Island Med Student

Okay, for the record, getting up at 5 a.m. every day and walking in the pitch black darkness to the hospital is becoming very old. I am NOT a morning person, and this is killing me! But I really shouldn’t be complaining, since I am home (and sometimes back in bed) by 8:30 a.m.

Anyway, since I promised, and since it made me feel better the last time I did it, here are some more “stuff learned” items from my neurology rotation:

1) All about myasthenia gravis, including diagnosis and treatment. (It’s an autoimmune neuromuscular disease leading to fluctuating muscle weakness and fatiguability.)

2) When/how/and why not to do the tensilon challenge test to diagnose myasthenia gravis. (Do it in the ICU, or somewhere where you have a crash cart ready.)

3) The differential diagnosis of generalized weakness, including Addison’s disease, hyper and hypokalemia, parathyroid disturbances, hypothyroidism, and myasthenia gravis.

4) What external progressive ophthalmoplegia is. (Causes weakness of external eye muscles.)

5) The difference between a thymoma (anti-thymus AB +) and thymus hyperplasia (anti-thymus AB -). You can differentiate the two via MRI.

6) What to do in the case of a myasthenic crisis. (It causes a paralysis of the respiratory muscles. If this happens, you should stop all myasthenia gravis medications. If the vital capacity is less than 500 cc, you must intubate. Then give a large does of steroids or immunoglobulins.)

7) All about normal pressure hydrocephalus, including its presentation (wet, wobbly, and weird), and treatment (possibly place a shunt).

8 ) If a patient walks in with a history of alcohol abuse and lower extremity ataxia only, give them a shot of thiamine.

9) How to diagnose and treat Wernicke-Korsakoff syndrome.

10) A PET scan on an Alzheimer’s patient will likely show decreased activity in the parietal lobe.

11) How to diagnose progressive supranuclear palsy. (It’s a rare degenerative disease involving the gradual deterioration and death of selected areas of the brain.)

12) If you are trying to diagnose normal pressure hydrocephalus, you can do the Mini Mental Status Exam (MMSE) before and after doing a lumbar puncture. If their MMSE score improves, there is a good chance they have normal pressure hydrocephalus.

13) What shunt nephritis is. (It’s rare disease of the kidney that can occur in patients being treated for hydrocephalus with a cerebral shunt.)

Note: I couldn’t find any cool photos to go with this post, so I just snapped a few using Photo Booth of me and my anatomy book. Fun!