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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
What should the BP be if giving tPA?
Less than 185/110
25
What is associated with worse prognosis in stroke?
Fever | Hyperglycemia
26
What is associated with decreased morbidity and mortality in the setting of an ischemic stroke if given within 48 hours?
ASA
27
What is the target INR if have a prosthetic valve?
3-4
28
What should be given for long term prevention after a stroke?
ASA or clopidogrel | Anticoagulation if new AF or hypercoaguable
29
When can an carotid endarterectomy be done?
60% occlusion in symptomatic patients | 70% occlusion in asx patients
30
How do you diagnose SAH?
CT without contrast
31
What is the CT without contrast is negative in SAH?
LP | May negative in first 6-12 h and after 24-48 h
32
What should be performed once SAH is confirmed?
Four vessel angiography (or CT angiography with 3D)
33
What should be done if there is a high suspicion for SAH but CT and LP are negative?
Four vessel angiography | Call neurosurgery
34
How do you prevent re bleeding in SAH?
Keep systolic bp less than 150
35
How do you prevent vasospasm after SAH?
CCB IVF Pressors to maintain a bp
36
How do you decrease ICP after SAH?
Raise the head of the bed | Hyperventilation
37
How do you treat hydrocephalus?
Lumbar drain | Serial LPs
38
What is the definitive treatment of SAH?
Surgical clipping | Endovascular coiling
39
What are the management steps of SAH?
Maintain Bp below 150 CCB IVF Raise head of bed/ hyperventilate
40
How do you diagnose a intra cerebral hemorrhage?
Noncontrast head CT
41
What is the treatment of intra cerebral hemorrhage?
Keep bp below 150 to prevent rebleeding Elevate head of bed Seizure prophylaxis Surgical eval if mass effect
42
How is subdural hematoma diagnosed?
CT scan without contrast
43
What is the treatment of subdural hemorrhage?
Surgical evacuation if symptomatic
44
How do you diagnose an epidural hematoma?
CT without contrast
45
What is the treatment for epidural hematoma?
Emergent neurosurgical evacuation
46
If there is no improvement in the facial nerve in one month, what should you do?
Do an MRI
47
If temporal arteritis is suspected, what should you order?
ESR
48
When is a CT/MRI needed?
Suspected SAH, increased ICP or focal neuro deficits
49
What is the first line therapy for migraines after NSAIDs have failed?
Triptans
50
What can be used for migraine prophylaxis?
Anticonvulsants (gabapentin or topiramate) TCA Bb CCBs
51
What other med can be used for migraine abortion?
Metoclopramide
52
What is the treatment for acute cluster headache?
``` High flow oxygen Dihydroergotamine Octreotide Sumatriptan Zolmitriptan ```
53
What is the prophylactic therapy for cluster headache?
Prednisone and ergotamine for transition | Verapamil, methysegide, lithium, valproic acid, topiramate for maintenance
54
What may be seen in CSF of cavernous sinus thrombosis?
Increased protein due to parameningeal irritation
55
What is the principal means by which to diagnose cavernous sinus thrombosis?
MRI with gad or venography
56
What is another way to diagnose cavernous sinus thrombosis?
Ct angiography | Ct venography
57
What is necessary for fungal cases of cavernous sinus thrombosis?
Para nasal sinus bx
58
What is the treatment of cavernous sinus thrombosis?
Penicillinase resistant antibiotics (nafcillin or oxacillin) + ceftriaxone or cefepime + metro for anaerobes + vanc for MRSA IV For 3-4 weeks
59
When should surgical drainage of cavernous sinus thrombosis be done?
If no response to antibiotics within 24 hours
60
How do you diagnose a seizure?
EEG | Elevated prolactin, CBC, RPR, glucose, CMP, toxicology, ESR
61
How do you evaluate a focal seizure?
MRI | CT with contrast looking for masses or structural abs
62
How do you treat seizures lasting longer than 2 minutes?
IV lorazepam | Phenytoin after 2 doses of BZD
63
What med is first line for treatment of partial seizures?
Carbamazepine
64
What is first line in children with partial seizures?
Phenobarbital
65
What should be considered for intractable temporal lobe seizures?
Anterior temporal lobectomy
66
What does the EEG show in a tonic clonic seizure?
10 Hz activity during tonic | Slow waves during clonic
67
How do you manage a tonic clonic seizure?
Protect the airway | Treat underlying cause
68
What are the first line drugs for a primary generalized tonic clonic seizure?
Phenytoin Fosphenytoin Valproate
69
What drugs may be used an adjunctive therapy for a primary tonic clonic seizure?
Lamotrigine | Topiramate
70
What meds can be used for secondary tonic clonic seizures?
Same drugs for partial | Carbamazepine, phenytoin, oxycarbazepine, valproate acid, phenobarbital
71
What does EEG show for an absence seizure?
Classic 3 per second spike and wave discharges
72
What is the first line treatment for absence seizures?
