Neurology 1

Front 1

What is Altered Mental Status?

Back 1

Any impairement in a pt's level of consciousness or cognition, varying from mild confusion to coma.

Front 2

What 3 things should be evaluated immediately in a pt with AMS?

Back 2

1) Oxygenation

2) Perfusion (i.e. blood pressure and pulse)

3) Glucose level

Front 3

What treatment should be given for an impaired level of consciousness of unknown etiology?

Back 3

1) Oxygen

2) Naloxone (opiate antagonist)

3) Glucose

If alcoholism is suspected, thiamine should be given with the glucose.

Front 4

What is a differential for acute AMS?

Back 4

"MD SPITSS"

Metabolic

Drugs

Stroke

Psychiatric

Infection

Tumor

Seizure

Structural (ICP, trauma)









































































































"MD SPITSS"
Metabolic

Drugs

Stroke

Psychiatric

Infection

Tumor

Seizure

Structural (ICP, trauma)

Front 5

What are the neurologic examination findings in toxic-metabolic encephalopathy?

Back 5

1) Impaired level of consciousness without focal neurologic signs.

2) Asterixis.

3) Myoclonus.

4) Tremor.

Front 6

What is asterixis? and how do you test for it?

Back 6

Asterixis is the inability to maintain posture due to a metabolic encephalopathy.

Have the pt extend arms and wrists.

Observe for brief downward flaps of the hands.

Front 7

What is the most common cause of toxic-metabolic encephalopathy in the hospital?

Back 7

Medications

Front 8

What are the features of serotonin syndrome?

Back 8

1) Confusion

2) Restlessness

3) Myoclonus

4) Shivering

5) Diaphoresis

Front 9

What are some common medications that can cause serotonin syndrome when used in combination?

Back 9

SSRI/SNRIs, tricyclics, ergotamines, triptans, MAOI (including linezolid), and some antiemetics (ondasetron)

Front 10

List 3 other general medical conditions that may cause toxic-metabolic encephalopathy.

Back 10

1) Infection - CNS or systemic

2) Organ failure - hepatic or renal

3) Electrolyte imbalance - (hypoglycemia, hyperglycemia, hyponatremia, hypercalcemia)

Front 11

What is dialysis disequilibrium syndrome?

Back 11

Headache, confusion, and somnolence usually associated with large fluid and solute shifts.

Front 12

What are the 3 cardinal signs of Wernicke's encephalopathy?

Back 12

Confusion, ophthalmoparesis, and ataxia

Front 13

What is the Tx of Wenicke's encephalopathy?

Back 13

Thiamine

Front 14

What lab tests are useful in evaluating a pt with AMS?

Back 14

1) Glucose

2) CBC

3) Live function tests

4) Electrolytes

5) BUN

6) Arterial blood gas

7) Drugs of abuse screen and serum drug levels.

8) Urinalysis

9) Head CT

10) EEG

Front 15

What is the confusional state that follows a seizure called?

Back 15

Postictal state: which usually resolves in a few minutes to hours.

Front 16

What is nonconvulsive SE (NCSE)?

Back 16

A rare type of seizure that presents with prolonged AMS without obvious motor activity.

Front 17

How is nonconvulsive SE (NCSE) diagnosed?

Back 17

EEG demonstrates continuous seizure activity.

Front 18

How is the confusion from a stroke distinguished from a toxic-metabolic encephalopathy?

Back 18

A stroke usually has focal neurologic signs such as aphasia or hemiparesis.

Front 19

What is another vascular cause of AMS, esp. in elderly pts?

Back 19

Subdural hematoma, which is diagnosed by CT scan

Front 20

What is the most common cause of anoxic encephalopathy?

Back 20

Cardiac arrest followed by resuscitation.

Myoclonus may be associated with the AMS. The prognosis is poor.