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Step 2 High Yield > Neuro Test And Tx > Flashcards

Neuro Test And Tx Flashcards

0
Q

What can be used for treatment in early Parkinson’s disease?

A

Dopamine agonists : ropinirole, pramipexole, bromocriptine

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1
Q

What is the mainstay of tx for Parkinson’s disease?

A

Levo/carbidopa
Levodopa is a dopamine precursor that can cross the Bb barrier
Carbidopa inhibits the peripheral conversion of levodopa to prevent side effects

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2
Q

What is apomorphine used for?

A

It is a dopamine agonist used for rescue therapy

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3
Q

What drug is neuroprotective in Parkinson’s disease and may decrease the need for levodopa?

A

Selegiline

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4
Q

What do COMT inhibitors do?

A

Increase the availability of levodopa

Decrease motor fluctuations

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5
Q

What drugs are not given alone in Parkinson’s?

A

COMT inhibitors

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6
Q

What drug has mild anti-PD activity?

A

Amantadine

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7
Q

What do amantadine do in Pd?

A

Improves akinesia, rigidity, and tremor

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8
Q

What can amantadine be used for in PD?

A

Temporary short term use in early disease

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9
Q

What other options are available for PD if medical therapy doesn’t work?

A

Surgical pallidotomy

Deep brain stimulators

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10
Q

How do you diagnose Huntington’s?

A

Clinically

Confirm with genetic testing

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11
Q

What is the treatment to minimize unwanted movement in Huntington’s?

A

Reserpine

Tetra benzine

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12
Q

What is the MOA of reserpine and tetrabenazine?

A

Inhibit VMAT and limit the release and packaging of dopamine

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13
Q

What should be used for psychosis in Huntington’s?

A

Atypical antipsychotics

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14
Q

What should be used for depression in Huntington’s?

A

SSRIs

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15
Q

How do you diagnose a stroke?

A

Labs

CT without contrast

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16
Q

What would you order if an embolic stroke is suspected?

A

ECG and an echo

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17
Q

When should you screen for a hypercoaguable state?

A

In patients with a history of thrombosis
First stroke
Younger than 50

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18
Q

When is tPA administered for an ischemic stroke?

A

Within 3 hours

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19
Q

When can intra-arterial thrombolysis be used?

A

Within 6 hours for a patient with occlusion of the MCA if they are not candidates for tPA

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20
Q

How do you treat signs or symptoms of brain swelling?

A

Hyperventilation (decreased CO2 causes vasoconstriction and decreases cerebral perfusion)
Mannitol

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21
Q

How do you monitor for brain swelling?

A

Serial CT scan

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22
Q

Why should you allow hypoxemia and HTN in ischemic stroke?

A

To maintain perfusion of the brain

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23
Q

What should you do if they have severe HTN (BP over 220 and 120) or a hemorrhagic stroke?

A

Treat with IV labetolol and nicardipine

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24
Q

What should the BP be if giving tPA?

A

Less than 185/110

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25
Q

What is associated with worse prognosis in stroke?

A

Fever

Hyperglycemia

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26
Q

What is associated with decreased morbidity and mortality in the setting of an ischemic stroke if given within 48 hours?

A

ASA

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27
Q

What is the target INR if have a prosthetic valve?

A

3-4

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28
Q

What should be given for long term prevention after a stroke?

A

ASA or clopidogrel

Anticoagulation if new AF or hypercoaguable

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29
Q

When can an carotid endarterectomy be done?

A

60% occlusion in symptomatic patients

70% occlusion in asx patients

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30
Q

How do you diagnose SAH?

A

CT without contrast

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31
Q

What is the CT without contrast is negative in SAH?

A

LP

May negative in first 6-12 h and after 24-48 h

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32
Q

What should be performed once SAH is confirmed?

A

Four vessel angiography (or CT angiography with 3D)

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33
Q

What should be done if there is a high suspicion for SAH but CT and LP are negative?

A

Four vessel angiography

Call neurosurgery

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34
Q

How do you prevent re bleeding in SAH?

A

Keep systolic bp less than 150

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35
Q

How do you prevent vasospasm after SAH?

