Neurology and Clinical Chemistry Flashcards

1
Q

What are neurological causes of coma?

A
  1. Cerebral infarction, hemorrhage
  2. Space occupying lesion/tumour, abscess, hematoma
    ➔ trauma
  3. Infections — meningitis, encephalitis
    ➔ epilepsy
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2
Q

What are the metabolic causes of coma?

A
  1. DM
  2. Hypoglycemia
  3. Renal failure
  4. Liver failure
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3
Q

What are the endocrine causes of coma?

A
  1. Hypopituitary coma
  2. Adrenal insufficiency
  3. Myxoedema coma
  4. Parathyroid abnormalities
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4
Q

What is CSF exam used for?

A

Blood in CSF suggests subarachnoid hemorrhage
- Look for xanthochromia due to:
1. oxyHb
2. methemoglobin
3. bilirbin last 2-3 weeks

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5
Q

A lot of intact RBCs in CSF exam suggest…

A

Traumatic tap — needle inadvertently entered an epidural vein during insertion

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6
Q

What is indicator of brain injury?

A
  1. CK-BB in CSF
  2. Serum S100B
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7
Q

What is the most common cause of acute bacterial meningitis? Symptoms?

A

Meningococcal meningitis

Symptoms
- Headache
- Stiff neck
- Fever
- Coma and death

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8
Q

What are the lab investigations for bacterial meningitis? What are the CSF findings in bacterial meningitis?

A

Culture & gram stain

CSF Findings
1. high PMN
2. low glucose — need for glucose as fuel by infiltrating immune cells in response to infection
3. high lactate — lactate produced by bacterial anaerobic metabolism

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9
Q

What are the two types of diabetic coma?

A
  1. DKA
    - Glucose > 20 mmol/L
    - high ketones
    - low pH — metabolic acidosis
  2. Hyperosmolar non-ketotic diabetic coma:
    - glucose > 40 mmol/L
    - normal ketones
    - low pH — lactic acidosis, secondary to dehydration
    low blood volume
    - hypoglycaemic coma
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10
Q

What are the clinical symptoms of acute intermittent porphyria?

A

Abdominal pain
Vomiting
Weight loss

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11
Q

What confirms acute intermittent porphyria?

A

ALA & PBG in urine

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12
Q

What are the symptoms of Guillain Barre Syndrome and CIDP and how to test for it?

A

Symptoms
- Generalized paralysis due to Ab destruction of myelin sheath
- Ascending paralysis

Test ➔ rule out hypo/hyperkalemia
- elevated protein in CSF
- normal WBC

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13
Q

What are examples of chronic and acute inflammatory neuropathies?

A

Chronic
➔ IgG4 Nodal/Paranodal Abs
➔ MGUS — IgM anti-MAG
➔ Multifocal Motor Neuropathy (MMN) — IgM + GM1/GM2 gangliosides

Acute
➔ GBS — IgG GD1 alp/beta, GM1 alp/beta & GT1 alpha ganglioside

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14
Q

What are the toxins and drugs that may cause peripheral neuropathy?

A
  1. Arsenic
  2. Pb
  3. Organophosphates
  4. Tricyclic antidepressants
  5. Dilantin
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15
Q

What can metabolic neuropathy be caused by?

A
  1. Alcohol — Vit B1 deficiency
  2. Vit B12 deficiency
  3. Diabetic neuropathy
  4. Uremia
  5. Myeloma
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16
Q

What are 3 lab investigations for peripheral neuropathy?

A
  1. Hematological studies
  2. Serum
  3. Protein electrophoresis
17
Q

How to classify intellectual disability (ID) or mental retardation?

A

IQ — 90-109 (50% of population)
➔ <90 (25% of population)
➔ <70 (1.8% of population) — mild ID
➔ <50 (0.4% of population) — severe ID

18
Q

What are the leading causes intellectual disability? (In decreasing order)

A
  1. Indeterminate (genetic?)
  2. Perinatal disorders
  3. Chromosome abnormalities
19
Q

What are some examples of congenital disorders? (decreasing order of frequency)

A
  1. Spina bifida
  2. Down’s
  3. Sex chromosomal disorder
20
Q

What are examples of perinatal disorders of extracerebral origin?

A
  1. Hypoxia & ischemia
  2. Cerebral palsy
  3. Hypoglycemia
21
Q

What are causes of intellectual disability in neonates and infants?

A
  1. Fetal alcohol syndrome
  2. Prematurity
  3. Heavy metal poisoning (Pb)
22
Q

What are some causes and investigations of dementia?

A
  1. Alzheimer’s ➔ beta amyloid and tau protein
  2. Hypothyroidism ➔ thyroid function test
  3. Nutritional deficiency ➔ Vit B12
  4. Creutzfeldt Jacob disease ➔ proten 14-3-3 for prion disease
23
Q

How much CSF is formed? How is it formed? How is it sampled?

A
  • 500 mL formed/day
  • Ultrafiltrate of plasma formed in choroid plexus
  • Sampled by lumbar puncture
24
Q

What is the difference between CSF and plasma?

A
  1. Lower total protein
    ➔ lower proportion of high MW proteins (lower IgG:albumin ratio)
    ➔ contains CSF specific transferrin also called tau protein, beta and gamma trace protein
    ➔ contains prominent prealbumin band
  2. Lower glucose
  3. Low cell count
25
Q

What is the clinical presentation for MS?

A

CP — Evidence of two separate attacks
1. Weakness
2. Numbness
3. Vision problems
4. Slurred speech

26
Q

What are the diagnostic tests for MS?

A
  1. MRI
  2. CSF IgG & CSF IgG synthetic rate
  3. Oligoclonal banding — examine IgG band pattern in both serum and CSF, look for 2 or more unique clonal bands present in CSF but not in serum
  4. Myelin basic protein in CSF
  5. Aquaporin 4 Ab detected in serious variant of MS (transverse myelitis)
27
Q

What is paraneoplastic neurologic syndrome?

A

Small portion of patients with occult or undetected malignancies may present many years before diagnosis of cancer with neurologic symptoms
➔ AutoAb generated in response to these cancers may be detected in the blood and may be responsible for the problem