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Extra questions for boards > Systemic diseases and Pregnancy > Flashcards

Systemic diseases and Pregnancy Flashcards

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1
Q

When to give anticoagulation in patients with ischemic stroke due to infective endocarditis

A

Only in patients with mechanical valves

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2
Q

Most common neurological complication of infective endocarditis

A

Ischemic stroke

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3
Q

Neurological complications of IE

A
  • Ischemic stroke (most common)
  • ICH (due to hemorrhagic conversion of an ischemic infarct)
  • SAH
  • Cerebral abscess
  • Meningoencephalitis
  • Seizures
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4
Q

MOA of septic emboli causing mycotic aneurysms

A

Septic cerebral emboli cause intraluminal arterial wall necrosis (due to arteritis) and destruction of the adventitia and muscularis with subsequent dilatation

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5
Q

Location of mycotic aneurysms

A

Distal arterial bifurcations

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6
Q

Neurologic complications in patients with native vs prosthetic valve endocarditis in a similar proportion: who’s worse

A

Similar proportions

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7
Q

In those with prosthetic valves, who has worse complications?

A

Mechanical valves > bioprosthetic valves

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8
Q

L sided vs R sided endocarditis: which is associated with higher risk of neurologic complications

A

L sided endocarditis

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9
Q

Sickle cell disease: which stroke is more common, ischemic or hemorrhagic?

A

Ischemic (also more common in children than in adults)

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10
Q

Role of transcranial Doppler ultrasonography in Sickle cell disease

A

Should be periodically performed, and when elevated velocities are detected, blood transfusion (or exchange transfusion) have been shown to reduce the risk of ischemic stroke

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11
Q

MGUS neuropathy

A

Demyelinating neuropathy

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12
Q

Antibodies found in IgM MGUS

A

Serum anti-MAG (causing neuropathy)

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13
Q

Thrombotic thrombocytopenic purpura (TTP): pentad

A

1- Microangiopathic hemolytic anemia
2- Thrombocytopenia
3- Renal dysfunction
4- Fever
5- Neurological sign (seizure, headache, encephalopathy)

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14
Q

TTP cause

A

Deficiency of the von Willebrand factor-cleaving protease –> platelets aggregate

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15
Q

TTP treatment

A

Plasma exchange

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16
Q

Whipple disease diagnosis

A

Positive periodic acid-Schiff (PAS) macrophage inclusions on bowel biopsy

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17
Q

Celiac disease: neuro symptoms

A
  • Axonal peripheral neuropathy
  • Ataxia (due to cerebellar atrophy 2/2 loss of Purkinje cells via immune mediated mechanisms)
  • Seizures
  • Inflammatory myopathy
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18
Q

Celiac disease: Biopsy

A

Atrophy of intestinal villi

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19
Q

IBD: Patients are at risk of

A

Arterial and venous thrombosis

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20
Q

IBD: Neuro symptoms

A
  • Venous thrombosis and ischemic stroke
  • Demyelinating and axonal neuropathy
  • Myopathy
  • Cranial neuropathy (CN VII ++)
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21
Q

Uremic twitching

A

Seen in CKD
Associated with alteration of cerebral phosphate metabolism

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22
Q

Hyper/Hyponatremia

A
  • HyperNa (>160): seizures, encephalopathy, coma
  • HypoNa (<115): seizures, encephalopathy –> needs to be corrected at 12 mEq/L/day or 0.5 mEq/L/hr to avoid central pontine myelinolysis
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23
Q

Hyper/HypoK

A

Peripheral mostly
- HyperK: Muscle weakness i/s/o hyperkalemic periodic paralysis or Addison disease
- HypoK: Myalgia, proximal limb weakness with sparing of bulbar muscles, sometimes tetany

