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. What would you like to do?
antiobiotic coverage for neonatal meningitis?
Antibiotic coverage for adult meningitis?
antibiotic coverage for elderly meningitis?
When do you do a ct scan before a lp ?
- cases of elevated ICP:
- focal neurological defect- seizure/motor defect
- papilledema--elevation of optic disc
- brain tumor
- bleeding diathesis
- cardiopulmonary instability
Rx for fungal meningitis?
Stain for cryptococcal meningitis?
what are teh picorna viruses?
Test for West nile virus?
Rbc in csf without history of trauma?
meningitis + change in mental status?
Test to rule out Brain Abcsess?
3 examples where steroids are given to decrease inflammation?
- brain abcess
From where would you isolate the polio virus?
What drugs are contraindicated in migraines with auras?
Cluster headache treatment?
migraine headhache prophylaxis?
- anti depressants tca
What drug has less anti- ach effect?
- amitryptilline has more anti-ach effect
Tyramine causes these types of headaches?
what type of headache would an obese woman with papilledemia have?
headache and extraocular muscle palsy
cavernous sinus thrombosis
headache after sex?
post coital cephalagia
Diagnostic pseudotumor cerebri?
- csf pressure more than 200 mmHg
- exclusion of masses with CT or MRI
Pseudotumor cerebri inciting agebnts?
- vit a excess
- corticosteroid withdrawal
Rx for PTC?
- serial lumbar punctures
- csf shunt to the peritoneum
Trigeminal neuralgia Rx
headache worse with bending over?
sequale for post meningitis?
- hearing loss
- mental retardtion
In which hematoma can you perform an LP?
In which brain hemorrhage do you prophylax against seizures?
Which drugs lower the seizure threshold?
What seizure has the 3 cycle/sec spike and wave pattern?
1st line for tonic clonic?
1st line for absence?
1st line for status epilecpticus?
stevens johnson syndrome
- antibiotics- sulfa, penicillins
what 2 anticonvulsants cause blood dyscrasia?
what 3 conditions cause a cherry red spot in the eye?
- retinal artery occlusion
- nieman picks
- tay sachs
what 2 anticonvulsants cause folate deficiency?
- valproic acid
high alpha feto protein?
low alpha feto protein?
What is the pharmacologic treatment for Cerebral palsy motor movements/
- muscle relaxants---
- botulinum toxin
BP medications in ischemic stroke?
- no nitroprossuide
- ni nitroglycerin
hemorrhagic stroke bp goals?
sah meds and bp goals?
- no nitroprosside
- no nitroglycerin
toxicity of TCA?
- anticholinergic effects
Rx for CV toxicity caused by TCA?
LIthium causing nephrogenic DI?
- HTC--any nephrogenic DI
what is acute dystonia?
- torticollis rx--anti cholinderic--benztropine
- tardive dyskinesia--repetitive facial movemnts--grimacing--change to low potency or atypical
what are low potency anti psychotics?
What illegal street drug can cause parkinsons?
MPTP--side product in the production of meperidine(opiod)
MAO B inhibitor for parksinons?
Ergot dopamine agonist/>?
used as a rescue drug for sudden akinetic episode?
non ergot dopamine agonists/?
antimuscarinic used in parkinsons for tremor?
used in mild parkinsons disease and increases dopamine release
Presentation of ALS?
- 80% assymmetric weakness of hands, shoulder, pelvic girdlses
- 20%-dysarthia, dysphagia
Drug for ALS?
Riluzole--decreases glutamate excitatory toxicity
Rx for huntington?
tetrabenazine and other neuroleptics for the chorea movements
What do you seen in dementia caused by picks disease?
- personality changes- innappropriate behavior
lewy body dementia?
- parkinsoniona symptoms
- + dementia
- visual hallucinations
WHAT ARE the drugs for alzheimers?
- memantine--NMDA receptor antagoinst
- rivastigimne, galantamien
What causes bilateral bells palsy?
Albuminocytologic dissociation is seen where?
