Neuro

Question 1

Acute Stroke Tx and Work-Up

Answer 1

• CT head w/o contrast (r/o bleed)
• Ultimately, ECHO, EKG/ telemetry, Holter monitor if no abnormalities while inpatient, carotid duplex US

TX

• If < 3 hrs do tPA
• If > 3 hrs Aspirin
• Can do clot retrieval with catheter up to 8-12 hrs after

STATIN (goal LDL < 70)

Question 2

What do you do if someone has a stroke while on ASA?

Answer 2

Add dipyridamole OR switch to clopidogrel

Question 3

When can tPA be used up to 4.5 hrs after presentation?

Answer 3

If pt < 80 yo

If NIH stroke scale < 24

No DM, no previous stroke

Question 4

Indications for PFO Closure

Answer 4

R to L shunt confirmed w/ bubble study

AND pt < 60

AND stroke appears to be embolic

**Still give them anti-platelet medications

Question 5

Indications for Carotid Endarterectomy

Answer 5

> 70% stenosis + symptomatic

DEFINITELY DO NOT OPERATE IF < 50% STENOSIS

Question 6

Tx of Pseudotumor Cerebri

Answer 6

Weight loss

acetazolamide to dec CSF production

VP shunt

Optic nerve fenestration (last resort)

Question 7

Best Cluster Headache PPX

Answer 7

Verapamil

Question 8

Tx of Status Epilepticus

Answer 8

1 - benzo (lorazepam or diazepam)
2- fosphenytoin&raquo_space; fenytoin
3 - phenobarbital
4 - general anesthesia (neuromuscular block and propofol with intubation)

Question 9

When would you start an AED after first seizure?

Answer 9

Family history

Abnormal EEG

CT lesion

Present in status

Focal neuro findings

Question 10

1 side effect of carbamazepine

Answer 10

SIADH (hyponatremia)

Question 11

Normal WBC to RBC ratio in CSF

Answer 11

1 WBC for every 500-1000 RBCs

Question 12

Tx of SAH

Answer 12

Nimodipine (prevent vasospasm)

Phenytoin to prevent seizure

Embolization w/ coil&raquo_space;> surgical clipping

May need VP shunt if hydrocephalus

Question 13

Tx of Brain Abscess

Answer 13

PCN + metro + ceftriaxone

Use vancomycin instead of PCN if recent neurosurgery

Question 14

Which 3 migraine drugs worsen Parkinson’s

Answer 14

ANTI-DOPAMINE

Prochlorperazine

Metoclopramide

Chlorpromazine

Question 15

Shy-Drager Syndrome

Answer 15

parkinsonism + orthostasis

Question 16

Tx of Restless Leg Syndrome

Answer 16

pramipexole (dopamine agonist)

IRON (if low)

Question 17

Sequence of Parkinson’s Treatment

Answer 17

1 - anti- cholinergic (benztropine, trihexylphenidyl)

2 - dopamin agonists (pramipexole and ropinirole)

3 - Carbidopa - levodopa (on/off phenomena)

4 - adjuncts (COMT inhibitors like tolcapone or MAO inhibitors like selegiline)

5 - deep brain stimulation

Question 18

Side effect of natalizumab in MS

Answer 18

Progressive multifocal leukencephalopathy

Presents as worsening neuro deficits and new white matter hypodense lesions

Question 19

Best 2 drugs for prevention of MS relapse

Answer 19

Beta interferon

glatiramer

Question 20

ALS Tx + Mechanism

Answer 20

Riluzole (reduces glutamate buildup in neurons)

Question 21

Charcot-Marie-Tooth

Answer 21

Distal weakness and sensory loss

Wasting in legs

Hyporeflexia

Tremor

High foot arches

Abnormal EMG

NO TREATMENT!

Question 22

What antibody is associated w/ Miller-Fisher Syndrome?

Answer 22

GQ1b antibody

Question 23

What is the best initial imaging in myasthenia?

Answer 23

Chest imaging to look for thymoma

Question 24

What drug is coupled with neostigmine/pyridostigmine in MG?

Answer 24

Glycopyrrolate (anticholinergic to block extra Ach at muscarinic receptors)

Question 25

GBS

Answer 25

Hyporeflexia + ascending paralysis + labile BPs + increased CSF protein

Test inspiratory capacity (LFTs)

TX = IVIG and plasmapheresis (NO STEROIDS)

Question 26

Dementia Tx

Answer 26

Donepazil, rivastigmine, galantamine (inc Ach)

Memantine

Question 27

What is the best initial diagnostic test in MG? What is the most accurate test?

Answer 27

Initial - Anti-acetycholine receptor antibodies
(if negative try anti-MUSK)

Accurate - EMG w/ repetitive stimulation

Question 28

MRI Gadolinium Reaction

Answer 28

Collagen deposits and fibrotic nodules in skin, heart, lungs, liver

“nephrogenic systemic fibrosis”

Look for in MS because multiple MRIs over lifetime

Question 29

Tx of Dyskinesia in HD

Answer 29

Tetrabenazine