D\'s Neuro Step 2

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Author:
JCremer
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29315
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D\'s Neuro Step 2
Updated:
2010-08-08 13:56:01
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USMLE Step
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Neuro
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  1. Top 3 causes of bacterial meningitis <1 month
    • E. Coli
    • Group B Strep
    • Listeria
  2. Treating bacterial meningitis <1 month.
    • Ampicillin and
    • Ceftoxamine or Gent
  3. Top 2 causes of bacterial meningitis 1 mo-60yrs
    • Strep pneumonia
    • N. Meningitis
  4. Treating bact meningitis 1 mo -60yrs
    • 1. Cefotaxime or Ceftriaxone
    • 2. Vancomycin
    • 3. Dexamethasone IV-if over 6 months
  5. Top 4 causes bacterial meningitis in >60, etohism, dehabiltiating comorbidities:
    • 1. Strep pneumonia
    • 2. Listeria
    • 3. Neiserria meningitis
    • 4. Gram - bacilli
  6. Treating bact meningitis >60, alcoholism, debilitating comorbidities.
    • 1. Ampicillin (listeria)
    • 2. Cefotaxime or ceftriaxone
    • 3. Vancomycin
    • 4. Dexamethasone
  7. Rational for dexamethasone use prior or with first antibiotic for bacterial meningitis treatment?
    risk neurologic squelae & hearing loss

    (esp with H. Influenza or TB meningitis)
  8. Treatment of viral meningitis
    • Acetaminophen
    • IVF
    • Empiric antibiotics until bacterial meningitis excluded.
    • Aycylovir
  9. Prophylaxis for meningitis
    Rifampin
  10. Dtug of Choice: Treating trigeminal neuralgia.
    Carbamazepine
  11. Tension HA treatment:
    NSAIDs (ketorolac)
  12. Cluster HA treatment:
    • 100% O2
    • Sumatriptain or DHE 45
  13. Migraine HA treatment:
    • NSAID
    • Triptan
    • Ergots
    • Antiemetics
  14. Prophylaxis for migraines
    • TCA
    • BB
    • CCB
    • Ergots
  15. HA made worse by foods with tyramine
    Migraine
  16. Obese female with HA & papilledema
    Pseudotumor cerebri
  17. Periorbital pain, ptosis, mitosis, HA
    Cluster HA
  18. HA & EOM palsy
    Cavernosus Sinus Thrombosis
  19. Symptoms suggesting brain tumor as cause of HA:
    • 1. Mild HA progressively worse over days-wks
    • 2. New onset after age 50
    • 3. Papilledema
    • 4. Sz, confusion, AMS
    • 5. Abnl neurologic signs
    • 5. Disturbs sleep, present on waking
    • 6. Vomiting b4 HA
    • 7. Known sytemic illness: HIV, cancer, collagen vas dz
  20. CSF pressure for pseudotumor cerebri
    • Non-obese: 200Hg
    • Obese: 250mmHg
  21. Inciting agents for pseudotumor cerebri:
    • Vit A excess
    • Accutane
    • Isoretinion
    • Tetracycline
    • Steriod withdrawl
  22. Treating Pseudotumor Cerebri:
    • Wt loss
    • Acetazolamide
    • Serial LP
    • Optic nerve decompression
    • CSF shunt
  23. 4 Most common sequelae of bact. Meningitis in kids?
    • 1. Hearing loss
    • 2. M. R.
    • 3. Sz
    • 4. Spastic paralysis
  24. Treatment for fungal meningitis
    Ampthotericin B intrathecally
  25. Organism causing bacterial meningitis with gram + diplococci:
    Strep pneumonia
  26. Organism causing bacterial meningitis with gram - diplococci
    N. Mengitidis
  27. Organism causing bacterial meningitis with small pleomorphic gram - coccobacilli
    H. Influenza
  28. Organism causing bacterial meningitis with gram + rods and coccobacilli
    Listeria
  29. Anticoagulant of choice for 1st TIA
    ASA
  30. Anticoagulant of choice for TIA/stroke due to a fib
    Warfarin
  31. Anticoagulant of choice for TIA/stroke + CAD
    Clopidogrel
  32. Anticoagulant of choice for repeat TIA/stroke while on ASA
    • Aggregnox
    • Clopidogrel
  33. Window shade being pulled over one eye
    • Retinal detachment
    • Or
    • Carotid artery stenosis
  34. 5 main lacunar syndromes
    • 1. Pure motor hemiparesis
    • 2. Pure sensory
    • 3. Ataxic Hemiparesis
    • 4. Sensory & Motor
    • 5. Dsyarthria-Clumsy Hand syndrome
  35. Treatment for SAH:
    • Discontinue anticoagulants
    • Reverse anticoagulants
    • Systolic BP <150 only if cog fxn intact
    • Labetotol
    • Nimodipine
    • Avoid hypoxia &  glucose
    • Normal pH, euvolemia, temp
    • Ventriculostomy
    • Surgical clipping/coil
  36. Lucid interval
    Epidural hematoma
  37. Broca's aphasia. Area injured, artery, deficit.
    Inferior frontal gyrus

    MCA superior

    • Expressive aphasia
    • Nonfluent
    • Good comprehension
  38. Wernicke's aphasia. Area injured, artery, deficit.
    Posterior superior temporal gyrus

