1
Q
PC:
- CONTRA weakness or sensory loss
- homonymous hemianopsia– looking towards side of lesion
- aphasia
A
MCA
2
Q
if you are right handed…
A
L dominant lobe
- handedness
- speech center
3
Q
PC:
- personality and confusion
- urinary incontinence
- legs> arms
A
ACA
4
Q
PC:
- IPSI sensory loss face, 9th, 10th CNs
- CONTRA sensory loss limbs
- limb ataxia
A
PCA
5
Q
best initial test for stroke
A
non-contrast CT
6
Q
diagnostic tests for stroke
A
- ECHO- PFO, surgical valve, thrombus
- EKG
- Holter
- carotid doppler– degree of stenosis
7
Q
tx for haemorrhagic stroke
A
NO TX
8
Q
tx for ischaemic stroke less than 3hrs
A
thrombolytics
9
Q
tx for ischaemic stroke greater than 3hrs
A
aspirin
10
Q
tx for ischaemic stroke greater than 3hrs and already on aspirin
A
ADD dipyridamole
or SWITCH to clopidogrel
11
Q
additional tx to add in for stroke
A
statins!
12
Q
experimental window for thrombolytics
A
3-4.5hrs
13
Q
carotid angioplasty and stenting
A
NOOOOOOO proven benefit
ALWAYS the wrong answer
14
Q
% carotid stenosis and tx
A
less than 50%= no tx
greater than 70%= endarterectomy
15
Q
PC pseudotumor cerebri
A
RICP and CN 6 palsy
16
Q
risk factors for pseudotumor cerebri
A
- obese young female
- venous thrombosis
- OCP
- vit A excess
17
Q
dx for pseudotumor cerebri
A
LP increase pressure
18
Q
tx for pseudotumor cerebri
A
- weight loss
2. acetazolamide
19
Q
tx for cluster headaches
A
- triptans
- octreotide
- ergotamine
- 100% oxygen, lithium, prednisone= ABORTIVE, not for mgiraines
20
Q
cluster prophylaxis
A
verapamil
prednisone
valproate
21
Q
best preventitive tx for migraines– if 3 attacks/month
A
propanolol
valproate
22
Q
tx trigeminal neuroalgia
A
oxcarbazepine or carbamezapine
23
Q
trigeminal neuralgia that doesn’t improve with medication
A
gamma knife surgery
24
Q
postherpetic neuralgia pain tx
A
- TCA’s
- gabapentin
- pregabalin
- carbamezapine
- phenytoin
- topical capsaicin
25
reduce incidence of postherpatic neurlagia
antiherpetic medications
26
clearly effective treatment for peripheral neuropathy?
NOOOPE
27
when to do EEG
when tried to exclude all the causes
| including CT or MRI
28
seizures of unclear etiology=
EPILEPSY
29
treatment for status epileptics
1. benzodiazepine
2. fosphenytoin> phenytoin
3. phenobarbital
4. GA
30
an unresolving seizure tx
NEUROMUSCULAR BLOCKING AGENTS
- succinylcholine
- vecuronium
- pancuronium
31
what to give before propofol
ventilator-- since propofol can stop breathing
32
when to give anti epileptic drugs after first seizure-- few circumstances
1. PC= SE or focal neuro signs
2. abnormal EEG or lesion on CT
3. fam hx of seizures
33
best tx for epilepsy
NOT CLEAR
34
which anti epileptic has the fewest side effects
leviracetam (!!! SJS)
35
best tx for absence seizures
ethosuximide
36
alcohol withdrawal seizures tx
NOT NOT NOT NOT NOT with anti epileptic drugs
37
when to stop anti epileptic meds
2 years seizures free
38
how to check for possibility of seizure recurrence
sleep deprivation EEG
39
patient with epilepsy, and driving....
recommend find an alternate means of transportation
40
SAH vs. meningitis
SAH
- more SUDDEN onset
- LOC
41
best initial test for SAH
non-contrast CT
42
most accurate test for SAH
LP-- xanthochromia
43
WBC: RBC ratio normal
1: 500
normal= SAH
abnormal= meningitis
44
why don't you use contrast for bleeds in brain?
BECAUSE BLOOD= WHITE
45
mortality rate if have recurrence of SAH
50-70%
46
tx of SAH
1. nimodipine
2. embolization (coiling)> clipping
3. VP shunt IF hydrocephalus
4. seizure prophylaxis
47
seizure prophylaxis for SAH
PHENYTOIN
48
if embolization is not one of the choices...
