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Step III
Step III - Neuro 3
| Question | Answer |
|---|---|
| What is the best initial tx for CJD | EEG (abnL) or MRI (normal) |
| What test can be done and shows what which confirms CJD and spares brain bx in pt | CSF for 14-3-3 protein |
| Parkinson’s Dz + dementia = | Lewy body dementia |
| How is NPH diagnosed | CT brain |
| What is the tx for NPH | Shunt |
| Are migraines unilateral or bilateral | 60 B/L; 40 Unilat |
| What are some triggers of migraines | Caffeine, menses, cheese, OCP |
| In pt you suspect migraine when should you order MRI/CT head | Sudden/severity of sx, >40yo, presence of focal deficits |
| What is the best initial tx for migraines | Sumatriptan or ergotamine |
| What are prophylactic tx for migraines and when should you consider them | Propranolol >> CCB, TCA, SSRIs; if pt has migraine x4+/month |
| Man, tearing eyes, rhinorrhea, unilateral HA. Dx | Cluster HA |
| What is the best initial tx for cluster HA | Sumatriptan OR 100 oxygen OR steroids (special to cluster HA) |
| What is the prophylx tx for cluster HA | None |
| What is the best initial test for temporal arteritx | ESR |
| What is the tx for temporal arterx | Steroids |
| Obese young woman, HA, double vision, papilledema, h/o Vitamin A use. CT/MRI is nL | Pseudotumor cerebri |
| Most accurate test for Pseudotumor cerebri | LP w/ HIGH opening pressure (NPH has nL pressure) |
| Tx for Pseudotumor cerebri | Weight loss + acetazolamide (carbonic anhydride inhibitor) |
| What study should be done in all pts that c/o vertigo | MRI auditory canal |
| What two vertigo diseases DO NOT present w/ tinnitus/hearing loss | Benign positional vertigo and vestibular neuritis |
| What are the vertigo dz that present w/ tinnitus/hearing loss | Acoustic neuroma, labyrinthitis, meniere’s dz, perilymph fistula |
| What characteristic differnentiates labyrinthitis from meniere’s | acute vs chronic |
| Which dz presents w/ vertigo, hearing loss/tinnitus, and ataxia | Acoustic neuroma |
| What dz would you suspect in pt w/ vertigo, tinnitus/hearing loss and h/o trauma | Perilymph fistula |
| What is the tx for BPV | Meclizine |
| What is the suspected etio of vestibular neuritis and what is the tx | Viral infection; meclizine |
| What is the difference in ear structure affected b/t vestibular neuritis and labyrinthitis | Vestibular neuritis: vestibular part of CN VIII; labyrinthitis: cochlear part of CN VIII |
| What is the tx for labyrinthitis | Meclizine |
| Tx for Meniere’s | salt restrict + diuretics |
| What dz is acoustic neuroma a/w | NF 1/von recklinhausen |
| Tx for acoustic neuroma | Surgery |
| Tx for Wernicke Korsakoff | Thiamine THEN glucose |
| Under what circumstances in pt suspected of CNS infection would you do a CT before a LP | Hx CNS dz, significant delay in ability to do LP, papilledema, focal deficits, seizures, altered consciousness |
| Most accurate test for meningitis | Culture |
| Which test for meningitis has high spec and low sens | Gram stain |
| CSF shows GP diplococcus = | Pneumococcus |
| CSF shows GN diplococcus | Neisseria |
| CSF shows GP pleomorphic, coccobacilli= | hemophilus |
| CSF shows GP bacilli= | Listeria |
| What protein level EXCLUDES bacterial meningitis | NORMAL |
| What glucose level = bacterial meningitis | <60% |
| What is the best initial tx for meningitis | Cell count |
| If CSF shows neutrophils in thousands what tx do you do first | IV ceftriaxone, vanc, and steroids |
| HIV CD<100 in pt c/o neck stiffness | Cryptococcus |
| What is the best initial tx for Cryptococcus | India ink stain |
| Most accurate test for Cryptococcus | Cryptococcus Ag |
| What is the best initial tx for Cryptococcus | Amphotericin (followed w/ PO fluconazole) |
| When do you decide to continue fluconazole lifelong in pt w/ Cryptococcus | If CD count does not >100 |
| Most accurate test for lyme dz meningitis | Serology and western blot |
| Camper/hiker c/o fever, malaise, HA. Recently got rash on wrist and ankles now spreading to center | RMSF |
| Most accurate test for RMSF | Serology |
| Tx for RMSF | Doxy |
| Immigrant w/ h/o lung TB c/o fever, HA, neck stiffness over several WEEKS to MONTHS | TB meningitis |
| What does CSF show in TB meningitis | VERY high protein (acid fast may be negative) |
| Tx for TB meningitis | RIPE: rifampin, INH, pyrazinamide, ethambutol + steroids and longer duration than tx for TB lung |
| What is the only finding in viral meningitis | CSF lymphocytosis |
| What bug is MCC in meningitis of elderly, HIV+, asplenic, on steroids, neonate, leukemia/lymphoma pts | Listeria |
Created by:
DrINFJ
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