neuro infections, normal neuro, stroke, degenerative neuro

Question 1

What is the ddx for priapism?

Answer 1

1. Neurologic injury: cauda equina, spinal cord injury
2. Medication side effect- trazadone, prazosin
3. Perineal/genital trauma leading to laceration of the cavernous artery
4. sickle cell or leukemia

Question 2

What is spinal artery syndrome?

Answer 2

affects the anterior cord- corticospinal tract, spinothalamic tract, ventral horn, lateral grey matter. dorsal columns are spared. pts have bilateral loss of pain and temperature, bilateral spastic paresis below the level of the lesion, bilateral flaccid paresis at the level of the lesion

Question 3

What is the prophylactic treatment for close contacts of patients with bacterial meningitis?

Answer 3

rifampin or ciprofloxacin for Neisseria infection. rifampin for for H. influenzae infection in kids without prior vaccination

Question 4

What kinds of viruses cause meningitis?

Answer 4

enterovirus, echovirus, HSV, lymphocytic choriomenigitis virus, mumps virus.

Question 5

How is TB meningitis treated?

Answer 5

isoniazid, ethambutol, pyrazinamide, rifampin

Question 6

How can you differentiate btw TB meningitis and bacterial meningitis based on LP findings?

Answer 6

typically, bacterial meningitis shows incr. WBCs with a preponderance of PMNs, while TB meningitis has incr. WBCs with a lymphocytic prepronderance. both have elevated opening pressures and protein levels, and decreased glucose

Question 7

What viruses most often cause viral encephalitis?

Answer 7

VZV, HSV, mumps, polio, rhabdovirus, coxsachie virus arbovirus, flavivirus (japanese encephalitis, West Nile), measles
or, immunologic response to viral infection

Question 8

What are characteristic sx of West Nile encephalitis?

Answer 8

flaccid paralysis with maculopapular rash

Question 9

What are key s/sx of rabies infection?

Answer 9

malaise, HA, restlessness, fear of water ingestion, CNS excitability, painful laryngeal spasms, alternating mania and stupor. On pathologic exam, there will be rabies virus and negri bodies (round eosinophilic inclusions found in neurons)

Question 10

What is the tx of TIA? Include info about when to do carotid endarterectomy or angioplasty

Answer 10

1. If d/t atherosclerosis, give ASA and statin
2. Carotid endarterctomy or angioplasty for carotid narrowing >60% in asymptomatic men, >50% in symptomatic men, and >70% in symptomatic women
3. BB, valvuloplasty, valve replacement for AS
4. anticoagulation for arrhtymias

Question 11

When do you anticoagulate after ischemic stroke? When can antiplatelet meds be restarted after hemorrhagic stroke?

Answer 11

• anticoagulate within 48 hrs of ischemic stroke; may give LMWH if suspected evolving stroke
• antiplatelet drugs may be started 2 wks after hemorrhagic stroke if pt is stable

Question 12

What systemic conditions are associated with berry aneurysms?

Answer 12

adult polycystic kidney disease and Marfan syndrome

Question 13

What drug can induce a syndrome that is similar to parkinson’s disease?

Answer 13

1-methyl1-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), a side product of illicit opioid production

Question 14

What enzyme is inhibited by carbidopa?

Answer 14

dopamine decarboxylase

Question 15

What is benztropine? What symptoms of parkinson disease are helped by benztropine?

Answer 15

anticholinergic used as adjuvant tx for Parkinson disease. helpful for tremor and rigidity but not bradykinesia

Question 16

What symptoms of parkinson disease are helped by amantadine?

Answer 16

rigidity and bradykinesia. this drug also used against infulenza A and rubella. toxicity can cause ataxia

Question 17

What are the DA receptor agonists?

Answer 17

bromocriptine (ergot), pramipexole, ropinirole (both non-ergot). Non-ergots are preferred

Question 18

What is the medical treatment for ALS? What is required for clinical dx of ALS?

Answer 18

riluzole. dx requires LMN signs in at least 2 extremities and UMN signs in one region. sensation usually not involved.

Question 19

Where is the gene for Huntington’s disease located and how many repeats are needed for the disease to manifest?

Answer 19

found on chromosome 4; if 40 or more CAG repeats, disease is inevitable

Question 20

What are tx options for MS?

Answer 20

steroids, methotrexate in acute exacerbation; interferon beta, glatiramer acetate (copaxone), natalizumab to decrease frequency of exacerbations.

Question 21

What is the mechanism of memantine?

Answer 21

NMDA receptor antagonist to prevent excitotoxicity

Question 22

What are contraindications and MOA of triptans for HA?

Answer 22

5-HT1b/1d agonist. however, may induce vasoconstriction, so is contraindicated in pts with CAD or Prinzmetal angina