A

CCB
IVF
Pressors to maintain a bp

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36
Q

How do you decrease ICP after SAH?

A

Raise the head of the bed

Hyperventilation

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37
Q

How do you treat hydrocephalus?

A

Lumbar drain

Serial LPs

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38
Q

What is the definitive treatment of SAH?

A

Surgical clipping

Endovascular coiling

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39
Q

What are the management steps of SAH?

A

Maintain Bp below 150
CCB
IVF
Raise head of bed/ hyperventilate

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40
Q

How do you diagnose a intra cerebral hemorrhage?

A

Noncontrast head CT

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41
Q

What is the treatment of intra cerebral hemorrhage?

A

Keep bp below 150 to prevent rebleeding
Elevate head of bed
Seizure prophylaxis
Surgical eval if mass effect

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42
Q

How is subdural hematoma diagnosed?

A

CT scan without contrast

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43
Q

What is the treatment of subdural hemorrhage?

A

Surgical evacuation if symptomatic

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44
Q

How do you diagnose an epidural hematoma?

A

CT without contrast

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45
Q

What is the treatment for epidural hematoma?

A

Emergent neurosurgical evacuation

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46
Q

If there is no improvement in the facial nerve in one month, what should you do?

A

Do an MRI

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47
Q

If temporal arteritis is suspected, what should you order?

A

ESR

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48
Q

When is a CT/MRI needed?

A

Suspected SAH, increased ICP or focal neuro deficits

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49
Q

What is the first line therapy for migraines after NSAIDs have failed?

A

Triptans

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50
Q

What can be used for migraine prophylaxis?

A

Anticonvulsants (gabapentin or topiramate)
TCA
Bb
CCBs

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51
Q

What other med can be used for migraine abortion?

A

Metoclopramide

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52
Q

What is the treatment for acute cluster headache?

A 
High flow oxygen 
Dihydroergotamine
Octreotide 
Sumatriptan
Zolmitriptan
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53
Q

What is the prophylactic therapy for cluster headache?

A

Prednisone and ergotamine for transition

Verapamil, methysegide, lithium, valproic acid, topiramate for maintenance

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54
Q

What may be seen in CSF of cavernous sinus thrombosis?

A

Increased protein due to parameningeal irritation

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55
Q

What is the principal means by which to diagnose cavernous sinus thrombosis?

A

MRI with gad or venography

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56
Q

What is another way to diagnose cavernous sinus thrombosis?

A

Ct angiography

Ct venography

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57
Q

What is necessary for fungal cases of cavernous sinus thrombosis?

A

Para nasal sinus bx

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58
Q

What is the treatment of cavernous sinus thrombosis?

A

Penicillinase resistant antibiotics (nafcillin or oxacillin) + ceftriaxone or cefepime
+ metro for anaerobes
+ vanc for MRSA
IV For 3-4 weeks

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59
Q

When should surgical drainage of cavernous sinus thrombosis be done?

A

If no response to antibiotics within 24 hours

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60
Q

How do you diagnose a seizure?

A

EEG

Elevated prolactin, CBC, RPR, glucose, CMP, toxicology, ESR

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61
Q

How do you evaluate a focal seizure?

A

MRI

CT with contrast looking for masses or structural abs

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62
Q

How do you treat seizures lasting longer than 2 minutes?

A

IV lorazepam

Phenytoin after 2 doses of BZD

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63
Q

What med is first line for treatment of partial seizures?

A

Carbamazepine

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64
Q

What is first line in children with partial seizures?

A

Phenobarbital

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65
Q

What should be considered for intractable temporal lobe seizures?

A

Anterior temporal lobectomy

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66
Q

What does the EEG show in a tonic clonic seizure?

A

10 Hz activity during tonic

Slow waves during clonic

67
Q

How do you manage a tonic clonic seizure?

A

Protect the airway

Treat underlying cause

68
Q

What are the first line drugs for a primary generalized tonic clonic seizure?

A

Phenytoin
Fosphenytoin
Valproate

69
Q

What drugs may be used an adjunctive therapy for a primary tonic clonic seizure?

