CH40: Nutritional Deficiency

Question 1

Lack of essential nutrient in the diet or from a conditioning factor that increases the need for these nutrients (p. 1184)

Answer 1

deficiency

Question 2

Characterized by nystagmus, abducens, conjugate gaze palsies, ataxia of gait and confusion (p. 1185)

Answer 2

Wernicke disease

Question 3

Retentive memory is impaired out of proportion to all other cognitive functions in an otherwise alert and responsive patient (p. 1185)

Answer 3

Korsakoff amnesic state

Question 4

Wernicke encephalopathy (p. 1185)

Answer 4

ophthalmoparesis with nystagmus
ataxia
acute apathetic-confusional state

Question 5

Most frequent eye movement abnormality seen in Wernicke’s disease (p. 1186)

Answer 5

Nystagmus

Question 6

Lesion of Korsakoff amnesic state (p. 1188)

Answer 6

mediodorsal nucleus of thalamus

Question 7

In chronic disease this is shrunken in Wernicke- Korsakoff syndrome (p. 1188)

Answer 7

mamillary bodies

Question 8

EEG in Wernicke- Korsakoff syndrome (p. 1188)

Answer 8

diffuse mild to moderate slow activity

Question 9

Which occular finding in Wernicke-Korsakoff syndrome shows most dramatic improvement afer thiamine? (p. 1189)

Answer 9

nystagmus

Question 10

Neuropathologic findings in Wernicke disease (p. 1189)

Answer 10

Symmerical lesions in the paraventricular regions of the thalamus and hypothalamus, mamillary bodies, periaqueductal region of the midbrain, floor of the fourth ventricle and superior cerebellar vermis

Question 11

A mitochondrial disorder implicating pyruvae metabolism resembling those if Wernicke disease but have slightly different distribution and histologic characteristics (p. 1189_

Answer 11

Leigh encephalomyelopathy

Question 12

Why is there hypothermia in WK disease (p. 1189)

Answer 12

Lesions in the posterior and posterolateral nuclei of the thalamus

Question 13

Treatment for WK Syndrome (p. 1190)

Answer 13

50 to 200mg IV and similar dose IM

Question 14

Cofactor for thiamine activity (p. 1190)

Answer 14

Magnesium

Question 15

This clinical entity is predominantly a cardiac disorder occurring among people whose diet is dominated by polished rice (p. 1190)

Answer 15

Beriberi

Question 16

Clinical findings of Beriberi (p. 1191)

Answer 16

thinness and tenderness of the leg muscles, loss or depression of the Achilles and patellar reflexes and at times a patchy blunting of pain and touch sensation over the feet and shins

Question 17

Most prominent neurologic feature in patients with Beriberi (p. 1191)

Answer 17

Painful syndrome

Question 18

Common manifestation of alcohol- induced nutritional neuropathy (p. 1191)

Answer 18

excessive sweating of the soles and dorsal aspects of the feet and the volar surfaces of the hands and fingers

Question 19

T/F In nutritional polyneuropathy, only the limbs are involved and the abdominal, thoracic, and bulbar muscles are usually spared. (p. 1191)

Answer 19

TRUE

Question 20

Neuropatholgoic feature of Neuropathic Beriberi (p. 1192)

Answer 20

axonal degeneration; distal parts of the longest and largest myelinated fibers in the crural and to a lesser extent, brachial nerves

Question 21

Treatment of Neuropathic Beriberi (p. 1193)

Answer 21

Aspirin or acetaminophen

Avoid opiates and synthetic analgesics

Question 22

In its fully developed form, it affects the skin, alimentary tract and hematopoietic and nervous systems (p. 1193)

Answer 22

Pellagra

Question 23

How does pellagra SCD (p. 1193)

Answer 23

Symptoms referable to both posterior and lateral columns, predominantly the posterior

Question 24

Which is deficient in pellagra (p. 1194)

Answer 24

nicoinic acid or tryptophan

Question 25

Treatment for pellagra (p. 1194)

Answer 25

Niacin 500mg per day for approximately 3 weeks

Question 26

Anti-hyperensive that can cause sensory polyneuropathy (p. 1194)

Answer 26

Hydralazine

Question 27

Pyridoxine also leads to ___ because pyridoxine is a coenzyme for the conversion of homocysteine to cystathionine (p. 1194)

Answer 27

Homocysteinuria

Question 28

Treatment for Pyridoxine deficiency (p. 1195)

Answer 28

50mg per day orally for several weeks, followed by 2mg per day and a resumption of a normal diet

Question 29

For nutritional folate deficiency, replacement is (p. 1195)

Answer 29

1mg Folate per day

Question 30

Most consistent sign of Vitamin B12 deficiency (p. 1196)

Answer 30

Loss of vibration sense

Question 31

First clinical manifestation of Vitamin B12 deficiency (p. 1196)

Answer 31

consisting of tingling pins and needles feelings or other vaguely described sensations

Question 32

Neuropathologic findings in B12 deficiency (p. 1197)

Answer 32

swelling of myelin sheaths, characterized by intramyelinic vacuoles and separation of myelin lamellae followed by a coalescence of small foci of tissue destruction into larger ones sievelike appearance (like HIV myelopathy)

Question 33

Essential cofactor of homocysteine to methionine (p. 1197)

Answer 33

Methylcomabamin

Question 34

serum B12 below ____ usually associated with neurologic symptoms of Vit B12 deficiency (p. 1198)

Answer 34

100pg/nL

Question 35

Treatment of Vitamin B12 deficiency (p. 1199)

Answer 35

1000micgro grams of cyanocobalamin or hydroxycobalamin IM each day for several days

Question 36

Common and uniform type of degeneration of the vermian and anterior lobes of the cerebellum (p. 1201)

Answer 36

Alcoholic cerebellar degeneration

Question 37

Instability of trunk in ACD (p. 1201)

Answer 37

3 Hz rhythmic swaying in the AP direction

Question 38

Pathologic finding in ACD (p. 1202)

Answer 38

degeneration of all he neurocellular elements of the cerebellar cortex but particularly of the Purkinje cells in the anterior and superior aspects of the vermis

Question 39

middle portion of the corpus callosum, which on gross examination appears rarefied and sunken and reddish or gray- yellow in color (p. 1203)

Answer 39

Marchiava- Bignami Disease