Peer 8 - nervous system disorders

Question 1

what age group is status epilepticus common in?

Answer 1

extremes of age

Question 2

tx of status epilepticus

Answer 2

benzodiazepines and phenytoin

2nd line: phenobarb, valproic acid, infusions of benzos and pentobarb or propofol

3rd line aggressive cooling, protecting airway, paralyzing the patient

Question 3

most common type of migraine?

Answer 3

migraine without aura

Question 4

most common type of primary headache?

Answer 4

tension headache

Question 5

tx of cluster headaches?

Answer 5

sumatriptan or high flow oxygen

Question 6

tx of myasthenic crisis?

Answer 6

close airway monitoring

Question 7

sx of myasthenic crisis?

Answer 7

respiratory failure requiring mechanical ventilation, can be triggered by infection, fever, or stress

Question 8

tx of epidural cord compression?

Answer 8

steroids and consult with rad onc if caused by malignancy

Question 9

age for simple febrile seizure?

Answer 9

6 mo to 5 years

Question 10

type of seizure in simple febrile seizure?

Answer 10

duration less than 15 minutes, generalized non focal, single episode

Question 11

best predictor of respiratory failure?

Answer 11

negative inspiratory force less than 30

Question 12

second best predictor of respiratory failure?

Answer 12

forced vital capacity less than 20

Question 13

SBP for ICH?

Answer 13

180

Question 14

tx of HTN with ICH?

Answer 14

nitroprusside or labetalol or nicardipine (best)

Question 15

tx of dystonic reactions or akathisia?

Answer 15

antimuscarinic agent: diphenhydramine or benztropine

Question 16

score system for stroke prediction after TIA?

Answer 16

ABCD, 5-6 pts bad

A - age 60 or older 1 pt
B - SBP >140 or DBP > 90 1 pt
C - clinical features of unilateral weakness 2pt or speech disturbance without weakness 1pt
D - duration of sx 10-59 minutes 1pt > 60 min 2pt

Question 17

most common cause of bilateral facial nerve palsy?

Answer 17

lyme disease from borrelia burgdorferi

Question 18

what should be started in patient with SAH?

Answer 18

nimodipine 60 mg orally q6 hours to reduce incidence of vasospasm

Question 19

cause of death in advanced parkinson disease?

Answer 19

respiratory failure

Question 20

work up of possible shunt malfunction and infection?

Answer 20

ct head, shunt series, shunt tap

Question 21

criteria for tPA administration?

Answer 21

inclusion: age >18 sx onset less than 180 minutes, BP less than 185/110, stroke scale lower than 20
exclusion: evidence of ICH on non con CT, minor or rapidly resolving stroke sx, high suspician of SAH, active internal bleeidng past 21 days, platelet less than 100000 or recent heparin in 48 hours or anticoag, head sx within 3 months, 14 days of major surgery, art puncture, LP within 7 days, seizure at stroke onset, AMI

Question 22

abx choice for epidural abscess?

Answer 22

cefepime and vanc

Question 23

brain abscess tx?

Answer 23

if herniated can use corticosteroids, hyperventilation, administration of mannitol