NEuro

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pszurnicki
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191400
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NEuro
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2013-03-10 22:32:37
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Neuro
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Neuro
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  1. antiobiotic coverage for neonatal meningitis?
    • amp+ gent 
    • steroids
  2. Antibiotic coverage for adult meningitis?
    • cetotaxime
    • ceftriaxone
  3. antibiotic coverage for elderly meningitis?
    • amp
    • ceftriaxone
  4. 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
    • hematoma
    • brain tumor
    • bleeding diathesis
    • cardiopulmonary instability
  5. menignitis prophylaxis ?
    • rifampin
    • ciprofloxacin
  6. Rx for fungal meningitis?
    intrathecal
  7. Stain for cryptococcal meningitis?
    india ink
  8. what are teh picorna viruses?
    • polio
    • echo
    • rhino
    • coxsackie
    • hav
  9. Test for West nile virus?
    IgM
  10. Rbc in csf without history of trauma?
    HSV encephalitis
  11. meningitis + change in mental status?
    encephalitis
  12. Rye syndrome?
    Hepatoencephalitis
  13. Test to rule out Brain Abcsess?
    MRI
  14. 3 examples where steroids are given to decrease inflammation?
    • meningitis
    • brain abcess
    • pcp
  15. From where would you isolate the polio virus?
    • throat
    • stool
    • csf
  16. What drugs are contraindicated in migraines with auras?
    OCP
  17. Cluster headache treatment?
    100% oxygen
  18. migraine headhache prophylaxis?
    • ccb
    • bb
    • anti depressants tca
  19. What drug has less anti- ach effect?
    • nortryptilline
    • amitryptilline has more anti-ach effect
  20. Tyramine causes these types of headaches?
    migraines
  21. what type of headache would an obese woman with papilledemia have?
    pseudotumor cerebri
  22. headache  and extraocular muscle palsy
    cavernous sinus thrombosis
  23. headache after sex?
    post coital cephalagia
  24. Diagnostic pseudotumor cerebri?
    • csf pressure more than 200 mmHg
    • exclusion of masses with CT or MRI
  25. Pseudotumor cerebri inciting agebnts?
    • vit a excess
    • corticosteroid withdrawal
    • tetracycline
  26. Rx for PTC?
    • acetazolamide
    • serial lumbar punctures
    • csf shunt to the peritoneum
  27. Trigeminal neuralgia Rx
    carbamezapine
  28. headache worse with bending over?
    sinus headache
  29. sequale for post meningitis?
    • hearing loss
    • mental retardtion
    • seuizures
  30. In which hematoma can you perform an LP?
    Subarachnoid hematoma
  31. In which brain hemorrhage do you prophylax against seizures?
    parenchymal
  32. Berry aneurysm disease?
    • apkd
    • marfans
  33. Which drugs lower the seizure threshold?
    • Buproprion
    • Tramadol
    • INH
    • Imipenem
  34. What seizure has the 3 cycle/sec spike and wave pattern?
    absence--ethosoxuamide
  35. 1st line for tonic clonic?
    • valproate
    • phenytoin
    • carbamezapine
  36. 1st line for absence?
    2nd line?
    • ethosuxamide
    • valproate
  37. 1st line for status epilecpticus?
    • diazepam 
    • lorazepam
  38. stevens johnson syndrome
    • lamotrigenie
    • phenobarbital
    • phenytoin
    • antibiotics- sulfa, penicillins
    • allopurionl
  39. what 2 anticonvulsants cause blood dyscrasia?
    • carbamezapine
    • ethosuxamide
  40. what 3 conditions cause a cherry red spot in the eye?
    • retinal artery occlusion
    • nieman picks
    • tay sachs
  41. what 2 anticonvulsants cause folate deficiency?
    • carbamezapine
    • valproic acid
  42. high alpha feto protein?
    • ntb
    • gastroschisis
    • omphaloccele
  43. low alpha feto protein?
    down syndrome
  44. What is the pharmacologic treatment for Cerebral palsy motor movements/
    • muscle relaxants---
    • dantrolene
    • baclofen
    • botulinum toxin
  45. BP medications in ischemic stroke?
    • labetalol
    • nicardapine
    • no nitroprossuide
    • ni nitroglycerin
  46. hemorrhagic stroke bp goals?
    • >140
    • labetalol
    • nitroprosside
  47. sah meds and bp goals?
    • 140
    • labetalol
    • nimodipine
    • no nitroprosside
    • no nitroglycerin
  48. toxicity of TCA?
