Uncovered High-Yield Topics Flashcards
What does a normal CSF study look like?
- Opening pressure 5-20 cm water
- Glucose 50-80 mg/dL (or ~2/3 of serum glucose)
- Protein 15-40 mg/dL
- WBC < 3 (<30 in neonates)
- RBC < 5
AIP vs Wilson’s disease
AIP is acute in onset while Wilson’s is gradual
AIP is associated with neuropathic sensations (abdominal pain w/o tenderness, tingling sensations) while Wilson’s is assocaited with movement disorders.
Five P’s of AIP
- Painful abdomen (often confused for acute abdomen, leading to a belly full of scars)
- Purple urine (urine is colorless initially, but exposure to light causes PBG in urine to oxidize and gives urine its color).
- Peripheral neuropathy (patchy numbness and paresthesias)
- Psychological disturbances (anxiety, confusion, psychosis, dementia)
- Precipitated by drugs or dietary changes (drugs that enhance cytochrome P-450 activity, sulfa drugs, barbiturates, some antipsychotics, alcohol)
Myotonic dystrophy
Myotonia
Delayed muscle relaxation
Should make you think of myotonic dystrophy
In whom should you use amitryptaline with caution?
- Patients over age 65 (it has anticholinergic activity)
- Patients on multiple other drugs that can cause serotonin syndrome
Steroid psychosis
People on high dose steroids can have steroid-induced psychosis!
Little is known about underlying risk factors, but if someone develops new psychosis on high-dose steroids you should trial holding the steroids.
Classic onset of ALS
- Dysphagia
- Dysarthria
- Tongue fasciculations
- Paradoxical breathing (expansion of abdomen on expiration rather than inspiration, caused by diaphragmatic weakness)
Things that mess with anterior horn cells
- Heritable syndromes (spinal muscular atrophy)
- Lead poisoning
- Polio myelitis
- West Nile Virus myelitis
Treatment of PCP intoxication
- Involves treatment of agitation and aggression
- Benzodiazepines
Really, most parotid gland masses are benign. But, if they grow to involve ___, they are probably malignant.
Really, most parotid gland masses are benign. But, if they grow to involve the facial nerve, they are probably malignant.
What diseases does a negative ANA likely exclude?
- SLE
- Scleroderma
-
MCTD
- The sensitivity for these diseases is quite high (>90%), but still not entirely perfect. Other diseases you really shouldn’t take a negative ANA into much consideration since it is closer to ~50% positivity
Wilson’s disease pathophysiology
- Autosomal recessive disorder
- Mutation in ATP7B, a transport protein
- It is genetic!! Not just copper toxicity
- Characterized by the reduced excretion of copper into the bile secondary to a transport abnormality, leading to the pathologic accumulation of copper in the liver and other tissues, particularly the brain
Copper chelators
- Penicillamine – pee out copper
- Trientine – poop out copper
Delayed facial nerve palsy
Sometimes occurs after trauma to the head
Basically, the facial palsy does not develop until ~24-48 hours later, when the edema becomes more significant
When this occurs, it will be a complete facial nerve palsy, not an isolated lower facial nerve palsy. The latter should be concerning for epidural hemorrhage.
Connection of the frontal eye field to the cranial nerves
Chiari malformation
Type I: Cerebellum into the spinal cord
Type II: More cerebellum into the spinal cord, and a myelomeningocele
COAT RACK for Wernicke’s and Korsakoff’s
A lesion above the red nucleus leads to resting ___.
A lesion below the red nucleus leads to resting ___.
A lesion above the red nucleus leads to resting flexion.
A lesion below the red nucleus leads to resting extension.
Basically think of the red nucleus as sending out a default “extend” signal to the body, which is overridden by cortical input.
Sign of diffuse axonal injury on CT
“Blurring of white-gray junction”
Various temporal lobe functions
Causes of Kluver-Bucy syndrome
Presentation/Features of Kluver-Bucy syndrome
Quick rule of thumb for HIV infections and CD4s
Transient global amnesia
- Presentation: Abrupt onset, transient memory loss following psychological stress or vigorous exercise
- Amnesia is anterograde, sometimes with partial retrograde
- By definition, takes < 24 hours to resolve, and resolution is complete
- Diagnosis: Clinical, but EEG and MRI have associated findings and can rule out other etiologies
- EEG: rule out epilepsy/simple partial seizure
- MRI: Shows focal hyperintensities in the hippocampi
- Treatment: None. Self-resolving. Sometimes may monitor for 24 hours if the diagnosis is in question.
Area postrema syndrome
Subtype of neuromyelitis optica (NMO), hence anti-AQP4 will be present.
Characterized by episodes of intractable nausea, vomiting, and/or hiccups
MRI shows enhancement of just the area postrema, which is in the dorsal medulla just inferior to the cerebellum.
