Neuro

Question 1

What happens with successive mannitol dosing?

Answer 1

more and more mannitol enters the stroke bed where the BBB is impaired and you get a paradoxical increase in edema

Question 2

Parkinsons disease

Answer 2

accumulation of alpha synuclein in the substantia nigra and the striatonigral tract

Question 3

mechanism of cefepime neurotoxicity

Answer 3

concentration dependent antagonism of GABA receptors, occurs in up to 15% of patients in ICU

Question 4

Cefepime neurotoxicity presentation

Answer 4

encephalopathy, somnolence, seizures, coma

Question 5

PRES- POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME causes

Answer 5

calcineurin inhibitors like tacrolimus and cyclosporine, malignant HTN, and eclampsia, TK inhibitors

Question 6

first line medication for convulsive status epilepticus

Answer 6

IV lorazepam

Question 7

The study that showed lorazepam as ideal drug in status firstline was what?

Answer 7

.1mg/kg and did not lead to cardiovascular collapse

Question 8

if no IV access what medication can you give IM for status?

Answer 8

fosphenytoin

Question 9

pathogenesis of PRES?

Answer 9

disordered cerebral autoregulation, endothelial dysfunction, cerebral ischemia due to vasocontstriction

Question 10

imaging seen with PRES?

Answer 10

increased signal in parietooccipital regions in T2 images.

• FLAIR improves sensitivity of dx
• DWI appears hypo or isointense

Question 11

BP management in PRES?

Answer 11

if malignant get diastolic prressure down to 100-105 mmHg- if not malignant then get MAP down 10%-25%

Question 12

Drug induced aseptic meningitis( presentation and bugs)

Answer 12

immunomodulators, NSAIDS, AED

T cell mediated reaction

Question 13

NORSE

Answer 13

new onset refractory status epilepticus, likely caused by non neoplastic autoimune, paraneoplastic, and infectious

Question 14

dosing of initial lorazepam for status?

Answer 14

.1mg/kg up to 8 mg

Question 15

what benzo and dose to give if no IV access for sz?

Answer 15

midazolam 10 mg IM

Question 16

treatment acute for seizures 2/2 hyponatremia?

Answer 16

150 cc of 3% or 2 amps of Na bicarb(100 meq in 100ml)

Question 17

induction regimen for intubation in a patient who is in refractory status?

Answer 17

1. 5 m/kg of prop, 2 mg/kg of ketamine, roc

- then start prop infusion 50-80 mcg/kg/hr

Question 18

what happens to GABA over time when using benzos for seizures?

Answer 18

the GABA receptors internalize, thereby reducing the sensitivity to benzos

Question 19

dosing of Keppra?

Answer 19

60mg/kg up to 4.5 G over 10 min

maintenance of 1-1.5 g q12

Question 20

valproic acid dosing and side effects?

Answer 20

load with 40mg/kg up to 3 g

• maintenance of 30-60 mg/kg daily divided into q12 or q8 dosing
• SE: thrombocytopenia, hyperammonemia, dont give in pregnancy

Question 21

VPA target dosing?

Answer 21

serum of 80-140 mg/dL

checkw free level in concern for toxicity- 4-11 ug/dL

Question 22

fosphenytoin(Cerebryx) SE?

Answer 22

bradycardia, hypotension, liver dysfucntion

Question 23

dosing of fosphenytoin?

Answer 23

20 PE/kg at 100-150 PE/min is loading

maintenance- 5-7 PE/kg/day

Question 24

criteria for brain death

Answer 24

• cause of coma known and irreversible
• tox screen neg
• if NMB make sure not stil paralyzed
• no severe acid base disturbances
• temp > 36 C
• no evidence of spontaneous respirations

Question 25

brain death testing

Answer 25

• pupils NR
• corneal reflex
• oculocephalic or oculovestibular
• no grimace to painful central stimuli
• no gag or cough
• no response to painful stimuli in limbs other than spinal cord reflexes

Question 26

brain death after reflexes?

Answer 26

apnea testing

• make sure HDS
• adjust vent to normalize PCo2
• Fio2 to 100%
• once vent off allow PCO2 to rise to 60 mmhg or 20 mmhg rise from normal baseline