Neurology

Question 1

occlusive stroke path

Answer 1

Thrombotic = plaque –> rupture
Embolic = Stroke from somewhere else (Afib, carotids, fat, air)

Question 2

occlusive stroke pt

Answer 2

focal neurological deficit, acute
HTN, DM, obese, smoker, vascular dz (thrombotic)
Young female w neck pain (dissection)
afib w valvular dz (embolic)
Think FAST (facial droop, arm drift, slurred speech, time/transport)

Question 3

occlusive stroke dx

Answer 3

1st: CT scan (r/o bleed)
2nd: MRI (tPA before MRI if acute)

Question 4

occlusive stroke tx 1

Answer 4

tPA
- <3hr if diabetic
- <4.5hr if not diabetic
-NEVER brain bleed before
-no recent GI bleed
-no surgery within 21d
-no trauma

Question 5

occlusive stroke tx 2

Answer 5

2ndary prevention
- aspirin first line
- aspirin + dipyridamole if fails aspirin
- clopidogrel if aspirin not tolerated
- warfarin INR 2-3 if CHADS2 > 2 & afib

Question 6

occlusive stroke risk

Answer 6

statins, LDL <70, high-potency
insulin, Hgb1C <7
ACE-I, BP < 135/<85

Question 7

occlusive stroke f/u

Answer 7

Echo (TTE –> TEE), if clot, heparin –> warfarin

U/S carotid; >70% stenosis or symptomatic, carotid endarterectomy (must wait weeks)

Question 8

hemorrhagic stroke path

Answer 8

HTN, intraparenchymal, subarachnoid

Question 9

hemorrhagic stroke pt

Answer 9

focal neurological deficit, worst headache of their life

Question 10

hemorrhagic stroke dx

Answer 10

non-con CT scan for blood

Question 11

hemorrhagic stroke tx

Answer 11

neurosurgery; MAP < 110

Question 12

BP goals in stroke (24 hours)
- stroke, tPA
- stroke, no tPA
- hemorrhagic

Answer 12

• < 180 / <110
• < 220 / <120
• MAP < 110

Question 13

Dizziness ddx

Answer 13

Posterior fossa tumor; benign paroxysmal positional vertigo; labyrinthitis/vestibular neuritis; meniere’s

Question 14

posterior fossa tumor path

Answer 14

tumor & demyelinating diseases

Question 15

posterior fossa tumor pt

Answer 15

Dizziness + NO ear symptoms, YES focal neuro deficit

Question 16

posterior fossa tumor dx

Answer 16

MRI MRA

Question 17

posterior fossa tumor tx

Answer 17

control blood flow; resect tumor

Question 18

benign paroxysmal positional vertigo pt

Answer 18

recurrent & reproducible vertigo <1 min with head movement

Question 18

benign paroxysmal positional vertigo path

Answer 18

otolith in semicircular canal

Question 19

benign paroxysmal positional vertigo dx

Answer 19

dix-hallpike = rotary nystagmus

Question 20

benign paroxysmal positional vertigo tx

Answer 20

Epley maneuver (otolith positioning)

Question 21

Labyrinthitis/vestibular neuritis path

Answer 21

post-viral syndrome, usually URI

Question 22

Labyrinthitis/vestibular neuritis pt

Answer 22

weeks after URI presenting w vertigo, n/v, tinnitus.hearing loss (loss specifically labyrinthitis)

Question 23

Labyrinthitis/vestibular neuritis dx

Answer 23

clinical, dx of exclusion

Question 24

Labyrinthitis/vestibular neuritis tx

Question 25

Meniere’s path

Answer 25

unknown

Question 26

Meniere’s tx

Answer 26

diuretic & low-salt diet

Question 26

Meniere’s dx

Answer 26

clinical

Question 27

Meniere’s pt

Answer 27

dizziness, tinnitus, hearing loss, episodic vertigo lasts >30m