neuro Flashcards
Spinal shock may result in bladder distension and acute urinary retention (AUR) if the injury occurs above the lumbosacral plexus. Management of spinal cord injuries in an emergency setting involves obtaining vital signs, airway stabilization, immobilization of the neck and body, a thorough neurological examination, and insertion of a urinary catheter. This patient has no bulbocavernosus reflex, which indicates that he will develop AUR unless catheterized. Therefore, the most appropriate next step would be to place a Foley catheter. Resolution of spinal shock, and return of the reflex usually occurs within 2–3 days of the injury. Persistence of the loss of the bulbocavernosus reflex would suggest a conus medullaris injury.
This patient has signs and symptoms of spinal shock, including flaccid, areflexic paralysis, hypotension, bradycardia, and no bulbocavernosus reflex.
one year child devp
By the end of one year, most children can stand without support, walk with support, know 1–3 words, and follow one-step commands with gestures. This child only has the gross motor development and speech development of a 6-month-old (sitting without support, monosyllabic speech). The fine motor development (pincer grip) and social development (e.g., willingness to engage in play by giving objects, separation anxiety) are appropriate for a 1-year-old child. The ability to feed onself with a spoon is only expected by the age of 15 months.
drugs that trigger porphyria
Barbiturates (like primidone) trigger acute intermittent porphyria by inducing synthesis of cytochrome P-450 enzymes that contain heme components, thereby reducing heme levels and leading to stimulation of δ-aminolevulinate synthase, which is part of the heme synthesis pathway. δ-aminolevulinate synthase stimulation leads to increased levels and accumulation of δ-aminolevulinate and porphobilinogen, causing the characteristic symptoms (e.g., abdominal pain, peripheral neuropathy, confusion, and elevated levels of aminolevulinic acid and porphobilinogen) seen in this patient.
paget disease activates
Paget disease of the bone is caused by RANKL-RANK receptor activation, which triggers downstream NF-κB signaling and increases osteoclast activity.
brain tumor neuronal origin stains for
synaptophysin
synaptophysin include neurocytomas, medulloblastomas, small cell carcinomas of the lung, and carcinoid tumors. Neurons also stain positive for neurofilaments, which are part of the neuronal cytoskeleton.
txt for organophosphate poisoning
Following atropine administration, an oxime (e.g., pralidoxime) and a benzodiazepine should be administered. In addition, decontamination of the patient (e.g., remove clothes, wash skin) is important to prevent absorption of the offending agent through the skin.
pralidoxine — acholinesterase reactivator
how can alcoholism cause hypocalcemia
Magnesium is necessary for proper calcium absorption and balance; hypomagnesemia is associated with PTH resistance and reduced secretion of PTH. Chronic excessive alcohol intake causes hypocalcemia by two main mechanisms: vitamin D deficiency from malnutrition and alcohol-induced increase in urinary excretion of magnesium. Although this patient should also receive calcium replacement, hypocalcemia with hypomagnesemia will not improve until the magnesium level is corrected.
Decreased pinch strength and sensory deficits over the little finger and palmar surfaces of the medial aspect of the right hand are suggestive of ulnar nerve entrapment at the level of the wrist.
fracture of hook hamate
This man has a pelvic ring fracture with decreased sensation over the right medial thigh. This is consistent with an obturator nerve injury.
adduction of hi[
absent cremasteric reflex
genitofemoral nerve
A spinal disc herniation is caused by prolapse of the nucleus pulposus which develops from a different embryologic layer. derived from
notochord
caudal regressions yndrome
missing lumbo sacral area
diabetic mother
phenytpin teratogeninc
neural tube defects
neurons with eosinophilic cytoplasm and pyknotic nuclei.
12-24 hrs after ischemoa
Neutrophilic infiltration with central necrosis is seen on histopathologic examination of brain
1-3 days
Infiltration of macrophages (microglia) with local tissue destruction is seen on histopathologic examination of brain
3-5 days
n chromosome 9, which encodes an iron-binding mitochondrial protein
fraxatin
friedrich ataxia
upper eyelid droop
occulomotor injury
diabetic patient
microischemia
A child presenting a triad of preceding viral illness, hepatomegaly, and acute encephalopathy (vomiting due to elevated ICP, lethargy, and confusion) can be diagnosed with Reye’s syndrome caused by
aspirin
low does decreases uric acid excretion
ndicated for the prevention of seizure recurrence in status epilepticus and for short-term (< 5 days) treatment of epilepsy.
phenytoin
increases sodium efflux
status epilipticus
lorazepam to abort seizure
then phytoin for ecurrence
including diplopia, hepatotoxicity, and hyponatremia (probably due to associated SIADH), all of which are seen in this patient. Other possible side effects include Stevens-Johnson syndrome, ataxia, CYP-450 induction, and blood count abnormalities (agranulocytosis, aplastic anemia).
carbamezapine
An abnormal breathing pattern characterized by crescendo-decrescendo pattern of tidal volumes followed by a period of apnea.
cheyene stokes
galop rhhytm
heart failure
partial vs complete central DI
In partial central DI, urine osmolality increases by approximately 10%, while in complete central DI, urine osmolality increases by over 50%. This patient’s urine osmolality increased from 310 to 355 mOsm/kg H2O, an approximate 15% increase, which is sufficient to diagnose partial central DI.
