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EDIC Part (1) Course Notes > Neuro & Metabolic > Flashcards

Neuro & Metabolic Flashcards

(40 cards)

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1
Q

Herpes simplex virus? Types? (HSV)

A
  • type 1 & 2
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2
Q

Herpes simplex virus type 2 ? Common on what age group?

A

In Young children

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3
Q

Herpes simplex virus type (1)? Common in which age group?

A

Older adults

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4
Q

signs & symptoms of HSV infection?

A

Fever
Malaise
Headache
Confusion
Seizures

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5
Q

Investigation for HSV?

A
  • CT not sensitive for temporal lobe changes
  • CSF - Lymphocytosis & Elevated proteins
  • HSV PCR highly specific
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6
Q

Treatment of HSV?

A

Acyclovir

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7
Q

Prognosis for HSV encephalitis ?

A
  • Untreated mortality > 70%
  • Treated mortality < 20%
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8
Q

Complications post-SAH endovascular intervention?

A
  • Re-bleeding (unlikely after successful procedure)
  • Hydrocephalus
  • Delayed cerebral ischaemia (common: Day 4-21)
  • Seizures
  • Neurogenic pulmonary oedema
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9
Q

Types of hydrocephalus ?

A
  • Acute
  • Chronic / delayed onset
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10
Q

Mechanism of acute hydrocephalus?

A

Blockage in the flow of CSF within the ventricles due to intraventricular blood

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11
Q

Mechanism of chronic / delayed onset hydrocephalus?

A

Reduced absorption of CSF by the arachnoid villi due to fibrosis or inflammation

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12
Q

Mechanism of delayed cerebral ischaemia?

Note: May cause new neurological deficit or reduced GCS

A
  • Due to breakdown of blood products causing vasoconstriction
  • High risk day 7-10 post-bleed
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13
Q

Management of delayed cerebral ischaemia?

A
  • Nimodipine
  • Endovascular intervention
  • Hypertension
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14
Q

Management of Hydrocephalus?

A
  • Extra-ventricular drain
  • Shunt (chronically)
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15
Q

Indication for intubation in myasthenia gravis?

A
  • Decline in spirometry
  • Hypercapnia
  • Respiratory failure
  • Inability to clear secretions
  • Bulbar dysfunction
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16
Q

Whats is myasthenia gravis?

A

Disorder of the nuro-muscular junction (AchR antibodies) where autoantibodies block the nicotinic acetylcholine receptor and respiratory failure occurs.

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17
Q

Treatment of Myasthenia gravis?

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A
  • Steriods
  • Plasma exchange (vs) IVIg
18
Q

Neuro-protectibve measures in traumatic brain inury ?

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A
  • ICU admission
  • Intubation
  • Serial examination of neuro & pupil
  • Head elevation 30-45 degrees
  • Analgesia & Sedation
  • Temperature management
  • Anti-seizure medication
  • CPP > 60mmHg
19
Q

What is central diabetes insipidus?

Study These Flashcards
A

Deficiency of vasopressin (ADH) due to dysfunction of posterior pituitary or hypothalamus. Inability to absorb water in the collecting duct

20
Q

Signs & symptoms of Central Diabetes Insipidus?

Study These Flashcards
A
  • Inability to concentrate urine
  • Hypernatraemia
  • High serum osmolality / Low urinary osmolality
21
Q

Pathophysiology of DKA?

Study These Flashcards
A
  • Insulin deficiency
  • Hyperglycaemia
  • Osmotic diuresis
  • Hypovolaemia
  • Inability to utilise glucose
  • Ketosis & acidosis
22
Q

What is the normal anion gap?

23
Q

How do you calculate anion gap?

Study These Flashcards
A

(Na + K) - (HCO + Cl) =

24
Q

Causes of NAG metabolic acidosis?

Note: Normally loss of HCO & Na - Tx - NaHCO3

Study These Flashcards
A
  • Hyperchloraemia
  • Ileal-conduit
  • Diarrhoea, ileostomy & fistula
  • Renal tubular acidosis
  • Addison’s disease
25
SGLT2 inhibitors? (Dapagliflozin)
- Associated with HAG metabolic acidosis - Normal blood sugar (Euglycaemic DKA) - Prevents re-absorption of glucose in the PCT (Blocks SGLT2 proteins) -
26
SGLT2 inhibitors? (Dapagliflozin)
- Associated with HAG metabolic acidosis - Normal blood sugar (Euglycaemic DKA) - Prevents re-absorption of glucose in the PCT (Blocks SGLT2 proteins) - Decreases insulin production & increases glucagon production - Increases urinary glucose excretion - Promotes shift from glucose to fat metabolism
27
Diagnosis & management of hyponatraemia?
See picture attached Rapid correction requires 1.8% Normal Saline.
28
Reasons for weakness needing ICU admission?
- Malnutrition / Sepsis - Myasthenia gravis / Guillain-Barre Syndrome / Botulism / Tetanus - Respiratory muscles weakness / Weak swallowing
29
Common causes of weakness?
- Guillain-Barre Syndrom - Myasthenia Gravis - Botulism - Acquired critical illness neuropathy
30
Differential diagnosis of NM weakness?
- Brainstem - Spinal cord transverse myelitis - GBS - Myasthenia gravis - Botulism - Lambert-Eaton Syndrome (lung cancer) - Steroid myopathy - Polio - Periodic paralysis associated with low potassium - Porphyria - MND
31
Clinical signs of bulbar involvement ?
- Reduced cough strength - Difficulty in swallowing - Deviation of the tongue on protrusion - Changes in voice
32
How to measure the strength of respiratory muscles ?
- Maximal Inspiratory Pressure (manual occlusion of circuit) - Maximal expiratory pressure - Forced vital capacity (Spirometry)
33
How to measure weakness?
- MRC sum score (48 cut-off score)
34
Components tested in MRC sum score?
- Shoulder forward flexion - Forearm flexion - Writst flexion - Thigh flexion - Leg extension - Foot flexion
35
What is GBS?
- Ascending paralysis - Associated with Campylobacter diarrhoea (stool) - It can be immunilogically mediated - Raised proteins in CSF - Bulbar palsy + Peripheral weakness - Associated with Anti-GM1 & Anti-GQ1b - Loss of reflexes
36
Management of GBS?
- Consider IVIG - Plasma exchange - Supportive care
37
Signs & symptoms of Miller-Fisher Syndrome?
- Ophthalmoplegia - Sensory ataxia - Areflexia
38
Drugs exacerbating myasthenia gravis ?
- Gentamicin/ Streptomycin - Tetracycline - Quinine - Lignocaine - Muscle relaxant
39
What is botulism?
- Associated with drug users - Visual disturbance - Diplopia - Muscle weakness - Droopy eye-lids - Pre-synaptic disorder of NMJ
40
Diagnosis of GBS and other neurological conditions?
- Neurophysiological studies

EDIC Part (1) Course Notes (8 decks)

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