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Step III

Step III - Neuro 4

QuestionAnswer
What is the tx for listeria meningitis Ceftriaxone + vanc and add ampicillin
Adolescent, military, terminal complement deficiency pt who has meningitis. Etio Neisseria
Prophylactic tx for Neisseria meningitis contacts Respiratory isolation for pt, rifampin/cipro for close contacts (anyone who possibly shares saliva w/ pt), none needed for medical staff/classmates/co-workers
Pt w/ fever and confusion over several hours Encephalitis
MCC encephalitis Herpes (pt does not have to have prior herpes infection)
What is the best initial test for encephalitis CT head
Most accurate test for encephalitis PCR CSF
What is the best initial tx for encephalitis Acyclovir
Tx for encephalitis if acyclovir fails Foscarnet
Fever, HA, focal deficits Brain abscess
Brain abscess tx in HIV (-) pt brain bx
Brain abscess tx in HIV(+) pt and etio Toxoplasmosis; pyrimethamine + sulfadiazine x2wks then repeat CT head
Which brain lesion in HIV pt does not show ring enhancement and mass effect PML
Tx for PML None; raise CD count and disease goes away
Pt from Mexico w/ seizure Neurocysticercsosis
What is the best initial tx for Neurocysticercsosis and what does it show Head CT showing MULTIPLE 1cm cystic lesions +/- calcifications
Most accurate test for Neurocysticercsosis Serology
Tx for Neurocysticercsosis Albendazole + steroids
Pt c/o sudden HA, photophobia, stiff neck, LOC, no fever, focal deficits SAH
What is the best initial tx for SAH Head CT w/o (LP if CT shows no blood)
Most accurate test for SAH LP
Leukocytosis can be elevated in intracranial bleeds as well as infections. How do you tell the difference nL ratioof WBC: RBC = 1:500; if incr = infection
Tx for SAH Angio to det location of bleed then surgical clip/Embolization to stop bleed. If hydrocephalus do ventric. Add PO nimodipine (CCB) to prevent stroke
Spine dx where location is nontender LS strain
Spine dx where tender Cord compression
Spine dx where tender + fever Epidural abscess
Spine dx where pain w/ walking DOWNHILL Spinal stenosis
What are the etio of syringomyelia Trauma, tumor, congenital abnLs
Pt c/o capelike distribution loss of sensory and pain and temperature @ UE Syringomyelia
Diagnostic study for syringomyelia MRI
Tx for syringomyelia Surgery
What is the best initial test for cord compression MRI
Most accurate test for cord compression Bx
What is the best initial tx for cord compression Steroids
How is spinal stenosis and PAD similar and different Same CC pain w/ walking; different where spinal stenosis pulses are INTACT
What neurological loss is found in ant cerebral aa infarcrion Everything EXCEPT position and vibratory sense
Trauma to spine, ipsilat loss of position, vibratory sense, contralat loss of pain and temperature Brown sequard
Idiopathic dz of BOTH UMN and LNM ALS
Tx for ALS and MOA Riluzole (-) accumulation of glutamate
Weakness is a sign of UMN or LMN lesion BOTH
Spasticity is LMN or UMN UMN
Fasciculations is UMN or LMN LMN
Tx for diabetic peri neuropathy Gabapentin/pregablin
What is the best initial tx for carpal tunnel Splint
Tx for carpal tunnel after splint Steroid injection
Wrist drop = what nerve palsy Radial
Foot drop and inability to EVERT foot = what nerve palsy Peroneal
What is the sensory presentation of Bell’s palsy Facial hemiparesis upper and lower; loss of taste anterior 2/3 tongue, hyperaccusis, can’t close eyes at night
Etio of Bells palsy Viral
Tx for Bell’s palsy Acyclovir/valacyclovir + steroids
Pt had prior trauma/injury to ext. now c/o burning sensation w/ slightest touch to ext. Dx and tx Chr pain syndrome aka regional sympathetic dystrophy; NSAIDs, gabapentin OR surgical sympathectomy
Tx for RLS Ropinerole OR pramipexole
Most URGENT step in pt suspect of Guillain Barre and why Peak inspiratory pressure (weakened diaphragmn as dz ascends, tells you if pt will have respiratory failure before it happens
Weakness w/ chewing/eating, droopy eye as day progresses MG
What is the best initial tx for MG Ach-R AB
Most accurate test for MG clinical picture + Ach-R AB (more so than tensilon/edrophonium according to Kaplan)
What is the best initial tx for MG pyridostigmine or neostigmine
Tx for MG is initial Rx does not work Thymectomy in pt <60yo
Tx for MG if surgery and RX does not work Prednisone
What is used to keep pt off steroids in MG azathioprine and cyclosporine
Created by: DrINFJ