Homonymous hemianopsia

Neuro
Arousal without Awareness = Thalamus to Cortex is blocked
Brainstem --> Thalamus --> Cortex
Arousal Awareness
Brain death = EEG is flat < 2 microvolt
Intrinsic cortical activity = responsible for awareness.
Radiation = lesion restricted to white matter. necrosis of astrocyte, oligodendr
olia, axon, blood vessels. Proteinaceous spheroids adjacent to necrosis. Blood v
essels have thickened wall with fibrin-like material

Encephalitis = infection of brain parenchyma

Meningoencephalitis = encephalitis + meninges inflammation
Western Equine Encephalitis = carried by Culex
Eastern Equine Encephalitis = carried by Aedes
Hypoglycemia =
Treatment = give IV dextrose
Low glucose can produce stupor, coma, death.
Opioid overdose
Treatment = Naloxone (opioid receptor antagonist)
Todds Palsy
Ethylene glycol overdose
Treatment = Fomepizole, Dialysis > Ethanol

Acetaminophen Overdose
Treatment = use activated-charcoal to absorb as much tylenol as possible, then r
epeated doses of N-acetylcysteine (NAC).
NAC is most effective in the first 8 hours.
Anti-cholinergic Toxicity (from Benadryl/Diphenhydramine)
Symptoms = anhidrosis (no sweating), mydriasis (pupil dilation), delirium, fever
.
Also tachycardia, HTN, decrease bowel sounds, hallucination, urinary retention,
seizure, CV collapse
Red as beet, dry as bone, blind as a bat, hot as a hare, and mad as a hatter.
Treatment =
charcoal + sorbitol = to decontaminate GI tract
Seizure = benzo
tachyarrhythmia = Physostigmine
JC virus receptor = Sialic acid and 5-HT2a
Trasmission = inhalation, oral infection.
Latent in kidney
Trypanosoma Rhodesiense = East africa, shorter incubation, rare lymphadenopathy
, CNS invasion early
Rabies
Receptor = p75 neurotrophin receptor
Post-exposure prophylaxis = 1 dose of rabies IG and 4 doses of rabies vaccine ov
er 14-days (1st dose immediately after exposure, then on day 3, 4, and 14)
Conjunctival sac
Normal flora = S. epidermidis (have lysozyme and lactoferrin).
Lysozyme = hydrolyze glycosidic backbone of peptidoglycan in gram positive
Bacteria that use lactoferrin receptor to invade conjunctiva:
1. S. aureus
2. N. gonorrhea
3. Moraxella lucanata
4. Pasteurella
If patient has brain access, why cant do lumbar puncture? pt die
If Na < 120 meq/L = brainstem heniation, edema
Refractive error = pinhole vision
Corneal scarring = slit lamp? seen corneal injury and ulcer
Traction retinal detachment = neovascularization, macula not attached.
tonometry = T16 right 16 left? not glaucoma, it's normal
fluorescin exam = seen damage to cornea
W3
Right ear hearing loss
Normal Rinne =
Weber lateralize to the left = sensorineural loss on the right
Viral cochleitis = no external ear findings
Serous otitis media typically associated with large tonsils
Case #3
weber lateralize to right = left sensorineural hearing loss
Positive rinne left = normal conductive hearing in the left
negative rinne right =