Neuro step2

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Author:
gm1147
ID:
165924
Filename:
Neuro step2
Updated:
2012-08-13 18:55:26
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Neuro Neurology step2
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kaplan
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  1. MCA stroke
    • contralateral sensory and motor
    • Homonymous hemianopsia with eyes to lesion
    • Aphasia
  2. ACA stroke
    • Personality
    • Cognitive
    • Urinary incontinence
    • Leg more than arm weakness
  3. PCA stroke
    • Ipsilateral sensory loss of face, CN9, CN10
    • Contralateral sensory loss of limbs
    • Ataxia
  4. Stroke tx
    • Ischemic:
    • <3hr - thrombolytics
    • >3hr- ASA. If already on it, add dipyridamole or swtich to clopidogrel
    • Hemorrhagic: nothing
  5. Pseudotumor cerebri
    associations
    tx
    • obesity
    • venous sinus thrombosis
    • OCP
    • Vit A toxicity
    • Papilledema wit diplopia from CN6 palsy
    • tx with weight loss, acetazolamide, steroids, repeat LP, shunt
  6. Cluster HA tx
    • Ergotamine or triptan
    • 100% O2
    • prednisone
    • Li
  7. Migraine ppx
    • if 3+ per month
    • Propranolol
    • CCB
    • TCA
    • SSRI
    • Botox
  8. Trigeminal neuralgia tx
    • oxcarbazepine or carbamazepine
    • Surgery
  9. Sz causes
    • HypoNa, HyperNa
    • Hypoxia
    • HypoCa
    • HypoMg
    • Hypogly
    • CNS infection or lesion
    • Uremia
    • Hepatic failure
    • Withdrawal
    • Cocaine
  10. Sz tx
    • Lorazepam or diazepam IV
    • Phenytoin or fosphenytoin (latter has fewer AV block and hypotension)
    • Phenobarbital
    • Succinylcholine, vecuronium, pancuronium - intubate - midazolam or propafol
  11. Absence sx tx
    Ethosuximide
  12. Subarachnoid hemorrhage risk factors
    • PCKD
    • Tobacco
    • HTN
    • HLD
    • Etoh
  13. Normal WBC:RBC in CSF
    1:500-1000
  14. SAH tx
    • Nimodipine - CCB to prevent ischemic stroke
    • Embolization > clipping
    • VP shunt if hydrocephalus
    • Sz ppx - phenytoin. does not dec mortality
  15. Brain abcess tx
    • Pen + metro + ceftriaxone
    • Vanc if recent surgery
  16. Tuberous sclerosis
    • Sz, retardation
    • Adenoma sebaceum (red face nodules), shagreen patches (leathery trunk plaques), ash leaf patches
    • Retinal lesions
    • Cardiac rhabdomomas
  17. Neurofibromatosis
    • Neurofibromas
    • 8th nerve tumors
    • Cafe au lait spots
    • Meningiomas and gliomas
  18. Sturge-Weber
    • Port wine stain
    • Sz
    • Homonymous hemanopsia, hemiparesis, retardation
    • Ca angiomas
  19. Parkinson tx
    • Anticholinergic - benztropine and trihexyphenidyl
    • Amantadine - inc dopamine release

    • Dopamine agonisits - pramipexole and ropinirole. bromocriptine, cabergoline
    • Levodopa/carbidopa - most effective. on/off
    • COMT inh - tolcapone, entacapone block metabolism of levodopa
    • MAOi - rasagiline, selegiline - block metabolism of dopamine. can retard progression
    • Deep brain stimulation
  20. Shy-Drager syndrome
    Parkinsonism with orthostatis predominant
  21. Restless leg syndrome tx
    Dopamine agonists such as pramipexole
  22. Huntington disorder tx
    • Tetrabenazine for dyskinesia
    • Haloperidol or quetiapine for psychosis
  23. MS tx
    • Acute - steroids
    • Glatiramer
    • bINF
    • Natalizumab - inh a4intergrin. can cause PML
    • Mitoxantrone
    • Azathiprine
    • Cyclophosphamide
  24. ALS tx
    • Riluzole reduces glutamate buildup and may prevent progression
    • Baclofen for spasticity
    • CPAP and BiPAP
    • Trach
  25. Charcot-Marie-Tooth disease
    • Distal weakness and sensory loss
    • Wasting in legs
    • Dec DTR
    • Tremor
    • High arch in foot
    • inverted champagne bottle legs
    • No tx
  26. Hyperacusis
    • Loud sounds due to lack of stapedius muslce
    • In Bells
  27. Myasthenia gravis tests
    • Initial: acetylcholine R Ab
    • Edrophonium - short acting acetylcholinesterase
    • Accurate: EMG
    • Chest imaging for thymoma or thymic hyperplasia
  28. Myasthemia gravis tx
    • Neostigmine or pyridostigmine
    • Thymectomy if <60yo
    • Prednisone if >60yo
    • Crisis - IVIG or plasmapharesis

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