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Neurology – Awesome

Random neuro problems

when to prophylax for migraines and what medication? > 2/wk use B blockers or TCAs, if >15/mo use topiramate or botox
side effects of topiramate lose weight and + kidney stones
what sz med to use in pregnancy carbemazepine
prevention of cluster HA verapamil
prevention of tension HA B blockers or TCA
an orbital one sided HA cluster
a throbbing HA migraine
a band like HA tension
HA with rhinorrhea, ipsilateral Horner's, unilateral lacrimation cluster
treatment for cluster HA 100% O2, intranasal lidocaine, sumatriptan
In which diseases should you NOT use triptans CAD, vasculitis, and pregnancy
prochlorperazine or metronidazole - what class? dopamine antagonaist
prochlorperazine and metoclopramide - what class of drugs and what are they used for? dopamine antagonists - for migraine abortive therapy, antiemetics
Dihydroergotamine - what is it, what is the mechanism, when do you use it? similar to riptans, agonist to serotonin 5-HT(1D) receptors and causing vasoconstriction of the intracranial blood vessels; also acts on dopamine and adrenergic receptors. It can be used to treat acute intractable headache or withdrawal from analgesics.
when would you not use Dihydroergotamine DHE and triptans should not be taken within 24 hours of each other due to the potential for coronary artery vasospasm.
prevention of menstrual HA mefenamic acid 2 days prior and up to end of menstruation
pt has asthma and needs migraine ppx - what to use? no B blockers. use amitriptyline or topiramate
pt with recurring HA >5-6/day lasting 15-20 min, unilateral and retro-orbital - what is dx and tx chronic paroxysmal hemicrania, tx with indomethacin; indomethacin-responsive HA
who shouldn't use indomethacin and why most potent vasoconstrictor of afferent arteriole --> kidney insufficiency, don't use in old people
pt with blurring of disc margins on funds exam - wtd CT head (figure out reason for intracranial HTN) --> MRV --> LP
how to tx pseudo tumor cerebri? acetazolamide
what do you use acetazolamide for? pseudotumor cerebri and to ppx against acute mountain sickness
how does pseudo tumor cerebri affect your vision peripheral visual field loss --> central vision loss
how to treat trigeminal neuralgia carbemazepine
what is a side effect of Dihydroergotamine nausea, can take ondansetron prior to the medication
what is a side effect of carbamazepine neutropenia
how to treat Bell's Palsy artificial tears, patch the eye at night (because weak lid can't close by itself and eye gets dry) and give steroids
one-side facial paralysis sparing the forehead supranuclear lesion of CN7
one-side facial paralysis infranuclear lesion of CN7
Pt with hyperthyroidism and ophthalmopathy has double vision. What is the muscular defect and how to treat? thyroid ophthalmopathy causing the problem - - can't completely ABduct eyes. Tx with steroids or surgery
veil in front of eye; where would other neuro deficits be? amaurousis fugax - ipsilateral carotid artery stenosis; have contralateral motor or sensory problems.
new onset dizziness in an elderly person with h/o HTN must r/o vertebrobasilar syndrome from brainstem stroke - get MRA brainstem
4 bulbar signs diplopia, dysarthria, dysphonia, dysphagia
drop attacks in an elderly person must r/o vertebrobasilar syndrome from brainstem stroke - get MRA brainstem
how to tx vertebrobasilar syndrome? ASA
Pt comes with TIA. How to decide whether or not they are admitted? 1 pt each for: sx's >10 min, >60 yo, DM; 2 pt for sx's > 20 min and speech disturbance. Admit if 3 points or higher.
most important risk factor for stroke uncontrolled HTN
TIA and carotid US with > 70% stenosis - wtd CEA with ASA
TIA and carotid US shows > 90% stenosis and inoperable, wtd stent
TIA and < 50 % stenosis - wtd ASA + clopidogrel (Plavix)
If pt h/o TIA, what med must they be on? ASA
If TIA but pt already on ASA, ACEi (decreases recurrence, improves BP control), and statin, wtd next d/c ASA and start clopidogrel (don't use the two together in stroke! increases the risk of bleed)