Rx for GBS?
- IV immnoglobuin
Deep brain stimulation works how for parkinsons?
inactivates thalamus..the inhbitor of movement
best initial step in ruling out a fatal cause of a headache?
- tumor with focal neurological findings-- ct
- sah-- ct
- Temporal Arteritis-- steroids
how does sah present?
like sudden meningitis with 50% of people loosing consciesness
what pft test determines who should go to the icu?
best initial rx for gbs?
which is more efficacious, ivig or plasmapharesis?
does combining ivig and plasmapharesis make a difference?
best initial test for gbs?
most accurate test for gbs?
how are affected eyes in mg?
- extraocular muscles
eaten lambert syndrome is associated with what malignancy?
small cell carcinoma
what antibiotics block neuromuscular transmission and resembles mg?
best initial test for mg?
ach ab test
alternative best initial test for mg?
most accurate test for mg?
initial rx for mg?
pyridostigmine or neostigmine
if pyridostigmine and neostigmine dont work, next best step?
if that step doesnt work?
- thymectomy if <60 or beyond puberty
if respiratory symptoms present in mg , what do u do?
most accurate test for lambert eaton syndrome?
best initial and accurate test for ms?
if mri is inconclusive for ms, what is the best step?
rx for acute severe ms?
disesae modifiying drugs in ms?
bladder hyperactivity rx?
rx for urinary retention?
dementia vs delirium?
delirium is lack of sensory
lewy body dementia?
dementia + parkinsons symptoms
- social appropriatness
- and then
how does CJD presetn?
- rapid progression of dementia to death
- myoclonus jerks
most accurate test for cjd?
csf fluid showing 14-3-3
which dementia has hallucinations?
lewy body dementia
rx for alzeheimrs?
drug for mild parkinsons <60 yo and >60?
- <60 benztropine
- >60 amantadine
rx for severe parkinsons<60 and
levidopa and carbidopa <60
side effect of levi and carbidopa?
on and off effect
when do u use comt inhibitors?
with levi and carbidopa, otherwise you dont
difference between levidopa nand pramipexole and bromocriptine?
levidopa is more potent
benign essential tremor vs parkinsons tremor?
bst--resting and movement tremor
occurs wtih action
rx for restless leg syndrome
next best test in a galactorrhea?
causes of hyperprolactinemia?
- dopamine blockers
- adenoma of the pituitary
drugs that decrease size of a prolactinoma and decrease prolactin?
what gives the bilateral carpal tunnel syndrome?
pituitary gh overproduction from an adenoma
dx for giganistims or acromegaly?
igf or somatomedins
most accurate test for gigantism?
best initial test for pituitary adenomas?
altered hormone levels
rx for gigantism adenoma?
- dopamine agonists
dopamine agonists downregulate what pituatiry tumores?
- gh releasing adenoma
cause of hypopituitarism?
dx of hypopituatirism?
low gh level after hypoglycemia or arginine stimulation
causes of hypopituatirism?
- axis severance
necrosis of the pituitary from an adenoma that wasnt treated completely
signs of meningitis with a prior pituitary adenoma?
necrosis of the pituitary
when is empty sella syndrome found?
when a ct is performed for other reason and it is an incidental finding
causes of central di?
- infiltrative lesions
rx for central di?
consider what in euvolemic hypnatremia?
causes of siadh
- pulmonary diseases
- cns disease
rx for siadh?
- water restriction
severe confusion with hyponatremia rx?
hypertonic saline--the only time this is the rx
dx of primary hyperparathyrodism?
when is sx the answer for primary hyperparathyrodism?
3 causes of hypocalcemia?
- primary hypoparathyrodism
- vit d deficiency due to various conditions
why is magnesium needed to maintain normal calcium level?
- need mg to release pth
- need mg for osteoclasts to act normally
ekg finding with hypcalcemia?
ekg finiding with hypercalcemia?
how do you work up for hypocalcemia?