    • coma
    • convulsions
    • cardiotoxicity
    • anticholinergic effects
  49. Rx for CV toxicity caused by TCA?
    NaHCO3
  50. LIthium causing nephrogenic DI?
    • HTC--any nephrogenic DI
    • Amilioride--lithium
  51. what is acute dystonia?
    tardive dyskinesia?
    • torticollis rx--anti cholinderic--benztropine
    • tardive dyskinesia--repetitive facial movemnts--grimacing--change to low potency or atypical
  52. what are low potency anti psychotics?
    • thioridazine
    • chlorpromazine
  53. What illegal street drug can cause parkinsons?
    MPTP--side product in the production of meperidine(opiod)
  54. MAO B inhibitor for parksinons?
    selegiline
  55. Ergot dopamine agonist/>?
    bromocriptine
  56. used as a rescue drug for sudden akinetic episode?
    apomorphine
  57. non ergot dopamine agonists/?
    • bromocriptine
    • ropenirole
    • rotigotine
  58. COMT inhibitors?
    • entacapone
    • tolcapone
  59. antimuscarinic used in parkinsons for tremor?
    • trihexphenydyl
    • benztropine
  60. used in mild parkinsons disease and increases dopamine release
    amantadine
  61. Presentation of ALS?
    • 80% assymmetric weakness of hands, shoulder, pelvic girdlses
    • 20%-dysarthia, dysphagia
  62. Drug for ALS?
    Riluzole--decreases glutamate excitatory toxicity
  63. Rx for huntington?
    tetrabenazine and other neuroleptics for the chorea movements
  64. What do you seen in dementia caused by picks disease?
    • personality changes- innappropriate behavior
    • frontotemporal
  65. lewy body dementia?
    • parkinsoniona symptoms 
    • + dementia
    • visual hallucinations
  66. WHAT ARE the drugs for alzheimers?
    • memantine--NMDA receptor antagoinst
    • donepezil
    • rivastigimne, galantamien
  67. What causes bilateral bells palsy?
    • lyme
    • GBS
  68. Albuminocytologic dissociation is seen where?
    GBS
  69. Rx for GBS?
    • plamapharesis
    • IV immnoglobuin
  70. Deep brain stimulation works how for parkinsons?
    inactivates thalamus..the inhbitor of movement
  71. best initial step in ruling out a fatal cause of a headache?
    • tumor with focal neurological findings-- ct
    • sah-- ct
    • Temporal Arteritis-- steroids
  72. how does sah present?
    like sudden meningitis with 50% of people loosing consciesness
  73. what pft test determines who should go to the icu?
    fvc
  74. best initial rx for gbs?
    ivig
  75. which is more efficacious, ivig or plasmapharesis?
    equal
  76. does combining ivig and plasmapharesis make a difference?
    no difference
  77. best initial test for gbs?
    most accurate test for gbs?
    • lp
    • ncs and eem
  78. how are affected eyes in mg?
    • ptosis
    • extraocular muscles
  79. eaten lambert syndrome is associated with what malignancy?
    small cell carcinoma
  80. what antibiotics block neuromuscular transmission and resembles mg?
    aminoglycosides
  81. best initial test for mg?
    ach ab test
  82. alternative best initial test for mg?
    endrophonium-tensilon test
  83. most accurate test for mg?
    emg
  84. initial rx for mg?
    pyridostigmine or neostigmine
  85. if pyridostigmine and neostigmine dont work, next best step?
    if that step doesnt work?
    • thymectomy if <60 or beyond puberty
    • steroids
    • azathiprine
    • cyclosporine
    • cyclophosphamide
  86. if respiratory symptoms present in mg , what do u do?
    • ivig
    • plasmapharesis
  87. most accurate test for lambert eaton syndrome?
    emg studies
  88. Rx for ALS?
    Riluzole
  89. best initial and accurate test for ms?
    mri
  90. if mri is inconclusive for ms, what is the best step?
    oligoclonal bands
  91. rx for acute severe ms?
    steroids
  92. disesae modifiying drugs in ms?
    • interferon
    • glatiramer
  93. bladder hyperactivity rx?
    oxybutinin
  94. rx for urinary retention?
    bethenachol
  95. dementia vs delirium?
    delirium is lack of sensory
  96. work up for dementia?
    • rpr
    • thyroid
    • ct
    • b12 levels
  97. dx of pml?
    rx?
    • mri
    • control hiv
  98. lewy body dementia?
    dementia + parkinsons symptoms
  99. picks dz?
