D\'s Neuro Step 2
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Top 3 causes of bacterial meningitis <1 month
- E. Coli
- Group B Strep
Treating bacterial meningitis <1 month.
- Ampicillin and
- Ceftoxamine or Gent
Top 2 causes of bacterial meningitis 1 mo-60yrs
- Strep pneumonia
- N. Meningitis
Treating bact meningitis 1 mo -60yrs
- 1. Cefotaxime or Ceftriaxone
- 2. Vancomycin
- 3. Dexamethasone IV-if over 6 months
Top 4 causes bacterial meningitis in >60, etohism, dehabiltiating comorbidities:
- 1. Strep pneumonia
- 2. Listeria
- 3. Neiserria meningitis
- 4. Gram - bacilli
Treating bact meningitis >60, alcoholism, debilitating comorbidities.
- 1. Ampicillin (listeria)
- 2. Cefotaxime or ceftriaxone
- 3. Vancomycin
- 4. Dexamethasone
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)
Treatment of viral meningitis
- Empiric antibiotics until bacterial meningitis excluded.
Prophylaxis for meningitis
Dtug of Choice: Treating trigeminal neuralgia.
Tension HA treatment:
Cluster HA treatment:
- 100% O2
- Sumatriptain or DHE 45
Migraine HA treatment:
Prophylaxis for migraines
HA made worse by foods with tyramine
Obese female with HA & papilledema
Periorbital pain, ptosis, mitosis, HA
HA & EOM palsy
Cavernosus Sinus Thrombosis
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
CSF pressure for pseudotumor cerebri
- Non-obese: 200Hg
- Obese: 250mmHg
Inciting agents for pseudotumor cerebri:
- Vit A excess
- Steriod withdrawl
Treating Pseudotumor Cerebri:
- Wt loss
- Serial LP
- Optic nerve decompression
- CSF shunt
4 Most common sequelae of bact. Meningitis in kids?
- 1. Hearing loss
- 2. M. R.
- 3. Sz
- 4. Spastic paralysis
Treatment for fungal meningitis
Ampthotericin B intrathecally
Organism causing bacterial meningitis with gram + diplococci:
Organism causing bacterial meningitis with gram - diplococci
Organism causing bacterial meningitis with small pleomorphic gram - coccobacilli
Organism causing bacterial meningitis with gram + rods and coccobacilli
Anticoagulant of choice for 1st TIA
Anticoagulant of choice for TIA/stroke due to a fib
Anticoagulant of choice for TIA/stroke + CAD
Anticoagulant of choice for repeat TIA/stroke while on ASA
Window shade being pulled over one eye
- Retinal detachment
- Carotid artery stenosis
5 main lacunar syndromes
- 1. Pure motor hemiparesis
- 2. Pure sensory
- 3. Ataxic Hemiparesis
- 4. Sensory & Motor
- 5. Dsyarthria-Clumsy Hand syndrome
Treatment for SAH:
- Discontinue anticoagulants
- Reverse anticoagulants
- Systolic BP <150 only if cog fxn intact
- Avoid hypoxia & glucose
- Normal pH, euvolemia, temp
- Surgical clipping/coil
Broca's aphasia. Area injured, artery, deficit.
Inferior frontal gyrus
- Expressive aphasia
- Good comprehension
Wernicke's aphasia. Area injured, artery, deficit.
Posterior superior temporal gyrus
- Word salad
- Poor comprehension
- Meaningless phrases
Conduction aphasia. Area injured, deficit.
- Angular gyrus
- Supramarginal gyrus
- Fluent speech
- Word substitutions
- Freq attempts to correct words
- Word finding pauses
Global aphasia. Area injured, deficit.
Large infarcts of L cerebral hemisphere
- Diff producing words
- Nonfluent speech
- Poor comprehension
- Limb ataxia
Decussation of PCML
Decussation of Lateral corticospinal tract.
Decussation of spinothalamic tract.
Ant white commissure of SC
What area of the brain is damaged: contralateral hemiballismis
What area of the brain is damaged: eyes look toward lesion side
Frontal eye field
What area of the brain is damaged: eyes look away from lesion side
What area of the brain is damaged: paralysis of upward gaze
What area of the brain is damaged: hemispatial neglect
- Nondominant parietal lobe
- (usually R)
What area of the brain is damaged: coma
What area of the brain is damaged: poor repetition
What area of the brain is damaged: poor comprehension
What area of the brain is damaged: poor vocal expression
What area of the brain is damaged: resting tremor
- Basal Ganglia
What area of the brain is damaged: intention tremor
What area of the brain is damaged: hyperorality, hypersexuality, disinhibited behavior
- Bilateral Amydala
- (Kluver bucy)
What area of the brain is damaged: dysarthria
What area of the brain is damaged: agraphia & acalculia
Dominant parietal lobe
What meds/withdrawal can cause seizures?
- B6 deficiency
DOC absence sz, 2nd drug.
Drugs causing steven Johnson syndrome
Antivonvulsant: ethosux, lamotrig, carbamaze, phenobarb, phenytoin
Antibiotic: sulfa, pen, allopurinol
Drugs inducing P450, speeding up metabolism
- B: Barbs
- C: Carbamazepine
- G: Grisofulvin
- P: Phenytoin
- Q: Quinidine
- R: Rifampin
- S: St. Johns wort
Spike and wave on EEG
- Less dopamine
- Too much ach
Weakness, flaccid paralysis, fasiculations, normal sensation.
ALS: loss of UMN & LMN
Treat hemiballismis with
Treat Tourette tics with:
MC brain tumor in kids? Adults?
Adult: glioblastoma multiforme
Mets to brain in order of decreasing frequency:
Lung>breast>melanoma> kidney> GI
Theta waves on EEG sleep stage?
Stage 1, light sleep
Sleep spindle & K complex on EEG. Sleep stage?
Stage 2, intermidiate sleep
Delta waves on EEG, sleep stage?
Stage 3 & 4, deep sleep
Low voltage, high frequency pattern.
Narcolepsy polysomnography shows what?
- Mutiple arousals
- Decreased latency until REM sleep
Most sleep in what stage?
Benzo's do what to sleep?
- Increase stage 2
- Decrease stage 3 & 4
Not a normal sleep cycle!
Decorticate posturing (elbows flexed, legs extended)
Cortical or thalamic compression
Decerebrate posturing (legs extended, elbows extended)
Tay Sachs absence of what enzyme?
- Infection: viral, syphilis
- Autoimmune: A.S., JRA
- Inflammatory: UC, Crohn's
Gradual vision loss from peripheral to central, halos around lights, cupping of optic disk. Diagnosis?
Inflammed eye, painful, blurred vision, hard, dilated nonreactive. Quick onset. Diagnosis? Tx?
Closed angle glaucoma
- Laser iridotomy
Peripheral to central vision loss vs central to peripheral vision loss
Periphcentral: open angle
Centralperiph: macular degeneration
Cherry red spot via fundoscopic exam:
- Tay sach's
- Niemann Pick
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