6 Neuro

Question 1

Acute ischemic stroke, first day after admitted.

Carotid U/S or CTA. what looking for?

Answer 1

If >70% stenosis with sxs, do carotid endartectomy

If <70% or no sxs, medical management

Question 2

Pt with acute ischemic stroke, not getting TPA. When does not get ASA? (3)

Answer 2

do no give with TPA

1. allergy–Plavix
2. GI bleed–plavix
3. stroke while on ASA–do ASA and dipyridamole

Question 3

BP Goals in acute ischemic stroke

TPA
no TPA

Answer 3

TPA: must be 185/110 before TPA. then, keep <180/105.

no TPA: <220/120

Question 4

seizure differential

Answer 4

VITAMINS

vascular
infxn
trauma
autoimmune
metabolic (glu, electrolyes)
idiopathic
neoplastic
'sychiatric'

Question 5

sz types, general terms

Answer 5

1. generalized
   - absence
   - myoclonic
   - clonic
   - tonic
   - atonic
2. partial (aka focal)
   - simple partial
   - complex partial

Question 6

tremor types (3)

Answer 6

1. intention–cerebellar
2. postural–genetic/essential
3. resting–parkinsons

Question 7

Parkinson’s sxs

Answer 7

TRAPS

tremor
rigidity, cogwheel
akinesia
postural instability
shuffling gait

Question 8

Parkinson’s meds

-when to use each

Answer 8

1. > 65, functional: amantadine
2. <65, functional: bromocriptine/pramipexole/ropirinole
3. older, nonfunctional: carbidopa-levodopa

Question 9

Disk herniation tx:

surgery vs conservative

Answer 9

same outcome at 1 year, but surgery better earlier at 6 mo.

Question 10

Elderly male with sciatica sxs, but no heavy lifting hx. Think what

Answer 10

Osteophyte (similar presentaion as herniated disk)

-get XR then MRI to r/u compression fx. May need surgery

Question 11

spinal stenosis

• what sxs
• what dx and tx

Answer 11

leg/butt ‘claudication’ but posttional (shopping cart sign)

• XR is normal, MRI shows
• laminectomy

Question 12

Delirium: how to assess

Answer 12

CAM–confusion assessment method: (AIDA)

• Acute onset, fluctuating course
• Inattention
• Disorganized
• Altered LOC

1st 2 must be present, + #3 or #4.

Question 13

Normal pressure hydrocephalus: sxs

Answer 13

wet, wobbly, wacky

Question 14

Peripheral vertigo DDx (4 main ones), and their tx

Answer 14

short duration:
BPPV–epley
Meniere’s–also hearing loss. Low salt and diuretics

long duration:
vestibular neuritis
labyrinthitis–also hearing loss
(these get steroids if dx’ed early)

Question 15

States of coma/brain function (3), what is difference

Answer 15

Tests: EEG (cortex), Reflexes (brainstem)

Coma: decreased EEG, reflexes good

PVS: No EEG, yes reflexes

Brain dead: No EEG, no reflexes

Question 16

Brain death reflexes (3)

Answer 16

1. corneal
2. cold water caloric stim
3. VOR (dolls eyes)

Question 17

myasthenia gravis

• crisis tx
• chronic tx–first line, refractory

Answer 17

acute myasthenic crisis: IVIG or plasmapheresis

• pyridostigmine first line (cholinergics)
• refractory–AZT, prednisone

-also thymectomy

Question 18

What autoimmune dz you don’t give steroids? (2)

Answer 18

• Guillain barre

- MS ‘pseudorelapse’– when sxs worsen from a reversible inflammation (eg UTI infection). Always r/u infection!

Question 19

Guillan Barre

-tx

Answer 19

IVIG or plasmapheresis

NEVER steroids

Question 20

MS: When NOT to give steroids in a flare?

Answer 20

When the ‘flare’ is a pseudorelapse. caused by reversible infection or other inflammation.

Question 21

ICU: pt with continued AMS after anoxic brain injury or head trauma. Think what

Answer 21

Possible non convulsive Status epilepticus. Get EEG