Ethosuximide
73
What is the second line treatment for absence seizures?
Valproic acid
74
During status epilepticus what do you do?
``` ABCs Stat head CT LP only after CT if meningeal signs EEG if stable IV lorazepam or diazepam with loading dose of fosphenytoin ```
75
If seizures continue after acute management what should you do?
Intubate and load with phenobarbital | Consider IV sedation and continuous EEG monitoring
76
How do you diagnose wester's syndrome?
Look for abnormal interictal EEG with hypsarrhythmia
77
What is the treatment of west syndrome?
Hormonal therapy with ACTH, prednisone, and clonazepam or valproate
78
How do you diagnose Lennox-gastaut syndrome?
Abnormal interictal EEG with slow spike and wave complexes
79
How do you diagnose benign paroxysmal positional vertigo?
Dix-hall pike maneuver
80
How do you treat BPPV?
Epley maneuver
81
What is contraindicated as treatment for BPPV?
Antivertigo meds because they can cause chronic unsteadiness
82
How do you diagnose acute peripheral vestibulopathy?
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
What is indicated if patient is at high risk for central lesions?
MRI with diffusion weighted imaging
84
What is the treatment of peripheral vestibulopathy?
Corticosteroids within 72 h of onset | Meclizine
85
How do you diagnose Ménière's disease?
Two episodes lasting 20 minutes Hearing loss documented by audiometry Tinnitus Aural fullness
86
What is the treatment of Ménière's disease?
Low sodium diet and diuretics = first line Migraine diet, meds BZD Anti emetics
87
What is the treatment for severe unilateral cases of Ménière's disease?
Ablation
88
How do you diagnose vestibular migraine?
Diagnosis of exclusion | Dizzy spells with photophobia or photophobia a highly suggestive
89
How do you treat vestibular migraine?
Migraine meds, diet and lifestyle changes | BZDs and anti emetics can be tried
90
What are the tests for diagnosing myasthenia gravis?
Edrophonium test = anticholinesterase which leads to amelioration of symptoms Ice test - put pack of ice over one eye, will resolve ptosis
91
What can yield confirmation of myasthenia gravis?
An abnormal single fiber EMG | Decremental response to repetitive nerve stimulation
92
What else should be order if suspect myasthenia gravis?
Chest CT to look for thymoma
93
What is the mainstay of treatment for MG?
Steroids | Immunosuppressants : azathioprine, cyclosporine, MMF
94
What is used for symptomatic treatment of MG?
Pyridostigmine (anticholinesterase)
95
What can be used for relief in severe cases?
Plasmapheresis | IVIG
96
What can be curative of MG?
Resection of thymoma
97
What should no be given to patients with MG?
Aminoglycosides | Bb
98
How do you diagnose Lamber Eaton syndrome?
Repetitive nerve stimulation will give incremental response Autoabs Chest CT looking for Small CC of the lung
99
What is the treatment for lambert eaton?
``` Treat small cell lung CA 3,4 diaminopyridine or guanidine Pyridostigmine Corticosteroids Azathioprine ```
100
How do you diagnose MS.
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
How do you treat MS symptomatically?
Baclofen for spasticity Cholinergics for urinary retention Anticholinergics for urinary incontinence Amitryptiline for painful paresthesias
102
What should be given for acute episodes of MS?
Corticosteroids
103
What can be given for relapsing remitting MS?
INF- beta | Copolymer 1
104
What can you give for worsening relapsing remitting or progressive MS?
Mitoxantrone
105
What is used as a second line?
Natilizumab Risk of PML! By JC virus activation
106
How do you diagnose Guillan barre?
See diffuse demyelination on nerve conduction studies
107
What is the treatment of Guillan-Barre?
ICU admit for respiratory failure Plasmapheresis and IVIG Aggressive physical rehab
108
How do you diagnose ALS?
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
What can be used for the prevention of disease progression in Alzheimer's?
``` Donepezil Rivastigmine Galantamine Tacrine (hepatotoxicity!) Memantine (may slow decline in moderate to severe disease) ```
110
How is Pick's disease diagnosed?
Clinical features and CT/MRI showing frontotemporal atrophy
111
How do you diagnose normal pressure hydrocephalus?
CT/MRI shows ventricular enlargement out of proportion to sulcal atrophy
112
What is the treatment for normal pressure hydrocephalus?
Surgical shunting if LP or continuous lumbar CSF drainage shows improvement
113
How do you diagnose CJD?
Clinically | Will have elevated levels of CSF 14-3-3 and tau protein
114
What is the treatment for an astrocytoma?
Resection if possible | Radiation
115
What is the treatment for glioblastoma multiforme?
Surgical removal | Radiation/chemo
116
What is the treatment for meningioma?
Surgical resection | Radiation if unresectable
117
What is the treatment for acoustic neuroma?
Observation/ surgical removal
118
What is the treatment for medulloblastoma?