surgical clipping
49
embolization for SAH is a type of
INTERVENTIONAL RADIAOLOGY
50
LOSS of all spinal functions, except position and vibration
| LOSS DTR's--> hyperreflexia
anterior spinal cord syndrome
51
LOSS of contralateral pain and temp
| LOSS of ipsilateral vibration and position
brown sequard
52
loss of sphincter tone and acute weakness/ sensation loss
spinal trauma
53
tx spinal trauma
glucocorticoids
54
LOSS of pain and temperature cape like
syringomyelia
55
big syringomyelia
LOSS of lateral corticospinal= LMN
56
BIGGEST syringomyelia
LOSS of hypothalamospinal= PAM
57
most accurate dx of syringomyelia
MRI
58
tx syringomyelia
- sx: tumor
| - drainage fluid
59
moa brain abscess
CONTINGUOUS-- sinusitis, mastoiditis or
| BSI-- anything that causes BSI-- pneumonia, endocarditis
60
best initial test for brain abscess
CT or MRI
61
most accurate test for brain abscess
BIOPSY-- determine organism
62
CSF for brain abscess
not helpful
63
LP for brain abscess
NOOOO contraindicated
64
edema and contrast enhancement on CT
- tumor
- infection
CANNOT TELL THE DIFFERENCE
65
empiric tx brain abscess
penicillin + metro + ceftriaxone (or cefepime)
66
intention and exertion tremor
BET
67
BET improves with
alcohol
68
BET tx
propanolol
69
MCC parkinsonism
idiopathic
70
mild parkinson disease tx
- anticholinergics
| - amantadine
71
anticholinergics in PD
- benztropine
- trihexyphenidyl
Tremor and Rigidity
72
older patient intolerant of anticholinergics for PD
AMANTADINE
73
severe parkinson disease tx
- dopamine agonists
- L-dopa/carbidopa
- COMT inhibitors
- MAO inhibirotrs
- deep brain stimulation
74
dopamine agonists for PD
BEST INITIAL tx
75
L-dopa/carbidopa for PD
most effective
| ON/OFF
76
COMT inhibitors for PD
extend duration of L-dopa/Carbidopa by blocking the metabolism of dopamine
77
MAO inhibitors for PD
single or adjunct
block metabolism of dopamine
POSSIBLY SLOW the progression
78
deep brain stimulation for PD
Tremor and Rigidity
79
only PD med that possibly slows the progression
MAO inhibitors
80
severe PD presenting with psychosis
tx= antipsychotics
| psychosis is secondary to the PD treatment
81
parkinsonism + orthostasis
Shy Drager syndrome
82
tx spasticity
- baclofen
- dantrolene
- TIZANADINE
83
RLS a/w
fe deficiency anaemia
84
RLA tx
dopamine agonist
| - pramipexole
85
3M's of huntingtons
Mood
Movement
Memory
86
dx HD
GENETIC TEST
87
tx dyskinesia in HD
tetrabenazine
88
psychosis tx in HD
- haloperidol
| - quetiapine
89
imaging HD
CT/MRI-- caudate nucleus involvement
90
sexual function MS
generally intact
91
best initial test MS
MRI
92
most accurate test MS
MRI
93
oligoclonal bands MS
only found in 85%;
| correct answer if equivocal or non diagnostic MRI
94
visual and auditory evoked potentials for MS
WRONG WRONG WRONG WRONG WRONG ANSWER
95
steroids in MS
shorten duration of exacrerbation
96
natalizumab
alpha 4 integrin inhibitor
| ---> PML
97
best initial MS relapse prevention meds
- beta interferon
| - glatiramer
98
poor prognosis ALS
weak cough and swallowing
99
dx of ALS
electromyography
100
riluzole ALS
reduced glutamate buildup in neurons
| MAY prevent progression of disease
101
tx ALS spasticity
baclofen
102
other tx for ALS
- CPAP
- BiPAP
- tracheostomy and maintenance ventilator
since MCC death= resp failure
103
CMT=
UMN + LMN + PES CAVUS
104
mcc peripheral neuropathy
diabetes
105
peripheral diabetic neuropathy young
TCAs
106
peripheral diabetic neuropathy older
pregabalin
| gabapentin
107
risk factors for lateral cutaneous nerve of thigh
- obesity
- pregnancy
- sitting with crossed legs
108
worsening pain with waling, pain/numbness in ankle and sole of foot
TIBIAL NERVE--> tarsal tunnel syndrome
109
random risk factor for peroneal palsy
HIGH BOOTS
110
two additional things for facial nerve palsy
- hyperaccusis
| - taste disturbances
111
dx test for facial nerve palsy
NO TEST
112
complication of facial nerve palsy
CORNEAL ULCERATION
113
what nerves does GBS affect
peripheral nerves
114
most specific test for GBS
nerve conduction studies/ electromyography
115
CSF in GBS
INCREASED protein with
| normal cell count
116
treatment of GBS
- IVIG
or
- plasmapharesis
117
wrong answers for tx of GBS
prednisone
| plasmapharesis AND IVIG
118
LFT's GBS
DECREASE- FVC
| DECREASE- peak inspiratory pressure
119
pupils in mg
NORMAL
120
best initial test for MG
- AChR antibodies; if without--> anti-MUSK
121
other test for MG, NOT done anymore in canada
edrophonium test
122
most accurate test for MG
electromyography-- decreased strength with repetitive stimulation
123
imaging for MG
CHEST- CT with contrast OR MRI
| ---> thymoma
124
best initial tx MG
neostigmine or pyridostigmine
125
if tx fails in MG
T CELL SUPPRESSION
- less than 60--> thymectomy
- greater than 60--> prednisone, then imunosuppresants
126
acute myasthenia crisis tx
- IVIG OR
| plasmaphresis
127
diffuse symmetrical atrophy on MRI
- AZD
- chronic alcoholism
- untx HIV
128
CSF findings for CJD
14-3-3 protein
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