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Neurology USMLE Step 3 > Section 2: Seizures, Parkinson's Disease, Multiple Sclerosis and Dementia > Flashcards

Section 2: Seizures, Parkinson's Disease, Multiple Sclerosis and Dementia Flashcards

1
Q

Name some medications associated with seizure

A
  • Imipramine
  • Meperidine
  • INH
  • Metronidazole
  • Bupropion
  • Fluoroquinolones
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2
Q

First line drugs for the prevention of partial seizures

A
  • Carbamazepine
  • Lamotrigine
  • Phenytoin
  • Valproate
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3
Q

First line drugs for the prevention of primary generalized seizures

A
  • Valproate
  • Lamotrigine
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4
Q

First line drugs for the prevention of absence seizures

A
  • Ethosuximide
  • Valproate
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5
Q

First line drugs for the prevention of myoclonic or atonic seizures

A

Valproate

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6
Q

List the signs and symptoms of elevated ICP

A
  • Headache on awakening
  • Nausea/vomiting
  • Drowsiness
  • Diplopia
  • Blurry vision
  • Papilledema
  • CN VI palsies
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7
Q

Outline the management of Status Epilepticus

A
  1. Benzodiazepines, such as Ativan (lorazepam).
  2. If the seizure persists after moving the clock forward 10– 20 minutes, then add fosphenytoin.
  3. If the seizure persists after moving the clock forward another 10– 20 minutes, then add phenobarbital.
  4. If the seizure persists after moving the clock forward 10– 20 minutes again, then add general anesthesia, such as pentobarbital, thiopental, midazolam, or propofol.

N/B: Potassium disprders do not cause seizures

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 6911-6914). . Kindle Edition.

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8
Q

Diagnostic tests in seizures

A
  • CT scan of head urgently; MRI later if CT head shows nothing
  • Sodium, glucose, calcium, oxygen, creatinine, and magnesium levels
  • Urine toxicology studies
  • EEG (later on if the above tests do not show)
  • Consultation
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9
Q

Indications for Rx of first episode of seizures

A
  • Strong family history of seizures
  • Abnormal EEG
  • Status epilepticus that required benzodiazepines to stop the seizure
  • Non-correctable precipitating cause, e.g., brain tumor

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 6930-6932). . Kindle Edition.

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10
Q

List the first line medications for seizures

A
  • Valproate
  • Carbamazepine
  • Phenytoin
  • Levetiracetam (Keppra)
  • Lamotrigine
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11
Q

What anti-seizure medication is associated with Steven-Johnson syndrome?

A

Lamotrigine

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12
Q

List the second line anti-seizure medications

A
  • Gabapentin
  • Phenobarbital
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13
Q

Most dangerous anti-seizure medication in pregnancy

A

Valproic acid

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14
Q

Causes of generalized tonic clonic seizures

A
  • Hyponatremia or hypernatremia
  • Hypoxia
  • Hypoglycemia
  • Any CNS infection (encephalitis, meningitis, abscess)
  • Any CNS anatomic abnormaity (trauma, stroke, tumor)
  • Hypocalcemia
  • Uremia (elevated creatinine)
  • Hepatic failure
  • Alcohol, barbiturate, and benzodiazepine withdrawal
  • Cocaine toxicity
  • Hypomagnesemia (rare)

Use the mnemonic VITAMINS

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15
Q

Patients with Parkinson’s Disease (PD) presents with tremulousness and a slow, abnormal “festinating” gait. List the physical findings in PD.

A
  • Cogwheel rigidity
  • Resting tremor (resolves when the pt moves or reaches for something)
  • Hypomimia (a masklike, underreactive face)
  • Micrographia
  • Orthostasis
  • Intact cognition and memory
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16
Q

Rx of mild symptoms of PD

  • Under age 60
  • Over age 60
A
  • Anticholinergic agents (benztropine, hydroxyzine)
  • Amantadine (oleder patients more prone to adverse effects of anticholinergic agents - constipation, glaucoma, and urinary retention)
17
Q

Rx of severe symptoms of PD

A
  1. Levodopa/Carbidopa
  2. Dopamine agonists (pramipexole, ropinerole, cabergoline)
  3. COMT inhibitors (Tolcapone, entacapone)
  4. MAO inhibitors (Selegilene, rasagilene)
18
Q

PD

  1. Main advantage of levodopa/carbidopa
  2. Main advantage dopamine agonists
  3. Main disadvantage of levodopa/carbidopa
  4. Main disadvantage dopamine agonists
  5. How do COMT inhibitors work?
A
  1. Greatest efficacy
  2. Fewer adverse effects
  3. “On-off” phenomena with uneven long-term effects and more adverse effects
  4. Less efficacy
  5. By blocking the metabolism of dopamine, and extend the effect of dopamine-based medications. They are not effective by themselves
19
Q

Likely diagnosis and treatment of the following type of tremor:

  1. Resting tremor
  2. Tremor with intention (action) only
  3. Tremor both at rest and with intention
A
  1. Parkinson’s disease; Amantadine
  2. Cerebellar disorders; Rx etiology
  3. Essential tremor; Propranolol
20
Q
  1. Most common abnormality in multiple sclerosis (MS)
A
  1. Optic neuritis
21
Q

List other common features in MS

A
  • Motor and sensory abnormalities
  • Defects of the bladder (bladder atony)
  • Fatigue
  • Hyperreflexia
  • Spasticity
  • Depression

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7000-7002). . Kindle Edition.