A

Lamotrigine

Topiramate

70
Q

What meds can be used for secondary tonic clonic seizures?

A

Same drugs for partial

Carbamazepine, phenytoin, oxycarbazepine, valproate acid, phenobarbital

71
Q

What does EEG show for an absence seizure?

A

Classic 3 per second spike and wave discharges

72
Q

What is the first line treatment for absence seizures?

A

Ethosuximide

73
Q

What is the second line treatment for absence seizures?

A

Valproic acid

74
Q

During status epilepticus what do you do?

A 
ABCs 
Stat head CT
LP only after CT if meningeal signs 
EEG if stable 
IV lorazepam or diazepam with loading dose of fosphenytoin
75
Q

If seizures continue after acute management what should you do?

A

Intubate and load with phenobarbital

Consider IV sedation and continuous EEG monitoring

76
Q

How do you diagnose wester’s syndrome?

A

Look for abnormal interictal EEG with hypsarrhythmia

77
Q

What is the treatment of west syndrome?

A

Hormonal therapy with ACTH, prednisone, and clonazepam or valproate

78
Q

How do you diagnose Lennox-gastaut syndrome?

A

Abnormal interictal EEG with slow spike and wave complexes

79
Q

How do you diagnose benign paroxysmal positional vertigo?

A

Dix-hall pike maneuver

80
Q

How do you treat BPPV?

A

Epley maneuver

81
Q

What is contraindicated as treatment for BPPV?

A

Antivertigo meds because they can cause chronic unsteadiness

82
Q

How do you diagnose acute peripheral vestibulopathy?

A

Abnormal vestibulo-ocular reflex
Horizontal nystagmus that beats to one side, the side of the lesion
No vertical eye misalignment when covering the other

83
Q

What is indicated if patient is at high risk for central lesions?

A

MRI with diffusion weighted imaging

84
Q

What is the treatment of peripheral vestibulopathy?

A

Corticosteroids within 72 h of onset

Meclizine

85
Q

How do you diagnose Ménière’s disease?

A

Two episodes lasting 20 minutes
Hearing loss documented by audiometry
Tinnitus
Aural fullness

86
Q

What is the treatment of Ménière’s disease?

A

Low sodium diet and diuretics = first line
Migraine diet, meds
BZD
Anti emetics

87
Q

What is the treatment for severe unilateral cases of Ménière’s disease?

A

Ablation

88
Q

How do you diagnose vestibular migraine?

A

Diagnosis of exclusion

Dizzy spells with photophobia or photophobia a highly suggestive

89
Q

How do you treat vestibular migraine?

A

Migraine meds, diet and lifestyle changes

BZDs and anti emetics can be tried

90
Q

What are the tests for diagnosing myasthenia gravis?

A

Edrophonium test = anticholinesterase which leads to amelioration of symptoms
Ice test - put pack of ice over one eye, will resolve ptosis

91
Q

What can yield confirmation of myasthenia gravis?

A

An abnormal single fiber EMG

Decremental response to repetitive nerve stimulation

92
Q

What else should be order if suspect myasthenia gravis?

A

Chest CT to look for thymoma

93
Q

What is the mainstay of treatment for MG?

A

Steroids

Immunosuppressants : azathioprine, cyclosporine, MMF

94
Q

What is used for symptomatic treatment of MG?

A

Pyridostigmine (anticholinesterase)

95
Q

What can be used for relief in severe cases?

A

Plasmapheresis

IVIG

96
Q

What can be curative of MG?

A

Resection of thymoma

97
Q

What should no be given to patients with MG?

A

Aminoglycosides

Bb

98
Q

How do you diagnose Lamber Eaton syndrome?

A

Repetitive nerve stimulation will give incremental response
Autoabs
Chest CT looking for Small CC of the lung

99
Q

What is the treatment for lambert eaton?

A 
Treat small cell lung CA
3,4 diaminopyridine or guanidine 
Pyridostigmine 
Corticosteroids 
Azathioprine
100
Q

How do you diagnose MS.