    • social appropriatness
    •  and then
    •  memory
  100. how does CJD presetn?
    • rapid progression of dementia to death
    • myoclonus jerks
  101. most accurate test for cjd?
    csf fluid showing 14-3-3
  102. which dementia has hallucinations?
    lewy body dementia
  103. rx for alzeheimrs?
    • donepezil
    • rivastigmine
    • galantamine
  104. drug for mild parkinsons <60 yo and >60?
    • <60 benztropine
    • >60 amantadine
  105. rx for severe parkinsons<60 and 
    >60?
    levidopa and carbidopa <60
  106. side effect of levi and carbidopa?
    on and off effect
  107. when do u use comt inhibitors?
    with levi and carbidopa, otherwise you dont
  108. difference between levidopa nand pramipexole and bromocriptine?
    levidopa is more potent
  109. benign essential tremor vs parkinsons tremor?
    bst--resting and movement tremor
  110. cereberllar treomr?
    occurs wtih action
  111. rx for restless leg syndrome
    • pramiprexole
    • ropinerole
  112. next best test in a galactorrhea?
  113. causes of hyperprolactinemia?
    • hypothyroid
    • cimetidine
    • dopamine blockers
    • adenoma of the pituitary
    • pregnancy
  114. drugs that decrease size of a prolactinoma and decrease prolactin?
    • carbegoline
    • bromocriptine
  115. what gives the bilateral carpal tunnel syndrome?
    pituitary gh overproduction from an adenoma
  116. dx for giganistims or acromegaly?
    igf or somatomedins
  117. most accurate test for gigantism?
    mri
  118. best initial test for pituitary adenomas?
    altered hormone levels
  119. rx for gigantism adenoma?
    • octeotride
    • dopamine agonists
  120. dopamine agonists downregulate what pituatiry tumores?
    • prolactinoma
    • gh releasing adenoma
  121. cause of hypopituitarism?
    craniopharyngioma
  122. dx of hypopituatirism?
    low gh level after hypoglycemia or arginine stimulation
  123. causes of hypopituatirism?
    • axis severance
    • tuberculosis
    • sarcoidosis
  124. pituitary apoplexy?
    necrosis of the pituitary from an adenoma that wasnt treated completely
  125. signs of meningitis with a prior pituitary adenoma?
    pituitary apoplexy
  126. sheehan syndrome?
    necrosis of the pituitary
  127. when is empty sella syndrome found?
    when a ct is performed for other reason and it is an incidental finding
  128. nephrogenic di?
    • demeclocycline
    • lithium
    • hypercalcemia
  129. causes of central di?
    • infiltrative lesions
    • malignancy
    • sarcoid
    • tuberculiod
  130. rx for central di?
    desmopressin intranasally
  131. consider what in euvolemic hypnatremia?
    SIADH
  132. causes of siadh
    • pulmonary diseases
    • cns disease
    • chlorpropramide
    • vincristine
    • vinblastine
    • sertraline
  133. rx for siadh?
    • water restriction
    • demeclocycline
  134. severe confusion with hyponatremia rx?
    hypertonic saline--the only time this is the rx
  135. dx of primary hyperparathyrodism?
    high pth
  136. when is sx the answer for primary hyperparathyrodism?
    • symptomsatic 
    • young pts
  137. 3 causes of hypocalcemia?
    • primary hypoparathyrodism
    • hypomagnessemia
    • vit d deficiency due to various conditions
  138. why is magnesium needed to maintain normal calcium level?
    • need mg to release pth
    • need mg for osteoclasts to act normally
  139. ekg finding with hypcalcemia?
    ekg finiding with hypercalcemia?
    • qt prolongation
    • short qt
  140. 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
  141. acute management for hypocalcemia?
    • calcium gluconate iv 
    • then
    • oral calcium
  142. 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
  143. Definition of diabetes?
    Fasting blood glucose level of >126 on two different occasions 2 weeks apart
  144. how do you follow diabetes state?
    Hb1ac
  145. Hb1ac of 6.5 is equivalent to what fasting blood glucose?
    125
  146. tight glycemic control controls what diabetic complications?
    microvascular--retinopathy, nephropathy, neuropathy
  147. what are the treatment modalities in type 2 dm?
    • exercise and weight loss
    • oral hypoglycemics
    • insulin
  148. side effect of sulfonylurea?
    • hypoglycemia
    • weightloss
  149. sulfonylurea in dm with kidney failure?
    tolbutamide
  150. MOa of metformin?
    benefit?