22
Q

Multiple Sclerosis

  1. Best initial diagnostic test
  2. Most accurate diagnostic test
  3. When do you do a lumbar tap in MS
A
  1. MRI
  2. MRI (There is no reason to order a CT scan of the head. The CT is far less sensitive than an MRI)
  3. Presence of oligoclonal bands is only useful if the MRI is nondiagnostic

Visual and auditory evoked potential are always wrong answers

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7003-7007). . Kindle Edition.

23
Q

Best initial therapy for MS

A

Steroids are the best initial therapy for acute exacerbations to help speed resolution

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7008-7017). . Kindle Edition.

24
Q

Disease-modifying therapy in MS

A
  • Beta interferon
  • Glatiramer (copolymer I)
  • Mitoxantrone
  • Fingolimod (oral)
  • Azathioprine
  • Cyclophosphamide
  • Natalizumab (inhibitor of alpha-4 intergrin)

** Natalizumab causes progressive multifocal leukoencephalopathy (PML)**

Glatiramer and beta-interferon are rthe best first choice for prevention of relapse

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7008-7017). . Kindle Edition.

25
Additional medications for other symptoms in MS 1. Fatigue 2. Spasticity Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7008-7017). . Kindle Edition.
1. Amantadine 2. Baclofen or tizanidine Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7008-7017). . Kindle Edition.
26
Minimum investigations for all patients with memory loss
* Head CT * B12 level * Thyroid function testing (T4/ TSH) * RPR or VDRL Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7025-7029). . Kindle Edition.
27
Rx for Alzheimer's disease
* Donepezil * Rivastigmine * Galantamine These are anticholinesterases * Memantine Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7033-7034). . Kindle Edition.
28
The 3 Ws of Normal Pressure Hydrocephalus
* Wet: Urinary incontinence * Weird: Dementia * Wobbly: Wide-based gait/ ataxia Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7056-7057). . Kindle Edition.
29
Diagnostic tests and Rx of NPH
Diagnostic tests: * Head CT * LP Rx: * Shunt placement
30
Parkinson's Disease + Dementia
Lewy Body Dementia
31
Diagnosis: * Personality and behavior become abnormal first. * Then memory is lost afterward * There is no movement disorder * Head CT or MRI shows focal atrophy of the frontal and temporal lobes Rx of above condition Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7037-7048). . Kindle Edition.
Pick Disease (Frontotemporal dementia) Treat the same as Alzheimer’s with less response. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7037-7048). . Kindle Edition.
32
Creutzfeldt-Jakob Disease (CJD) CJD is caused by prions, transmissible protein particles. It manifests as rapidly progressive dementia and the presence of myoclonus. The patient is younger than in Alzheimer’s. The EEG is abnormal. What is the most accurate diagnostic test? What is the finding in CSF and what is the benefit? Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7037-7048). . Kindle Edition.
The most accurate diagnostic test is a brain biopsy CSF shows a **14-3-3 protein**. The presence of the 14-3-3 protein spares the patient the need for brain biopsy. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7037-7048). . Kindle Edition.
33
Diagnosis: * Dementia * Psychiatric disturbance with personality changes * Chorea/ movement disorder Diagnostic testing Rx for above condition Mode of inheritance Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7064-7066). . Kindle Edition.
Huntington Disease (HD) Genetic testing No Rx available to reverse HD * **Tetrabenazine** for dyskinesia * **Haloperidol, quetiapine** or a traid of different antipsychotics for psychosis Autosomal dominance
34
Describe the dementia syndromes
**All patients have memory loss and should have a head CT/ MRI, VDRL, B12, and T4** Conditions vary as follows: * Alzheimer’s: No focal deficits. Treatment is with anticholinesterases and memantine * Pick’s/ frontotemporal: Personality and behavior are affected first * Lewy body: Parkinsonian symptoms accompany dementia * Huntington’s: Presents with movement (chorea) and personality disorders * Normal pressure hydrocephalus: Remember WWW: Wet, weird, wobbly. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 7072-7082). . Kindle Edition.
35
True or False * Avoid tyramine-containing (TC) foods with MAO inhibitors * Give an example of such food * Why should TC foods be avoided
* True * Cheese * They precipitate HTN
36
Medications likely to slow the progression of Parkinson's Disease
MAO inhibitors * Rasagiline * Selegiline
37
Internuclear ophthalmoplegia (INO) is the inability to adduct one eye with nystagmus in the other eye. INI is characteristic of what diseas?
Multiple Sclerosis
38
Rx for spasticity
* Baclofen * Dantrolene * Tizanadine (centrally acting alpha agonist)
39
Side effects of phenytoin
* Nystagmus on lateral gaze * Gingival hyperplasia * Mobilliform rash * Hirsuitism * Megaloblastic anemia * Osteomalacia * Lymphadenopathy * Lupus-like syndrome * Teratogenic

Neurology USMLE Step 3 (10 decks)

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