A

MRI shows multiple asymmetric peri ventricular whie matter lesions especially in the corpus callosum
CSF show pleocytosis, more than 2 oligoclonal bands and increased IgG

101
Q

How do you treat MS symptomatically?

A

Baclofen for spasticity
Cholinergics for urinary retention
Anticholinergics for urinary incontinence
Amitryptiline for painful paresthesias

102
Q

What should be given for acute episodes of MS?

A

Corticosteroids

103
Q

What can be given for relapsing remitting MS?

A

INF- beta

Copolymer 1

104
Q

What can you give for worsening relapsing remitting or progressive MS?

A

Mitoxantrone

105
Q

What is used as a second line?

A

Natilizumab

Risk of PML! By JC virus activation

106
Q

How do you diagnose Guillan barre?

A

See diffuse demyelination on nerve conduction studies

107
Q

What is the treatment of Guillan-Barre?

A

ICU admit for respiratory failure
Plasmapheresis and IVIG
Aggressive physical rehab

108
Q

How do you diagnose ALS?

A

Clinically
Get CT/MRI to r/o structural lesions
EMG/nerve conduction studies to rule out other demyelinating issues - will show widespread denervation and fibrillation potentials

109
Q

What can be used for the prevention of disease progression in Alzheimer’s?

A 
Donepezil
Rivastigmine 
Galantamine
Tacrine (hepatotoxicity!)
Memantine (may slow decline in moderate to severe disease)
110
Q

How is Pick’s disease diagnosed?

A

Clinical features and CT/MRI showing frontotemporal atrophy

111
Q

How do you diagnose normal pressure hydrocephalus?

A

CT/MRI shows ventricular enlargement out of proportion to sulcal atrophy

112
Q

What is the treatment for normal pressure hydrocephalus?

A

Surgical shunting if LP or continuous lumbar CSF drainage shows improvement

113
Q

How do you diagnose CJD?

A

Clinically

Will have elevated levels of CSF 14-3-3 and tau protein

114
Q

What is the treatment for an astrocytoma?

A

Resection if possible

Radiation

115
Q

What is the treatment for glioblastoma multiforme?

A

Surgical removal

Radiation/chemo

116
Q

What is the treatment for meningioma?

A

Surgical resection

Radiation if unresectable

117
Q

What is the treatment for acoustic neuroma?

A

Observation/ surgical removal

118
Q

What is the treatment for medulloblastoma?

A

Surgical resection with chemo/radiation

119
Q

What is the treatment for ependymoma?

A

Surgical resection

Radiation

120
Q

What is the tx for craniopharyngioma

A

Surgical resection

121
Q

How do you diagnose a brain tumor?

A

Contrast CT
MRI with gad (best for vascular and soft tissue)
MRI without gad

122
Q

How do you get a histologic dx of a tumor?

A

CT guided bx

Surgery

123
Q

How do you diagnose NF?

A

MRI with gad

124
Q

What are the diagnostic criteria for NF1?

A 
2+:
6 cafe au lait spots
2 Lisch nodules
Freckling in axilla or inguinal area
Optic glioma
First degree relative 
Bone abnormality (kyphoscoliosis)
125
Q

What does a head CT show in someone with tuberous sclerosis?

A

Calcified tubers in the cerebrum in the periventricular area

126
Q

Why do you do a ECG on someone with tuberous sclerosis?

A

To evaluate for cardiac rhabdomyoma

127
Q

What do you treat infantile spasms in tuberous sclerosis with?

A

ACTH or vigabatrin

128
Q

What can be given for generalized seizures in tuberous sclerosis?

A

Lamotrigine

129
Q

What is the tx for Broca’s aphasia?

A

Speech therapy

130
Q

What is the treatment for closed angle glaucoma?

A

Eyedrops: Timolol, pilocarpine, apraclonidine
Systemic meds : acetazolamide, IV mannitol
Laser peripheral iridotomy (curative)

131
Q

What is the medical treatment of open angle glaucoma?

A

Topical Bb
Pilocarpine to decrease production of aqueous humor
Carbonic anhydrase inhibitors

132
Q

How do you diagnose open angle glaucoma?

