Day 1 - Neuro Part 2 CVD/Hemorrhagic, Seizures, Peds

Question 1

Anticoagulant for patient w/ history of stroke/TIA: (1) first (2) due to Afib (3) co-morbid CAD (4) repeat while on ASA

Answer 1

(1) ASA (2) Warfarin (3) Clopidogrel (4) Aggrenox (aspirin/extended-release dipyriadmole)/Clopidogrel

Question 2

Classic s/sx carotid artery stenosis

Answer 2

Carotid bruit, TIA, amaurosis fugax, CVD; Vertigo & syncope not caused by carotid artery stenosis

Question 3

Indications for carotid endarterectomy

Answer 3

(1) Symptomatic carotid stenosis of 70-99% occluded (if 100% stenosed, body compensated - benefits of surgery not there) (2) Symptomatic 50-69% (marginal benefit, more benefit w/ men & performed within 2 weeks of Stroke/TIA) (3) 80-99% stenosis, expected live > 5 yrs; surgeon w/ low complication rate

Question 4

Non-surgical tx for carotid artery stenosis

Answer 4

BP 50; TG

Question 5

5 main Lacunar infarct syndromes

Answer 5

All absent cortical signs: (1) Pure motor hemiparesis (2) Pure sensory stroke (3) Ataxic hemiparesis (4) Sensory motor stroke (5) Dysarthria clumsy hand syndrome

Question 6

Tx SAH

Answer 6

(1) Discontinue all anticoagulants; Reverse any anticoagulants (2)

Question 7

Meds or med withdrawal cause seizure

Answer 7

(1) Buproprion (Wellbutrin) - lower seizure threshold (2) Buspirone - lower seizure threshold (3) Enflurane (think: E for epileptic) (4) Withdrawal for benzos, barbs, alcohol, & anticonvulsants (5) Pheophylline overdose (used for COPD, asthma 2nd/3rd line, low therapeutic index) (6) B6 deficiency (no B6, no GABA, no inhibitory = excess excitation; typically caused by Isoniazid)

Question 8

Meds used as prevention for following recurrent seizures: (1) Gran Mal/Tonic Clonic (2) Simple partial (3) Absence (4) Myoclonic

Answer 8

(1) Valproic acid (aka Valproate), Carbamazepine, Phenytoin, Lamotrigine, or Topiramate (may be used in combination w/ each other) (2) Lamotrigine, Carbamazepine, Phenytoin… 2nd line - Valproic Acid, Topiramate (3) Ethosuximide… 2nd line - Valproic Acid (4) Valproic Acid

Question 9

Med(s) matching: (1) side effect of Gingival hyperplasia (2) Tx Absence seizures (3) Tx Trigeminal neuralgia (4) side effect of Stevens-Johnson syndrome (short list)

Answer 9

(1) Phenytoin (2) Ethosuximide (3) Carbamazepine (4) Anticonvulsants (Ethosuximide, Lamotrigine, Carbamazepine, Phenobarbital, & Phenytoin), also Antibiotics (penicillin, sulfa drugs), Sulfa drugs, allopurinol

Question 10

Drugs known for inducing cytochrome P450 (i.e., speed metabolism of other drugs, like Warfarin & OCPs):

Answer 10

BCGPQRS: Barbiturates, Carbamazepine, Griseofulvin, Phenytoin, Quinidine, Rifampin, St. John’s wort (OTC herb)… also, Ethanol

Question 11

Arnold-Chiari malformation - Definition & Type I v. Type II

Answer 11

Downward displacement of the cerebellar tonsils and medulla through foramen magnum; Type I - most common, often asymptomatic, headaches and/or cerebellar sx; Type II - usually accompanied by other neurologic abnormalities; Types up to IV - larger size, more neurologic abnormalities

Question 12

Neurologic abnormalities assoc. w/ Arnold-Chiari malformation

Answer 12

(1) Hydrocephalus (2) Syringomyelia (3) Myelomeningocele

Question 13

CP p/w & assoc. w/

Answer 13

Spastic paresis of any/all limbs with clonus, Persistence of primitive reflexes, Tendency to drool, Athetosis, Choreiform, Involuntary grimacing, Delayed psychomotor development, Ataxia, Atonic (hypotonia); Encephalopathy - lethargy, decreased spontaneous movement, hypotonia, suppressed primitive reflexes; Assoc. w/ Epilepsy, Mental retardation, & Sensory impairment