    MCA inferior

    • Receptive
    • Word salad
    • Poor comprehension
    • Meaningless phrases
  39. Conduction aphasia. Area injured, deficit.
    • Angular gyrus
    • Supramarginal gyrus

    • Fluent speech
    • Word substitutions
    • Freq attempts to correct words
    • Word finding pauses
  40. Global aphasia. Area injured, deficit.
    Large infarcts of L cerebral hemisphere

    • Diff producing words
    • Nonfluent speech
    • Poor comprehension
    • Limb ataxia
  41. Decussation of PCML
    Medulla
  42. Decussation of Lateral corticospinal tract.
    Medullary pyramids
  43. Decussation of spinothalamic tract.
    Ant white commissure of SC
  44. What area of the brain is damaged: contralateral hemiballismis
    Subthalamic nucleus
  45. What area of the brain is damaged: eyes look toward lesion side
    Frontal eye field
  46. What area of the brain is damaged: eyes look away from lesion side
    PPRF
  47. What area of the brain is damaged: paralysis of upward gaze
    Supracollicular nucleus

    (parinaud's syn)
  48. What area of the brain is damaged: hemispatial neglect
    • Nondominant parietal lobe
    • (usually R)
  49. What area of the brain is damaged: coma
    RAS
  50. What area of the brain is damaged: poor repetition
    • Arcuate fasiculus
    • (MCA)
  51. What area of the brain is damaged: poor comprehension
    • Wenicke's
    • (MCA)
  52. What area of the brain is damaged: poor vocal expression
    • Broca's
    • (MCA)
  53. What area of the brain is damaged: resting tremor
    • Basal Ganglia
    • (parkinsons)
  54. What area of the brain is damaged: intention tremor
    Cerebellar hemisphere
  55. What area of the brain is damaged: hyperorality, hypersexuality, disinhibited behavior
    • Bilateral Amydala
    • (Kluver bucy)
  56. What area of the brain is damaged: dysarthria
    Cerebellar vermis
  57. What area of the brain is damaged: agraphia & acalculia
    Dominant parietal lobe
  58. What meds/withdrawal can cause seizures?
    • Buproprion
    • Buspirone
    • Enflurabe
    • B6 deficiency

    • Withdrawl:
    • Benzo's
    • EtOH
    • Barbs
    • Anti-convulsant

    • Theo OD
    • Trauma
  59. DOC absence sz, 2nd drug.
    1st: Ethusuximide

    2nd: Valproate
  60. Drugs causing steven Johnson syndrome
    Antivonvulsant: ethosux, lamotrig, carbamaze, phenobarb, phenytoin

    Antibiotic: sulfa, pen, allopurinol
  61. Drugs inducing P450, speeding up metabolism
    • B: Barbs
    • C: Carbamazepine
    • G: Grisofulvin
    • P: Phenytoin
    • Q: Quinidine
    • R: Rifampin
    • S: St. Johns wort

    Ethanol
  62. Spike and wave on EEG
    Absense sz
  63. Parkinsons
    • Less dopamine
    • Too much ach
  64. Weakness, flaccid paralysis, fasiculations, normal sensation.
    ALS: loss of UMN & LMN
  65. Treat dystonia with:
    • Carbidoba
    • Levodopa
    • Botox
  66. Treat hemiballismis with
    Haloperidol
  67. Treat Tourette tics with:
    • Clonidine
    • Haloperidol
    • Methylphenidate
    • Dextroamphetamine
  68. MC brain tumor in kids? Adults?
    Kids: medulloblastoma

    Adult: glioblastoma multiforme
  69. Mets to brain in order of decreasing frequency:
    Lung>breast>melanoma> kidney> GI
  70. Theta waves on EEG sleep stage?
    Stage 1, light sleep
  71. Sleep spindle & K complex on EEG. Sleep stage?
    Stage 2, intermidiate sleep
  72. Delta waves on EEG, sleep stage?
    Stage 3 & 4, deep sleep
  73. Low voltage, high frequency pattern.
    REM sleep
  74. Narcolepsy polysomnography shows what?
    • Mutiple arousals
    • Decreased latency until REM sleep
  75. Most sleep in what stage?
    Stage 2
  76. Benzo's do what to sleep?
    • Increase stage 2
    • Decrease stage 3 & 4

    Not a normal sleep cycle!
  77. Decorticate posturing (elbows flexed, legs extended)
    Cortical or thalamic compression
  78. Decerebrate posturing (legs extended, elbows extended)
    Midbrain involvement
  79. Tay Sachs absence of what enzyme?
    Hexosamimidase A

    (AR)
  80. Uveitis causes
    • Infection: viral, syphilis
    • Autoimmune: A.S., JRA
    • Inflammatory: UC, Crohn's
  81. Gradual vision loss from peripheral to central, halos around lights, cupping of optic disk. Diagnosis?
    Glaucoma-open angle
  82. Inflammed eye, painful, blurred vision, hard, dilated nonreactive. Quick onset. Diagnosis? Tx?
    Closed angle glaucoma

    • Acetazolamide
    • Pilocarpine
    • Laser iridotomy
  83. Peripheral to central vision loss vs central to peripheral vision loss
    Periphcentral: open angle

    Centralperiph: macular degeneration
  84. Cherry red spot via fundoscopic exam:
    • CRAO
    • Tay sach's
    • Hurler's
    • Niemann Pick

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