Neurology

Question 1

Absolute CI to thrombolytics

Answer 1

• history of hemorrhagic stroke
• presence of an intracranial neoplasm
• stroke within 1 year
• brain Sx or cerebral trauma within 6 months
• surgery or actively bleeding within 6 weeks
• cpr within 6 weeks
• suspicious of aortic dissection
• presence of a bleeding disorder

Question 2

Ticlopidine s/e

Answer 2

TTP

Neutropenia

Question 3

Seizures

Dx.: what to order

Answer 3

BMP: sodium, mag, glucose, bun, cr,

Liver and renal function
—> accounts for most seizures

Head ct

Urine tox

Further management:
Eeg
Neurological consultation

Question 4

Treat chronic seizure after the first time if…

Answer 4

• family Hx
• abnormal eeg
• brain tumor
• status epilepticus that required BZD

Question 5

PD

Presents also with…

Tx
<60
>60

Answer 5

Orthostasis

Tx
Mild:
<60= benztropine or hydroxyzine
>60 = amantadine

Severe:
- l dopa carbidopa
Dopamine. Agonists like pramipexole, cabergoline Or ropinofole

Don’t use anticholinergics in the elderly

When levodopa causes psychosis—> quietiapine

Question 6

HD Tx

Answer 6

Chorea—> tetrabenazine

Symptom control —> antipsychotics

Question 7

Pseudotumor cerebri features

Answer 7

Pseudotumor—> HA +

• sixth nerve palsy
• visual field loss
• transiently obscure vision
• pulsatile tinnitus

Question 8

Meniere’s

Tx

Answer 8

Salt restriction
Diuretics

Severe disease —> ablation of the 8 th CN ( vestibulococchlear) on 1 side

Question 9

Perform head CT before an LP in the following circumstances:

Answer 9

• Hx of CNS disease
• focal neurological deficits
• papilledema
• seizures
• altered consciousness
• sign delay in performing an LP

Question 10

Cryptococcus

Best initial

Most accurate

Tx

Answer 10

IndiA ink

Cry Ag

Tx
Amphotericin + 5- FC
Add
Oral fluconazole
   - stop if cd4 rises >100
   - continued if cd4 does not rise

Question 11

Neurocystercicosis Tx

Answer 11

No calcification—> albendazole and steroids

Calcification—> anti epileptic drugs

Question 12

Seizures what to order

Answer 12

• BMP
• sodium, bun and cr
• glucose
• Ca
• Mg
• ct, if shows nothing then mri
• Ûrine tox
• lft’s

Question 13

MS Tx

Answer 13

Best initial: steroids!

Thrn

Disease modifying therapy:

- b ifn, 
Glatiramer
Natilizumab= PML
Mitoxantrone
Fingolimod
Dalfampridine

Additional

Fatigue: Amantadine

Spasticity: baclofen, tizanidine

Question 14

Restless legs syndrome

Tx
Associated with what

Answer 14

Tx :
Pramipexole or ropinorole ( dopamine agonists used to treat PD)

associated with iron deficiency

Question 15

MG Tx

Answer 15

Best initial; pyridostigmine, neosyigmine

Steroids

Thymemctomy in <60 if thymemctomy or pyridostignine/ neostihmine fail

Azo. and cyclosporine used to wean ppl of steroids