A

Tonometry
Ophthalmic exam shows - cupping of disk
Visual field testing

133
Q

How do you diagnose macular degen?

A

Fundoscopy reveals drusen and/or pigmentary changed in patients with strophic AMD

Hemorrhage and subretinal fluid if exudative

134
Q

What slows disease progression in AMD?

A

Combo of multivitamins (C, E, beta carotene and zinc)

135
Q

What improves vision in patients with exudative AMD?

A 
VEGF inhibitors (bevaxizumab, ranibizumab)
Pegatinib
136
Q

What can be used in conjunction with VEGF inhibitors?

A

Photodynamic therapy

137
Q

What is the treatment for central retinal artery occlusion?

A

Intra-arterial thrombolysis within 8 h to ophthalmic artery

Can try high flow oxygen, IV acetazolamide, ocular massage, drainage of anterior chamber

138
Q

What is the treatment of central retinal vein occlusion?

A

Laser photo coagulation

139
Q

What is the drug of choice for partial seizures?

A

Phenytoin

140
Q

How do you diagnose spinal cord compression?

A

MRI of the spine

141
Q

How do you diagnose an acoustic neuroma?

A

MRI with gad

142
Q

What is the first line treatment for RLS?

A

Dopamine agonists: ropinirole, pramipexole

143
Q

What is an alternative tx to RLS?

A

Gabapentin

144
Q

What is the nonpharmcologic tx for RLS?

A

Leg massage
Heating pads
Regular exercise

145
Q

When should iron supplementation be given?

A

When serum ferritin levels are less than75

146
Q

What may patients with RLS take if other treatment don’t work?

A

Opioids

147
Q

What is the tx for spinal cord compression?

A

Stat MRI

IV glucocorticoids

148
Q

What is the diagnostic test for syringomyelia?

A

MRI

Myelography

149
Q

How do you diagnose a brain abscess?

A

CT or MRI

150
Q

What is the tx of brain abscess?

A 
Broad spectrum IV antibiotics: third gen ceph (ceftriaxone) + vanc + metro for 6-8 weeks 
Surgical drainage 
Do serial MRI/CT to follow resolution 
Prophylactic antiepileptics
Dexamethasone for cerebral edema
Mannitol to decrease ICP
151
Q

How do you diagnose Guillan barre?

A

LP - shows normal WBC and lots of protein

152
Q

What is the treatment for acute agitation?

A

Haloperidol

153
Q

What is the first initial step in tx an acute episode of glaucoma?

A

IV mannitol

154
Q

What are the first line tx for hypertensive encephalopathy?

A

Nitroprusside

Labetolol

155
Q

How do you asses respiratory function in Guillan Barre?

A

Serial vital capacity

If below 15 ml/kg = increased risk of respiratory failure

156
Q

What is the first line tx of pseudo tumor cerebri (idiopathic intracranial HTN)?

A

Acetazolamide (inhibits choroid plexus carbonic anhydrase)

157
Q

What can be added for continued sx of IIH with acetazolamide tx?

A

Furosemide

158
Q

What is the tx for IIH with progressive vision loss?

A

Surgical intervention with optic nerve sheath decompression or lumboperitoneal shunting

159
Q

What is the tx for trigeminal neuralgia?

A

Carbamazepine

160
Q

What are surgical tx for trigeminal neuralgia?

A

Surgical gangliolysis

Suboccipital craniectomy

161
Q

What is the best thing to do after someone has had a seizure and the blood panels come back with metabolic acidosis?

A

Check again in 2 hors because it usually resolves on its own

162
Q

How do you diagnose IIH?

A

MRI

LP with opening pressure (dx= greater than 250)

163
Q

What do you give for stroke with no prior antiplatelet therapy?

A

Aspirin

164
Q

What do you give for a stroke on aspirin?

A

Aspirin + dipyramidole or clopidogrel

165
Q

What is the therapy for a stroke on aspirin with large intracranial atherosclerosis?

A

Aspirin + clopidogrel

166
Q

What is the diagnostic test for hydrocephalus?

A

CT of brain

Step 2 High Yield (20 decks)

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