No withdrawal to pain
4. No motor response

Question 4

Complications of therapeutic hypothermia (4)

Answer 4

Hypotension
Bleeding
Ventricular ectopy
Infection

Question 5

Predominant symptoms in the delayed category post carbon monoxide poisoning

A) headache
B) papilledema
C) seizures
D) extrapyramidal features

Answer 5

D) extrapyramidal features

Question 6

Characteristic lesions of CO poisoning that had produced coma

Answer 6

Early: mild cerebral edema

Late: discrete lesions in the gp > inner putamina

Question 7

Treatment of CO poisoning

Answer 7

Initial: inspired oxygen

Carboxyhgb > 40% or w coma or sz: hyperbaric

Question 8

In mountain sickness, HA, n/v, weakness, insomnia can be experienced at ____ ft

Answer 8

8,000

Question 9

Which of the following is NOT true of Monge Disease?

A) also called chronic mountain sickness
B) a/w pulmonary hypertension
C) a/w secondary polycythemia
D) a/w daytime headaches
E) a/w mild mental dullness

Answer 9

D) a/w daytime HAs

Monge Disease a/w nocturnal headache & papilledema

Question 10

Which of the following is NOT true of hypercapnic pulmonary disease?

A) Papilledema may be asymmetric
B) a/w myoclonus and asterixis
C) Frequently a/w prolonged coma
D) fast-frequency tremor

Answer 10

C) Frequently a/w prolonged coma

Prolonged coma is rare (compared to hypoxic enceph)

Question 11

Causes of hypercapnic pulmonary disease:

Pulmo (3)
Neurologic (2)

Answer 11

Pulmo

1. COPD
2. Emphysema
3. Fibrosing lung disease

Neuro

1. Neuromuscular weakness
2. Medullary respiratory center involvement

Question 12

Which of the following treatment measures for chronic hypercapnic pulmonary disease is NOT true?

A) Use of PPV
B) Phlebotomy
C) Antibiotics
D) Aminophylline may produce high BP and seizures
E) None of the above

Answer 12

E) None of the above

Question 13

At what glucose level do you expect:

a) Confusional state, seizures
b) Coma, irreparable brain injury

Answer 13

a) 30mg/dL

b) 10mg/dL

Question 14

Most common causes (top 3) of hypoglycemic encephalopathy?

Answer 14

Insulin/diabetic agent use
Pancreatic tumor
Depletion of liver glycogen

Question 15

Seizures and focal signs such as a hemiparesis, a hemisensory defect, choreoathetosis, or a homonymous visual field defect are more common in ______ than in any other metabolic encephalopathy and may erroneously suggest the possibility of a stroke.

Answer 15

Hyperosmolar nonketotic hyperglycemia

Question 16

What is a sensitive and reliable indicator of impending coma for hepatic encephalopathy?

a) MRI
b) GCS
c) EEG
d) Serum ammonia

Answer 16

c) EEG

Findings:
Paroxysms of bilaterally synchronous slow or triphasic delta waves
Initially frontally
Interspersed with alpha activity

Question 17

MRI findings in hepatic encephalopathy?

Due to?

Answer 17

Symmetric T1 hyperintensities in the globus pallidus

2/2 manganese deposition

Question 18

Histologic finding in hepatic encephalopathy?

Answer 18

Alzheimer type II astrocytes

Question 19

Mainstay of treatment in hepatic encephalopathy?

Answer 19

Oral lactulose

ammonia -> ammonium

Question 20

Main cause of death in patients awaiting liver transplants (neurologic)

Answer 20

Cerebral edema

Question 21

5 treatment measures for Reye Syndrome?

Answer 21

HHIT Lactulose

Hemodialysis
Hypertonic solutions
Intravenous glucose
Temperature control
Lactulose

Question 22

Which of the following is true regarding Uremic Encephalopathy?

a) Progressive neurologic deterioration
b) Myoclonic twitches disappear during sleep
c) Uremic patients are prone to infections, including meningitis
d) Cerebral edema is evident

Answer 22

c) Uremic patients are prone to infections, including meningitis
* Symptoms fluctuate
* Myoclonic twitches are incessant during wakefulness and sleep
* Cerebral edema is notably absent

Question 23

This neurologic symptom occurs in up to 70% of dialysis disequilibrium patients

Answer 23

Headache

Question 24

Population of HD patients who present with dialysis disequilibrium (those at risk)

Answer 24

Pts undergoing rapid HD

Early stages of dialysis program

3rd-4th hour of HD / 8-48 h after completion

Question 25

Characteristically, dialysis encephalopathy begins with ____

Answer 25

Dysarthria (hesitant, stuttering) Aphasia

Question 26

A characteristic clinical feature of dialysis encephalopathy is transient improvement in speech with _____

Answer 26

IV diazepines

Question 27

Pathologic changes in dialysis encephalopathy include microcavitation more severe in _____

Answer 27

left frontotemporal operculum

Question 28

Which of the following are considered common symptoms in septic encephalopathy? a) Asterixis b) Focal cerebral disorder c) Myoclonus d) Paratonia, polyneuropathy

Answer 28

d) Paratonia, polyneuropathy

Question 29

Which of the following is NOT a cause of SIADH? a) Head trauma b) GBS c) Cerebral infarction d) Neoplasm e) None of the above

Answer 29

e) None of the above Other causes: Bacterial meningitis SAH

Question 30

Fluid intake restriction for the following Na levels. Format ___ ml/24h a) Na < 120 mEq/L b) Na < 130 mEq/L c) Na 130 mEq/L

Answer 30

a) Na < 120 mEq/L: 500ml/24h b) Na < 130 mEq/L: 1,000 ml/24h c) Na 130 mEq/L: 1,500 ml/24h

Question 31

Calcium level that produces neurologic symptoms

Answer 31

Ca > 12 mg/dL

Question 32

MCC of hypercalcemic encephalopathy a) young patient b) older patients

Answer 32

a) young - hyperparathyroidism | b) older - osteolytic bone tumors, mets, MM

Question 33

True or false: delirium and convulsions are common in hypercalcemic encephalopathies

Answer 33

False

Question 34

What is the essential pathologic attribute of CPM?

Answer 34

Dissolution of sheaths of myelinated fibers and sparing of neurons

Question 35

More than 1/2 of CPM cases occur in the late stages of _____

Answer 35

Chronic alcoholism

Question 36

CPM by the numbers: a) Occurs in rapid correction of pts w/ initial serum Na ___ b) Correct hyponatremia by ___ within 24 h ___ within 48 h

Answer 36

a) <130 mEq/L b) 10 mEq/L x 24h <21 mEq/L x 48h

Question 37

Non-wilsonian vs. wilsonian hepatocerebral degeneration: Cirrhosis is more common in? Cortical lesions are more common in?

Answer 37

Both in Acquired / Non-Wilsonian Hepatocerebral Degeneration

Question 38

Hyperthermia severely affects which part of the brain?

Answer 38

Cerebellum

Question 39

Most frequent and potentially preventable and correctable metabolic cause of encephalopathy in the world

Answer 39

Neonatal Myxedema (Cretinism)