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24
Q

Hyper/HypoCa

A
  • HyperCa: HA, encephalopathy, seizure, coma
  • HypoCa: Seizures, tetany, perioral and digital tingling, tonic muscle spasms (carpopedal spasm) sometimes leading to ospithotonos
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25
Hyper/HypoMg
- HyperMg: Areflexia/hyporeflexia, muscle weakness with possible respiratory failure - HypoMg: encephalopathy, tremor, myoclonus, seizure
26
Most common extraocular abnormality in thyroid disease
Restricted upward gaze
27
Myopathy in thyroid disease
Associated with elevated CK level
28
SLE: CNS symptoms
- Headaches and seizures: most common - Neuropsychiatric (cognitive dysfunction, depression, anxiety, psychosis) - Aseptic meningitis - Increased risk of ischemic strokes (due to cardioembolism, APLS, premature ICAT and rarely vasculitis)
29
SLE: PNS symptoms
- Cranial neuropathies - Peripheral mononeuropathy or mononeuritis multiplex - Demyelinating or axonal polyneuropathy - Plexopathy
30
Rheumatoid arthritis is associated with?
Atlanto-axial dislocation: from inflammation and resulting laxity of the ligaments, with pannus formation
31
Brown syndrome
Associated with rheumatoid arthritis: dysfunction of the superior oblique tendon (cannot elevate nasally)
32
Churg– Strauss syndrome
- Asthma - Eosinophilia - Sinus and pulmonary involvement
33
Wegener granulomatosis
- Glomerulonephritis - Paranasal sinusitis - Pulmonary involvement Diagnosis: presence of granulomas on biopsy + the presence of cytoplasmic antineutrophil cytoplasmic (C-ANCA) antibody and antibodies to proteinase-3
34
Polyarteritis nodosa
- Vasculopathy in multiple organ systems (GI, renal, cardiac) with prominent constitutional symptoms - May be associated with chronic hepatitis B - Skin: livedo reticularis, skin ulcerations, and subcutaneous nodules - Abdominal angiogram demonstrates small aneurysms in mesenteric arteries
35
Takayasu arteritis
Large-vessel vasculitis - Common in females of Asian descent - Commonly involved: subclavian arteries - Can lead to strokes, constitutional symptoms and symptoms related to organ ischemia such as peripheral claudication
36
Behçet disease
Uveitis and orogenital ulcers are characteristic. - Diagnostic criteria: recurrent oral ulceration, plus two of the following: recurrent genital ulceration, eye lesions including uveitis, skin lesions (such as papulopustular lesions), or a positive pathergy skin test
37
Sarcoidosis
- Lungs (most commonly) - Skin - Heart - Nervous system: central and peripheral
38
Most common presentation of neurosarcoidosis
- Cranial neuropathy: CN VII ++
39
Diagnosis of sarcoidosis
History, examination, and demonstration of noncaseating granulomas on biopsy
40
Marker of disease activity in sarcoidosis
Increased serum ACE levels
41
Neurosarcoidosis: classic finding on MRI
Diffuse leptomeningeal enhancement (predominance at the base of the brain)
42
Diagnosis of pheochromocytoma: In general + Most sensitive
Measurement of catecholamines, metanephrines, and vanillylmandelic acid (VMA) in a 24-hour urine collection Measurement of plasma-free metanephrines is the most sensitive test
43
Anterior pituitary aka adenohypophysis: neurotransmitters
Six hormones: - TSH - ACTH - PRL - GH - LH - FSH They are regulated by hypothalamic releasing and inhibiting hormones delivered via the hypophyseal portal system
44
Posterior pituitary aka neurohypophysis
- Oxytocin - Vasopressin = ADH = antidiuretic hormone These hormones are synthesized in the hypothalamus and transported down the axons to the posterior pituitary for storage and release directly into the bloodstream from the axon of neurons whose cell bosies reside in the hypothalamus
45
Embryology: Origin of anterior pituitary = adenohypophysis
Rathke pouch, which originates from oropharyngeal membrane
46
Pituitary blood supply
Superior and inferior hypophyseal arteries which arise from the ICA
47
- TSH: regulated by
TRH
48
ACTH: regulated by
CRH
49
PRL: regulated by
Dopamine
50
GH: regulated by
GHRH
51
LH and FSH: regulated by
GnRH
52
Posterior pituitary or neurohypophysis: embryological origin
Extension of the neuroectoderm of the diencephalon
53
Which cells synthesize ADH and oxytocin
Magnocellular neurons in the supraoptic and paraventricular nuclei of the hypothalamus
54
Cerebral salt wasting vs SIADH: what's the difference
- SIADH: euvolemic - Cerebral salt- wasting: hypovolemic
55
Treatment of cerebral salt wasting
Salt supplementation and intravenous isotonic (or sometimes hypertonic) fluid administration
56
Treatment of SIADH
Fluid restriction and correction of underlying causes; in severe cases, diuretics may be used
57
Cause of cerebral salt wasting syndrome
May in part relate to increased levels of atrial natriuretic peptide released from the cardiac atria
58
Postpartum cerebral angiopathy
Along the spectrum of RCVS --> leads to multifocal vasospasm. Most commonly with headache, although seizure and/or focal neurologic deficit may occur Benign, responsive to CCB and/or corticosteroids.
59
Empty delta sign
Triangular area of central hypodensity surrounded by a rim of hyperintensity in the superior sagittal sinus
60
Chorea gravidarum
Occurs during pregnancy as an acute-onset chorea, associated with antiphospholipid antibody syndrome
61
Management of eclampsia
- Delivery - BP control with IV HLZ or labetalol - For seizure prevention or control: IV magnesium sulfate, with close monitoring as magnesium toxicity may lead to maternal respiratory distress
62
Rapid reversal of ICH while on Warfarin
- Fastest (within hours): Prothrombin complex concentrate (PCC), contains vit K dependent clotting factors --> rapid reversal and normalization of INR within 10 minutes +/- FFP - To sustain: Vit K
63
Xyrem (Sodium oxybate, the sodium salt of gamma hydroxybutyric acid GHB): used for
- Cataplexy - Excessive daytime sleepiness in narcolepsy
64
Adie's pupil: cause
Denervation of the parasympathetic ciliary ganglion
65
Adie's pupil: symptoms
- Acute onset - Isolated dilated pupil - Light-near dissociation (reacts slowly to light) - Preserved or increased accommodation
66
Adie's pupil: findings on exam
- Segmental iris constriction - Vermiform movements of the pupillary border
67
Adie's pupil vs CN3 palsy
CN3 palsy would have a dilated pupils but also: - Headache - Ptosis - Down and out eye - Impaired accommodation (preserved or increased in Adie's pupil)

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