NEURO

Question 1

Abortive therapy for migraine headache?

Prophylactic treatment?

Answer 1

sumatriptan (Imitrex) or ergotamine to abort migraine headache

propranolol (justified when 4+ HA/month) for migrain ppx

Question 2

Abortive therapy for cluster headache?

Prophylactic treatment?

Answer 2

triptans, 100% oxygen, steriods to abort cluster headache

verapamil (CBBs) for cluster HA ppx

Question 3

Which headache occurs in men (10 times more likely)

Answer 3

cluster

Question 4

Name triggers for migraine

Answer 4

Cheese

Caffiene

Menstruation

Oral contraceptive

Question 5

Vertigo that changes with position. Dx?

Answer 5

**Benign Positional Vertigo **

Will have a postive Dix-Hallpike maneuver

–> tx with meclizine

Question 6

Vertigo only. No hearing loss or tinnitus. Dx?

Answer 6

Vestibular neuritis

Is inflammation of the vestivular portion (therefore no hearing loss/tinnitus) of 8th cranial nerve. Presumably viral. No tests. Give meclizine.

Question 7

Vertigo + hearing loss / tinnitus following URI. Dx?

Answer 7

Labyrinthitis

Is inflammation of the cholea. Self limited. Give meclizine.

Question 8

Vertigo + hearing loss / tinnitus that is remitting and relapsing. Dx? Tx?

Answer 8

Meniere’s Disease

Tx with salt restriction and acetazolamide.

Question 9

HA + tenderness temporal area + jaw claudication. Dx? Feared complication?

Answer 9

Temporal arteritis

Blindess is the feared complication.

If visual sx –> high dose steroids

If no visual sx, get ESR, do bx

Question 10

HAs constantly preceded by menstruation.

Dx?, Tx?

Answer 10

Migraine Headache (mentruation is trigger)

Give low dose estrogen (HA caused by estrogen withdrawal)

Question 11

Patient with migraine. You want to give sumatriptan. What are the major contraindications to triptans?

Answer 11

Ischemic heart disease, Previous MI, Angina, Uncontrolled HTN

SSRIs, MAOIs, lithium

Question 12

Obese female on OCP with diplopia (6th nerve palsy). Dx? Tx?

Answer 12

Pseodotumor cerebri (Idiopathic Intracranial Hypertension)

Give acetozolamide or lasix –> if no success, recurrent LPs –> if no success, VP shunt

Question 13

Physical exam clue to differentiate betwen stroke and Bell’s Palsy?

Answer 13

Stroke spares the forhead (will be able to wrinkle forehead).

Bell’s palsy may not

Question 14

Pt with obvious stroke. Window for TPA?

Answer 14

3 hours

(but MUST do non-con head CT first to r/o hemorrhage –which is 20% of strokes)

Question 15

What are the absolute contraindications to TPA for stroke?

Answer 15

Previous CVA or head trauma in 3 months

Uncontrolled HTN (>185/110)

Previous intracranial hemorrhage

Intracranial mass

Recent brain or spinal surgery

Bleeding disorder, Active internal bleeding, Already anticoagulated, platelet < 100,000

Question 16

Indication for carotid endarterectomy?

Answer 16

70% occulusion with symptoms

**BUT **not if it’s 100% occluded. Then risks outweight benefits.

Question 17

Treatment of trigeminal neuralgia?

Answer 17

carbamazepine

Question 18

Stroke in a younger patient (<50). What is the cause?

Answer 18

More likely vaculitis or hypercoaguable state

Question 19

Workup for CVA?

Answer 19

Echo (vegetations)

Carotid dopper/duplex (endarterctomy if 70%)

EKG/holter

Also, if under age 50

Hypercoaguable workup (ANA dsDNA, protein C, S FV leiden def, antiphospholipid, etc)

Vasculitis workup (ESR, VDRL, RPR)

Question 21

Treatment for Parkinson Disease

Answer 21

Age over 60 = carbidopa/levodopa

Age under 60 = anticholenergics (benztropine)

Question 22

Treatment for restless leg syndrome?

Answer 22

Pramipexole (dopamine agonist also used in Parkinson Disease)

Question 23

Most important component of CSF analysis for dx of bacterial meningitis

Answer 23

Cell count: thousands of neutrophils = start IV CTX/Vanc/steroids. (Cx is best, obviously, but results later)

Gram stain

Protein: elevated in all meningitis (if low, not meningitis)

Glucose: low in bacterial meningitis

Question 24

What is the interpretation of the FENa

Answer 24

< 1% = prerenal
1 - 2% = renal
> 2% = ATN

Question 25

Metformin should not be used if creatine is ___.

Answer 25

1. 5 for men
2. 4 for women

(because of increased risk of metabolic acidosis)

Question 26

Indications for dialysis in patient with AKI?

Answer 26

pH < 7.1 (Metabolic acidosis -bicarb not
effective/indicated as in volume overload or ketoacidosis)
Uremia (Pericarditis/pleuritis, Neuropathy, Encephalopathy/altered MS)

• *Fluid overload** (refractory to diuretics)
• *Hyperkalemia** (K+ > 6.5, refractory to medical therapy)
• *Poisonings** and intoxications (Ethylene glycol, lithium)