Which is better - CEA or stent - for mortality benefit? for stroke reduction? CEA is better because it decreases mortality and reduces risk of stroke over stents
In what situation would you prefer a stent over CEA? when stenosis is at the high carotid bifurcation
TIA + Afib gets what med? warfarin
Pt with CAD going for CABG. What study to do before the surgery? carotid US to check if pt needs CEA as well, if needed to, CEA before CABG
What vessel and lesion is on which side? pt with R leg/foot weakness AND sensory loss, urinary incontinence, and upgoing babinski anterior cerebral artery (inner brain), contralateral lesion so lesion is on L side
What vessel and lesion is on which side? Pt with agraphia, astereognosis, aphasia and deja vu (if temporal lobe), and can't dress themselves (if parietal lobe) MCA (outer brain)
homonymous hemianopia, ipsilateral 3rd nerve palsy with dilated pupil, contralateral sensory abnormalities such as hemiplegia posterior cerebral artery
pain and temp loss on ipsilateral face and contralateral body; what vessel affected lateral medullary syndrome (Wallenberg) - vertebral artery
In lateral medullary syndrome, which side do you fall to? ipsilateral side, the side that your face symptoms are on, fall because of dizziness, not weakness
loss of vibration and proprioception on contralateral side medial medullary syndrome
locked in syndrome basilar artery stroke
GI illness that resolved ---> bilateral leg weakness, loss of sensation below the umbilicus, and hyperreflexia in the lower extremities; leukocytosis in the cerebrospinal fluid; vertebral lesions with enhancement on her MRI (sign of inflammation) transverse myelitis
multiple sclerosis (MS) - how to treat Glatiramer acetate is a disease-modifying agent - reduces the relapse rate by approximately one third
MRI of the brain showing ovoid white matter lesions MS
indications for head imaging for HA - nonacute HA with unexplained abnl finding on exam - change in pattern/freq/severity of HA's - progressive worsening of HA despite therapy - focal neuro signs/sx's - onset of HA with exertion/cough/sex - orbital bruit - onset of HA after age 40
when to get LP when pt comes in with HA - HA + suspicion of SAHem with neg CT head - infectious process - inflammatory process
Dix Hallpike result: mixed upbeat-torsional nystagmus with latency 2 to 40 seconds and duration less than 1 minute BPPV
how does someone with loss of proprioception walk? high-stepping gait, feet slapping
unilateral ocular symptoms, afferent pupillary defect, and contrast enhancement of the optic nerve on MRI - what is diagnosis optic neuritis
how to tx optic neuritis intravenous methylprednisolone
what medications reduce the risk of MS development in the first 3 years after an initial demyelinating event glatiramer acetate or interferon-beta agents
visual changes bilateral and associated with headache, HTN, and papilledema, no enhancement of the optic nerve on MRI. What is it and how to tx? benign idiopathic intracranial hypertension, tx with acetazolamide
Dense anesthesia, severe motor impairment, and lack of Doppler vascular signals indicate what in a limb, how to tx acutely ischemic nonviable limb; prompt amputation is warranted.
facial grimacing and akathisia, can be induced by dopamine receptor antagonists, such as metoclopramide and antipsychotic drugs Tardive dystonia
forceful, sometimes painful sustained contraction of muscles leading to twisted postures Tardive dystonia
flowing, patterned choreic movements of the face tardive dyskinesia
how to treat tradeoff dystonia therapeutic approach includes a gradual discontinuation of the offending agent, treatment with anticholinergic or dopamine receptor-depleting agents, and the judicious use of botulinum toxin injections
familial disorder causing generalized chorea, dementia, and behavioral changes Huntington
thunderclap headache, severe and explosive headache that is maximal in intensity at or within 60 seconds of onset - how to w/u? CT angiography or MR angiography, r/o potentially catastrophic conditions, especially subarachnoid hemorrhage
Created by: christinapham



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