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AACN NEURO-
encepalopathy BLUEPRINT
ACNPC-AG QUESTIONS
WITH ACCURATE ANSWERS
Approach to diagnosis for altered mental status: correct answer [1.] Identify the problem (history, exam); [ 2.] Are there focal neuro findings? (If so--needs CT scan; If no-- need MRI); [3.] If not do toxic-metabolic workup EEG can be useful for testing encephalopathy because correct answer [1] can help to differentiate neuro vs. psych; [2]. Rule out subclinical seizures or "non-convulsive status epilepticus" (encephalopathy mimic) Encephalopathy causes include: MENOMIC correct answer VIITTAMIN: Vascular, Inflammatory, Infectious, Traumatic, Toxins, Autoimmune, Metabolic, Idopathic/Genetic; Neoplastic Encephalopathy correct answer Definition: Inability to carry out a coherent plan of thought or Action. What mental status exam tests would you do in an encephalopathic patient? level of alertness, orientation, and attention
What test for encephalopathy? Vital signs and labs; Brain imaging can be normal but EEG shows encephalopathy, EEG can be useful for testing encephalopathy because [1] can help to differentiate neuro vs. psych; [2]. Rule out subclinical seizures or "non-convulsive status epilepticus" (encephalopathy mimic) Mimics of Encephalopathy include: Dementia with Lewy Bodies; REM sleep behavior disorder (act out dreams) and parasomnias (sleepwalking); Wernicke's aphasia; Psychosis, mania, depression; Nonconvulsive status epilepticus (last two: differentiate with EEG) The hallmark of encephalopathy is: Impaired ATTENTION (early finding in delirium, late finding in dementia) Symptoms of encephalopathy include: Hallucinations, delusions, agitation or lethargy; Irritation to light touch; Withdraw limbs unequally; Asterixis, myoclonus, tremor, sometimes hyperreflexia (acute liver malfunction)/hyporeflexia (thyroid derangement) T/F: Encephalopathy is often multifactorial: TRUE Why does encephalopathy occur? Metabolic homeostasis imbalance What can global disruption of metabolic homeostasis result in: Behavior change, poor coordination, ataxia, confusion, seizures, stupor and coma; May be a lag in recovery of CNS symptoms after the metabolic problem is corrected Encephalopathy causes include: VIITTAMIN: Vascular, Inflammatory, Infectious, Traumatic, Toxins, Autoimmune, Metabolic, Idopathic/Genetic; Neoplastic Vascular- Hypertensive encephalopathy Inflammatory- Urinary tract infection in elderly; Infection of the CNS (encephalitis)
Organ failure that can cause metabolic encephalopathy include: correct answer Uremia (kidney disease); Hyperammonia (liver disease) Prescription meds that can cause toxic encephalopathy include correct answer Overdose; Antibiotics (ciprofloxacin); and anticholinergic drugs and sedating drugs (diphenhydramine- benadril, lorazapam) in elderly Respiratory encephalopathy can be caused by correct answer High CO2, hypoxia Symptoms of encephalopathy include: correct answer Hallucinations, delusions, agitation or lethargy; Irritation to light touch; Withdraw limbs unequally; Asterixis, myoclonus, tremor, sometimes hyperreflexia (acute liver malfunction)/hyporeflexia (thyroid derangement) T/F: Encephalopathy is often multifactorial: correct answer true The hallmark of encephalopathy is: correct answer : Impaired ATTENTION (early finding in delirium, late finding in dementia) The most likely electrolytes to cause metabolic encephalopathy include correct answer SODIUM (low and high) and CALCIUM (high) Toxic metabolic workup includes: correct answer ABC's (vital signs, BP, Fever); Complete blood count; Basic metabolic profile (electrolytes, kidney function, glucose); Tox screen; Liver function tests Head and brain trauma and injury vascular causes correct answer Hypertensive encephalopathy Wernicke-Korsakoff Syndrome: correct answer : Prolonged thiamine deficiency; Chronic necrosis of
diencephalon (thalamus and hypothalamus),mammillary bodies, periventricular regions ofbrainstem, anterior cerebellum; Anterograde amnesia with confabulation Wernicke's encephalopathy correct answer Caused by alcohol, cancers, starvation and anorexia)Triad: nystagmus, gait ataxia and confusion; Responds to thiamine replacement (GIVE THIAMINE before glucose; thiamine is a cofactor for metabolism of carbs/sugars); What can global disruption of metabolic homeostasis result in: correct answer Behavior change, poor coordination, ataxia, confusion, seizures, stupor and coma; May be a lag in recovery of CNS symptoms after the metabolic problem is corrected What mental status exam tests would you do in an encephalopathic patient? correct answer level of alertness, orientation, and attention What test for encephalopathy? correct answer Vital signs and labs; Brain imaging can be normal but EEG shows encephalopathy, Why does encephalopathy occur? correct answer Metabolic homeostasis imbalance