- look at phosphate if high then low pth--primary hypoparathyrodism
- if phosphate is low..then secondary hypoparathyrodism--vit d deficiency
look at magnesium
acute management for hypocalcemia?
- calcium gluconate iv
- oral calcium
when do you look for vascular disease in type I diabetes and type II diabetes?
- type 1---5 years after the dx
- type 2---right away
Definition of diabetes?
Fasting blood glucose level of >126 on two different occasions 2 weeks apart
how do you follow diabetes state?
Hb1ac of 6.5 is equivalent to what fasting blood glucose?
tight glycemic control controls what diabetic complications?
microvascular--retinopathy, nephropathy, neuropathy
what are the treatment modalities in type 2 dm?
- exercise and weight loss
- oral hypoglycemics
side effect of sulfonylurea?
sulfonylurea in dm with kidney failure?
MOa of metformin?
- stops gluconeogenesis in the liver
- stops absorption in gi tract
- glucose into muscle
- no weight gain
- no hypoglycemia
most common side effect of metformin?
when do you not use metformin?
in kidney failure
moa of pioglitazone?
increases insulin sensitivity in fat and muscle
side effect of glitazones?
what are the short acting insluin?
old way of managing dm with insulin?
bid injections wiht regular and nph insulins
new and most efficacious way of managing dm type 1 with insulin?
long acting--glargine + rapid acting (lispro) or aspart
what causes dka
infections and other stress like infections
rx of DKA?
- confirm ketones in blood
how do you know if dka is fixed?
- anion gap is back to normal
- hco3 goes back to normal
Rx of hyperosmolar hyperglycmic episode?
what nerve is commonly affected as a complication of diabetes?
how do u pick up early diabetic nephropathy?
when do you give aceinhibitor in a aptient with diabetes mellitus?
- if a patient has
- hypertension 130/80
when do you refer to opthalmologist in diabetes?
- type 1---5 years after and then 1 year thereafter
- type2---every year
what is the somogyi effect?
- somogyi effect---hyperglycemia in the morning due to too much insulin at night
- dawn effect--hyperglycemia in the morning due to too little insulin at night
next best step in differentiating somogyi vs dawn effect?
cut back on insulin the person takes at night
what is a honeymoon period?
insulin needs in a diabetic decrease bc the pancreas is able to produce some insulin transiently
definition of hypoglycemia?
- symptoms of hypoglycemia
- reversal of symptoms with sugar
rx for sulfonylurea induced hypoglycemia?
treat and observer for 24 hours bc sulfonylureas act for 24 hours
best test for septic arthritis?
low potency neuroleptics?
high potency neuroleptics?
what should be done if the total cholesterol is <200?
- retest in 5 years
- check for lipid fractions if >200
what should be done if LDL is <130? and no cad risk factors?
- exercise +diet
what should be done if LDL >100 with cad risk factors?
hypertiglyceride causes what?
what binds c diff toxin?
Rx for high TG?
- Omega 6 fatty acids
when is screening for lipids done?
when lfts are what shoudl you not give statins?
what is contraindicated in prinzmetal angina?
is reversible or irriversible iechemia a reason to do PCI and/or cabg?
who gets pci?
- all unstable/nstemi/stemi and
- stable angina that isnt controlled with medical therapy
rx for which conditions is diagnositc?
- fluconazole for esophagitis
- taxol for cns toxoplamsosis
nitroglycerin makes what 3 coniditions better?
- esophageal spasm
what drugs are indicated post mi?
rx for bb toxicity?
- insulin with glucose
when are pvcs considered vtach?
when are pvcs becoming an issue/?
- more than 3 in a row
- when there is 3 in a minute
side effects of amiodarone?
- pulmonary fibrosis
- check pft, tft, lft
earliest ekg sign of chf?
best initial test for valvular heart disease?
best initial test for endocarditis lesions on the valves?
Carotid endartectomy is for whom?
- symptomatic and 70-90% stenosis
- asymptomatic and 80-90% stenosis
dx of pseudotumor cerebri?
- LP---increased pressure
What would you like to do?
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