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Question 1

1) Middle aged patient with right sided headaches presents to ED and gets an MRI showing large heterogeneously enhancing mass in right temporal lobe. Diagnosis? What should be administered (two options)?

Answer 1

GBM (heterogenous enhancement)

Administer IV mannitol (works quicker) or dexamethasone to decrease intracranial pressure

Question 2

5) Middle aged diabetic man presents with shooting electric pain in legs/feet. EMG shows small fiber axonal neuropathy. Diagnosis? 3 treatment options? (hint: one is an SNRI)

Answer 2

Diabetic neuropathy

Nortriptyline (TCA), gabapentin (GABA-ergic), duloxetine (SNRI)

Question 3

7) What is Fioricet? Indication?

Answer 3

Combo medication of caffeine, butalbital, acetaminophen used in abortive treatment of migraines and cluster headaches

Question 4

10) Medication related cause of IIH (pseudotumor cerebri) and primary and secondary treatment (if primary fails)?

Answer 4

Isotretinoin causes elevated vitamin A levels and IIH
Rx: multiple high volume LPs, if fails…then and only then go to shunt
Debatable…I think primary Rx is acetazolamide +/- furosemide

Question 5

13) Donepezil vs pyridostigmine. Indication for each?

Answer 5

Both are cholinesterase inhibitors
Donepezil is used in treatment of early dementia to slow progression, pyridostigmine is used in treatment of myasthenia gravis