Surgical resection with chemo/radiation
119
What is the treatment for ependymoma?
Surgical resection | Radiation
120
What is the tx for craniopharyngioma
Surgical resection
121
How do you diagnose a brain tumor?
Contrast CT MRI with gad (best for vascular and soft tissue) MRI without gad
122
How do you get a histologic dx of a tumor?
CT guided bx | Surgery
123
How do you diagnose NF?
MRI with gad
124
What are the diagnostic criteria for NF1?
``` 2+: 6 cafe au lait spots 2 Lisch nodules Freckling in axilla or inguinal area Optic glioma First degree relative Bone abnormality (kyphoscoliosis) ```
125
What does a head CT show in someone with tuberous sclerosis?
Calcified tubers in the cerebrum in the periventricular area
126
Why do you do a ECG on someone with tuberous sclerosis?
To evaluate for cardiac rhabdomyoma
127
What do you treat infantile spasms in tuberous sclerosis with?
ACTH or vigabatrin
128
What can be given for generalized seizures in tuberous sclerosis?
Lamotrigine
129
What is the tx for Broca's aphasia?
Speech therapy
130
What is the treatment for closed angle glaucoma?
Eyedrops: Timolol, pilocarpine, apraclonidine Systemic meds : acetazolamide, IV mannitol Laser peripheral iridotomy (curative)
131
What is the medical treatment of open angle glaucoma?
Topical Bb Pilocarpine to decrease production of aqueous humor Carbonic anhydrase inhibitors
132
How do you diagnose open angle glaucoma?
Tonometry Ophthalmic exam shows - cupping of disk Visual field testing
133
How do you diagnose macular degen?
Fundoscopy reveals drusen and/or pigmentary changed in patients with strophic AMD Hemorrhage and subretinal fluid if exudative
134
What slows disease progression in AMD?
Combo of multivitamins (C, E, beta carotene and zinc)
135
What improves vision in patients with exudative AMD?
``` VEGF inhibitors (bevaxizumab, ranibizumab) Pegatinib ```
136
What can be used in conjunction with VEGF inhibitors?
Photodynamic therapy
137
What is the treatment for central retinal artery occlusion?
Intra-arterial thrombolysis within 8 h to ophthalmic artery Can try high flow oxygen, IV acetazolamide, ocular massage, drainage of anterior chamber
138
What is the treatment of central retinal vein occlusion?
Laser photo coagulation
139
What is the drug of choice for partial seizures?
Phenytoin
140
How do you diagnose spinal cord compression?
MRI of the spine
141
How do you diagnose an acoustic neuroma?
MRI with gad
142
What is the first line treatment for RLS?
Dopamine agonists: ropinirole, pramipexole
143
What is an alternative tx to RLS?
Gabapentin
144
What is the nonpharmcologic tx for RLS?
Leg massage Heating pads Regular exercise
145
When should iron supplementation be given?
When serum ferritin levels are less than75
146
What may patients with RLS take if other treatment don't work?
Opioids
147
What is the tx for spinal cord compression?
Stat MRI | IV glucocorticoids
148
What is the diagnostic test for syringomyelia?
MRI | Myelography
149
How do you diagnose a brain abscess?
CT or MRI
150
What is the tx of brain abscess?
``` 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
How do you diagnose Guillan barre?
LP - shows normal WBC and lots of protein
152
What is the treatment for acute agitation?
Haloperidol
153
What is the first initial step in tx an acute episode of glaucoma?
IV mannitol
154
What are the first line tx for hypertensive encephalopathy?
Nitroprusside | Labetolol
155
How do you asses respiratory function in Guillan Barre?
Serial vital capacity | If below 15 ml/kg = increased risk of respiratory failure
156
What is the first line tx of pseudo tumor cerebri (idiopathic intracranial HTN)?
Acetazolamide (inhibits choroid plexus carbonic anhydrase)
157
What can be added for continued sx of IIH with acetazolamide tx?
Furosemide
158
What is the tx for IIH with progressive vision loss?
Surgical intervention with optic nerve sheath decompression or lumboperitoneal shunting
159
What is the tx for trigeminal neuralgia?
Carbamazepine
160
What are surgical tx for trigeminal neuralgia?
Surgical gangliolysis | Suboccipital craniectomy
161
What is the best thing to do after someone has had a seizure and the blood panels come back with metabolic acidosis?
Check again in 2 hors because it usually resolves on its own
162
How do you diagnose IIH?
MRI | LP with opening pressure (dx= greater than 250)
163
What do you give for stroke with no prior antiplatelet therapy?
Aspirin
164
What do you give for a stroke on aspirin?
Aspirin + dipyramidole or clopidogrel
165
What is the therapy for a stroke on aspirin with large intracranial atherosclerosis?
Aspirin + clopidogrel
166
What is the diagnostic test for hydrocephalus?
CT of brain

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