Neuro

Question 1

Vertigo

Answer 1

Retain on board
• Meclizine 25mg chew 1 tab PO
• Ondansetron 4mg 1 tab Sublingual

Question 2

Insomnia

Answer 2

Retain on board
• Counseling on good sleep hygiene, limit caffeine, alcohol, and nicotine before bed
• Diphenhydramine HCL 25mg cap PO before bed

Question 3

Chronic Pain Syndrome

Answer 3

Retain on board
• Referral to Physical therapy
• Educate on pain management
• NSAIDs
• Methocarbamol 500mg tab PO BID
• Follow up

Question 4

Encephalitis

Answer 4

MEDEVAC
• Empiric tx
• Ceftriaxone 1 gram inj IM requires IV antibiotics
• Valacyclovir 1 gram tab PO TID for 7 days

Question 5

Meningitis

Answer 5

MEDEVAC
• Ceftriaxone 1 gram inj IM tx pt requires IV antibiotics
• Ciprofloxacin 500mg tab PO for crew prophylaxis
• Isolate pt for droplet precautions
• Dark, quiet room, raise head of the bed 30 degrees
• CBC
• CT scan to r/o ICP
• Lumbar puncture to test CSF for infection

Question 6

Bell’s Palsy

Answer 6

MEDADVICE
• 60% of cases recover w/o tx
• Prednisone 10 mg PO Q4hr daily for 5 days followed by a 5-day taper
• Artificial tears for eye lubrication
• Valacyclovir 1 gram tab PO if caused by herpes virus

Question 7

Lumbar Disk Herniation

Answer 7

Possible MEDEADVICE
• Light Duty 48hrs
• NSAIDs
• Cyclobenzaprine 10mg tab PO
• phyiscal therapy

Question 8

Radiculopathy

Answer 8

MEDADVICE
• Light Duty
• SIQ x24hr
• Cyclobenzaprine (Flexeril) 5mg PO Q8Hr
• Referral to physical therapy
• MRI

Question 9

Carpal Tunnel Syndrome

Answer 9

• Wrist splint up to 3 months
• NSAIDS
• Dexamethasone 4mg inj into carpal tunnel
• Refer if sx persist more than 3 months despite tx or thenar muscle atrophy develops

Question 10

Cauda Equina Syndrome

Answer 10

MEDEVAC
• Emergency spinal surgery to remove bits of bone or discs, or tumors
• T3’s
• MRI

Question 11

Tension headache

Answer 11

• NSAIDS
• Amitriptyline
• Treat underlying anxiety or depression
• Refer to mental health

Question 12

Cluster headache

Answer 12

• 12-15L/min for 15min via non-rebreather mask
• Prednisone 60mg daily for 5 days followed by gradual withdrawal over 7-10 days

Question 13

Migraine

Answer 13

• Counsel pt on avoiding precipitating factors
• Rest in a quiet dark room
• Zolmitriptan 2.5mg sublingual

Question 14

Post-traumatic Headache

Answer 14

• Acetaminophen 325mg 1-2 tabs PO Q6hr

Question 15

Medication Overuse Headache

Answer 15

• Chronic daily headaches
• Unresponsive to medication
• Educate pt on weening off of meds and that the process will take about a month
• Gradual withdrawal from analgesics will eventually relieve headaches

Question 16

Seizures

Answer 16

MEDEVAC

• Clear the room, maintain the airway if needed
• Started IV catheters
• Blood work
• Electrolytes, LFT, CBC
• Finger stick glucose
• Diazepam 5mg IM Q5-10 minutes; do not exceed 30mg

Question 17

TIA

Answer 17

MEDEVAC
• EKG
• CBC
• FBG
• Rapid RPR
• CT/MRI
• Lipid panel
• Electrocardiography
• Thrombolytic therapy

Question 18

CVA

Answer 18

MEDEVAC
• Aspirin
• EKG
• CBC
• FBG
• CT/MRI
• Lipid panel
• Electrocardiography
• Thrombolytic therapy within 6hr

Question 19

Restless Leg Syndrome

Answer 19

Retain on board
• Ferrous sulfate 325 mg three times daily for 3-6 months
• Avoid aggravating drugs and caffeine
• Increase exercise
• Leg massage

Question 20

Altered Mental Status

Answer 20

• Glasgow Coma Scale
• Less than 8 = intubate
• Supportive therapy, 02, fluids
• If opioid overdose is suspected give Naloxone

Question 21

Closed head injury to include aneurysm

Answer 21

• MACE within 48hrs
• Direct observation for 24 hours
• Awaken the patient every 2 hours to ensure normal alertness
• No alcohol, sedatives, pain relievers other than NSAIDs should be given for 48 hours
• Ibuprofen 800mg tab PO max 3,200mg/d

Question 22

Spinal Cord Injury

Answer 22

MEDEVAC
• ABCs first
• immobilize the C-spine with cervical collar
• Maintain oxygenation and blood pressure
• Insert a Foley catheter if bladder paralysis is suspected
• Sedate patient if necessary
• Consult MO before giving Corticosteroids
• X-ray

Question 23

Basilar skull fracture

Answer 23

MEDEVAC
• Oxygen
• C-spine precautions
• Needs Head CT and Neurosurgeon

Question 24

ICP

Answer 24

MEDEVAC
• Secure & maintain an open airway
• Elevate head of bed 25-30 deg Reverse Trendelenburg
• Ventilate to maintain oxygenation
• IV fluids NS or LR
• Consult MO before giving Furosemide

Question 25

Subarachnoid Hemorrhage

Answer 25

MEDEVAC
• Bedrest
• Tylenol 325mg 3 tabs PO
• Tx sx for HA and anxiety
• give laxatives and stool softeners
• Lower SBP >140
• Referral to Neurology
• Avoid drugs that can lead to anticoagulation
• CBC
• EKG
• CT with CT angiography within 24hrs
• Lumbar puncture

Question 26

ICH

Answer 26

MEDEVAC
• Elevate head of bed to 30 degree
• EKG
• maintain O2 sat
• CBC
• FBG
• Non-contrast CT scan/MRI

Question 27

Subdural Hematoma

Answer 27

MEDEVAC
• Referral to Neurology
• CT scan
• Require surgical intervention

Question 28

Epidural hemorrhage

Answer 28

• Referral to Neurology
• CT scan
• Require surgical intervention

Question 29

Cranial Trauma

Answer 29

MEDEVAC
• Oxygen
• C-spine precautions and MEDEVAC ASAP
• Ultimately needs Head CT and Neurosurgeon
• Glasgow Coma Scale