Miscellaneous

Question 1

Wernicke’s Encephalopathy? Which Vitamin deficiency causes it?

Answer 1

Thiamine - B1

Question 2

WE: Cause?

Answer 2

Mostly alcohol
Poor diet
Persistent vomiting
Stomach Cancer

Question 3

WE: S and S?

Triad?

Answer 3

Ophthalmoplegia/nystagmus
Ataxia
Confusion
Peripheral sensory neuropathy.

Top 3: OorN/A/C form the classic triad.

Question 4

WE: Investigation and Treatment

Answer 4

Decreased red cell transketolase
MRI

Treatment - Thiamine

Question 5

WE: Relationship with Korsakoff?

2 main symptoms of Korsakoff?

Answer 5

If untreated leads to Korsakoff syndrome.

Confabulation and Amnesia - retro and anterograde.

Question 6

Refeeding syndrome?

Answer 6

Occurs within 4 days of starting to eat again after a period of serious malnutrition.
Can result in low levels of magnesium, phosphate and potassium.
Refeeding brings body to anabolic state, anabolic state requires many Vits and mins like magnesium, phosphate and thiamine. Insulin stimulates K into the cells, lowering potassium too.

Question 7

Idiopathic Intracranial Hypertension (IIP)

Epidemiology triad..

RF:

Answer 7

Young, overweight female.

Obesity, female, pregnancy, C-pill, steroids, vitamin A, lithium, tetracycline,

Question 8

IIP Features

Answer 8

Headache, blurred vision, papilloedema, enlarged blind spot, 6th nerve palsy. Pulsatile tinnitus. Neck and shoulder pain.

Raised ICP symptoms: V w/o N (at the beginning), worse when coughing, worse when lying down

Sometimes motor nucleus of CN7 can also be effected.

Question 9

IIP Management

IIP Complications

Answer 9

WL
Acetazalamide, Topiramate also used.
Repeated lumbar puncture
Surgery - Optic nerve sheath decompression
Lumbar-peritoneal shunt/Ventriculo-peritoneal shunt.

Vision loss

Question 10

Myasthenia Gravis MG - What is it?

What causes it?

3.) Which condition is closely related to MG? 20%…

Answer 10

Autoimmune condition caused by antibodies attacking the nicotinic receptors at the NM junction.
Under 50 more common in woman.
Associated with thymic hyperplasia.
Over 50 more common in men. - associated with thymic tumour or
atrophy, RA, SLE.

3.) Thymoma

Question 11

MG Presentation

Answer 11

Tiring and gets worse as day progresses. 
Extraocular - diplopia, ptosis 
Bulbar - Swallowing, chewing.
Speaking - Dysarthria and Hypophonia
Face and neck muscles.

Myasthenic snarl, diplopia, ptosis.
Counting to 50, the voice lowers.
Tendon reflexes are normal.

Question 12

MG Investigations

Answer 12

Antibodies - Anti-ACHR, is negative, look for MUSK antibodies.

CT for thymus

Question 13

MG Quick non-invasive test?

Improve by what length?

Answer 13

Ice pack test 2 mins improves by 2mm.

Question 14

MG Treatment? Which medication

Answer 14

Pyridostigmine - 60-120mg. 6xdaily, max 1.2g/day.

Cholinergic s/e - salivation, lacrimation, sweats, vomiting, miosis.

Question 15

MG Treat relapses? Meds and dose.

Answer 15

Prednisalone 5mg on alternate day

Osteoporosis prophylaxis.

Question 16

MG Resistant to meds? Next step?

Answer 16

Thymectomy. If below 50.

Question 17

MG crisis:

Answer 17

Weakness to resp m - fatal. during relapse.
Monitor FVC.
Treat with plasmapheresis or IV Ig.
Identify and treat the trigger.

Question 18

Hereditary sensory motor neuropathy (CMT disease)
First features?
Autosomal ..?

Answer 18

Weakness, footdrop, Distal muscle wasting, clawed toe.

A Dominant

Question 19

Neuropathic pain sx

Neuropathic First line tx?

Examples of neuropathic pain?

Answer 19

Shooting, burning pain
Tingling and numbness.

Pregabalin, Gabapentin, Amitriptyline, Duloxetine.

Diabetes, prolapsed disc, trigeminal neuralgia