    • stops gluconeogenesis in the liver
    • stops absorption in gi tract
    • glucose into muscle

    • no weight gain
    • no hypoglycemia
  151. most common side effect of metformin?
    gi disturbance
  152. when do you not use metformin?
    in kidney failure
  153. moa of pioglitazone?
    increases insulin sensitivity in fat and muscle
  154. side effect of glitazones?
    • edema
    • hepatotoxicity
  155. what are the short acting insluin?
    • lispro
    • aspart
  156. old way of managing dm with insulin?
    bid injections wiht regular and nph insulins
  157. new and most efficacious way of managing dm type 1 with insulin?
    long acting--glargine + rapid acting (lispro) or aspart
  158. what causes dka
    infections and other stress like infections
  159. rx of DKA?
    • insulin
    • fluids--isotonic
    • confirm ketones in blood
  160. how do you know if dka is fixed?
    • anion gap is back to normal
    • hco3 goes back to normal
  161. Rx of hyperosmolar hyperglycmic episode?
    • fluids
    • insulin
  162. what nerve is commonly affected as a complication of diabetes?
    cn 3
  163. how do u pick up early diabetic nephropathy?
    microalbuminuria
  164. when do you give aceinhibitor in a aptient with diabetes mellitus?
    • if a patient has
    • microalbuminuria
    • hypertension 130/80
  165. when do you refer to opthalmologist in diabetes?
    • type 1---5 years after and then 1 year thereafter
    • type2---every year
  166. what is the somogyi effect?
    dawn 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
  167. next best step in differentiating somogyi vs dawn effect?
    cut back on insulin the person takes at night
  168. what is a honeymoon period?
    insulin needs in a diabetic decrease bc the pancreas is able to produce some insulin transiently
  169. definition of hypoglycemia?
    • hypoglycemia
    • symptoms of hypoglycemia
    • reversal of symptoms with sugar
  170. rx for sulfonylurea induced hypoglycemia?
    treat and observer for 24 hours bc sulfonylureas act for 24 hours
  171. best test for septic arthritis?
    sonogram
  172. low potency neuroleptics?
    • chlorpromazine
    • thioridazine
  173. high potency neuroleptics?
    • haloperidol
    • fluphenazine
    • doperidol
    • thiothiaxene
  174. what should be done if the total cholesterol is <200?
    >200?
    • retest in 5 years
    • check for lipid fractions if >200
  175. what should be done if LDL is <130? and no cad risk factors?
    130-160
    >160?
    • nothing
    • exercise +diet
    • Statins
  176. what should be done if LDL >100 with cad risk factors?
    stati
  177. hypertiglyceride causes what?
    pancreatitis
  178. what binds c diff toxin?
    cholestyramine
  179. Rx for high TG?
    • Omega 6 fatty acids
    • fibrates
  180. when is screening for lipids done?
    • men >35
    • women>45
  181. when lfts are what shoudl you not give statins?
    2x ULN
  182. what is contraindicated in prinzmetal angina?
    • aspirin
    • bb
  183. is reversible or irriversible iechemia a reason to do PCI and/or cabg?
    reversible
  184. who gets pci?
    • all unstable/nstemi/stemi and
    • stable angina that isnt controlled with medical therapy
  185. rx for which conditions is diagnositc?
    • fluconazole for esophagitis
    • taxol for cns toxoplamsosis
  186. nitroglycerin makes what 3 coniditions better?
    • ischemia
    • gerd
    • esophageal spasm
  187. what drugs are indicated post mi?
    • aspirin
    • bb
    • acei
    • statins
    • spironolactone
  188. rx for bb toxicity?
    • glucagon
    • atropine
    • insulin with glucose
    • calcium
  189. when are pvcs considered vtach?
    when are pvcs becoming an issue/?
    • more than 3  in a row
    • when there is 3 in a minute
  190. side effects of amiodarone?
    • hypothyrodism
    • pulmonary fibrosis
    • check pft, tft, lft
  191. Rx for PVC, MAT?
    BB
  192. earliest ekg sign of chf?
    LVH
  193. best initial test for valvular heart disease?
    best initial test for endocarditis lesions on the valves?
    • tte
    • tee
  194. Carotid endartectomy is for whom?
    • symptomatic and 70-90% stenosis
    • asymptomatic and 80-90% stenosis
  195. dx of pseudotumor cerebri?
    rx?
    • ct-negative
    • LP---increased pressure
    • acetazolamide

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