MTB3- Neurology Flashcards by nioo salem

Fqirst step when you’re suspeciouse of TIA?

Head non-contrast CT Scan to R/o hemorrhagic stroke

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appraoch to TIA or stroke?

First step is to take a non contrast head CT to R/o hemorrhagic stroke. If it’s less than 3 hours start theombolytics , if it’s more than 3 hours then start ASA. If the patient is already on ASA switch to Clopidogrel or add Dipyridamole.
Statins for all the patients with non-hemorrhagic stroke.

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Contraindications to thrombolytic therapy?

mass or tumor - cerebral trauma or brain
Hx of hemorrhagic strokes Surgery within 6 months
Active bleeding or surgery within 6 weeks - Aortic dissection
bleeding disorder - CPR within 3 weeks
stroke within 1 year

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Ophtalmic A. Leision?

Amaurosis Fugas

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Tx of cluster headache?

Prophylaxis of cluster headache?

Triptanes + o2

Verapamil

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Charactristics of Pseudotumor cerebri?

pupilledema with NL CT n MRI, headache, double vision ( sixth nerve palsy) , pulsutile tinitus
Weight loss
Acetazolamide
surgery, if it’s not possible then shunt or optic nerve sheath fenestration

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How is the management of stroke after non- contrast CT and ASA or thrombolytics?

find the origine of the stroke:
echo to fanid vegetations or clot
ECG holter monitoring( if ECG is NL then Warfarin & dabigartan , Rivaroxaban for atrial fibrilation )
carotid dopler/ sono=> if there is more than 70 but less than 100 occulosion then end- Artherectomy
Always consider HTN, DM, Hyperlipidemia
if the patient is young then: ESR/ AnA / DS DNA/ protein c and s and factor v leiden and anti phospholipid syn. & VDRL/ RPR

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Lacunar stroke charactristics?

absence of cortical deficits - possible bulbar signs
Ataxia
Parkinsonian signs
Sensory deficit
Hemiparesis

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Pos. Inf. cerebral A leision:

Ipsilateral face
contralateral body
vertigo n horner

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Pos. Cerebral A. Leision?

Prosopagnosia( inability to recognise faces)

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Vertebrobasilar A leision?

1- Vertigo 6- Ataxia
2-Nausea n vomitting 7- bilateral findings
3- drop attack loss of conciousness 8- vertical nystagmus
4- dysarthria n dystonia
5- sensory changes in face and scalp

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Ant cerebral A leision?

profound lower extremity weakness
mild upper extremity weakness
urinary incontinence
Personality change

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Middle cerebral A leision?

upper extremities weakness
Aphasia
Apraxia/ Neglect
eyes deviate toward the leision
contralateral homonymous Hemianopia

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Treatmentof MILD Parkinson’s disease under 60 and over 60?

Under 60 => Benzotropine/Hydroxyzine

Over 60=> Amantadine

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1st and 2nd line for long term management of Parkinson?

1st line=> 1- valproic acid 2- Carbamazepine3- Phenytoin4- Levetiracetam 5- maybe Lamotrigine

2nd line=> Gabapantin / Phenobarbital

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What med to substitute for Levodopa when there is psychosis with levopdopa?

Quetiapine

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When parkinson meds are not effective which med to use?

COMPT inh. Tolcapone/ Entecapone

Mao inh. Selgiline/ Rasagiline

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Treatment of severe parkinsonism ?

1- Levodopa carbidopa

2- RPG=> Ropirinole/ pramopaxole/ carbergoline

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What is the best initial test to DX MS?
What is the most accurate test to DX MS?
Tx of MS?

MRI
MRI/ if not diagnostic then lumbar tap and oligoclonal bands
steroids/ b- interferone/ glatiramer/ mitoxantrone/ natalizumab/ fingolimod/ dalfapiridine

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Diagnostic test for NPH ?

Head CT

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What tests need to be done in a patient with memory loss?

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B12 level
thyroid function tests
head CT
VDRL or RPR

Side effect of Natalizumab?

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PML

What is Lewy body dementia?

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Parkinson+ dementia

CJD management?

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abnormal EEG
LP shows 14-3-3 pr
Brian Biopsy

Is there dementia in Pick disease? | Management of Huntington?

Yes | Antipsychotics/ tetrabenzain for movement disorders

What are the causes of Vertigo?

- BPPV : changes with position - Vestibular Neuritis : vertigo occurs without position changes - Labyrinthitis : Acute+ hearing loss - Menieres disease: Chronic+ hearing loss - Acoustic Neuroma: Ataxia+ hearing loss - perilymph fistula: hx of trauma + hearing loss

Tx of BBPV? Tx of Vestibular neuritis? Tx of Labyrinthitis?

- Meclizine ( Antivert ) - Meclizine - Steroids

DDX for vertigo solo!?

- BPPV ( Hallpike n Apply) | - Vestibular Neuritis ( Meclizine )

DDX for Vertigo + tinitus+ hearing loss?

``` Labyrintitis ( meclizine ) Menieres disease ( salt restriction n Diuretics) ```

Dx for Vertigo+ hearing loss+ tinitus + Ataxia?!

Acoustic Neuroma

Thousands of neurofils in csf?

Meningitis - start IV ceftriaxone/ Steroids/ Vancomycine

When cryptoccocus is the answer?

Hiv patient CD

Charactristics of rocky mountain spotted fever? | Tx for Rocky Mountain spotted fever?

Rash started from wrists and ankles. | Doxycycline

Tx for lyme disease?

IV ceftriaxone or Penicillin

Best initial test for encephalitis? | Most accurate test for encephalitis?

- Brain CT | - LP ( PCR of CSF)

Next step in genoccocal meningitis?

- Respiratory isolation and start prophylaxis with Rifampin, Cipro, ceftriaxone in people in close contact

How is the management of PML?

Because it's basically is in HIV positive patients , there is no specific TX other than raise CD4

DX of Neurocysticercosis? | Tx for Neurocysticercosis?

Patient comes from Mexico with Seizure. When the lesions are still active and there is no calcificationd Albendazole. When there are calcified and then only antiepileptics.

How is the management of large intracranial hemorrhage?

- hyperventilation by intubaion and decreasing Pco2 to 28-32 to have the brain vessles to be constricted - Manitol - Surgery

Mechanismof cycosporine and Azathioprine?

Idecrease the function of T lymphocytes

Best diagnostic test for myasthenia gravis? | Management of Myastenia gravis?

- Anti Acetyl cholin RS Antibody, if it's not charactristic then using Edrofonium and Tensilon test - Pyridostigmine and Neostigmine ---- noresponse? ------> Steroids Need long term steroids? ----------> Azathioprine and Cyclophosphamide

Tx of Diabetic Neuropathy?

Gabapantin/ pregabalin

TIA & Stroke?

- TIA takes less than 24 hours / stroke is more than 24 hours - TIA invloves the face and causes Aphasia - Stroke is more than 24 hours and has more seriouse consequences

Tx for spinal epidural abcess?

Most of the time it's staph and tx is Oxacillin or Naficillin.

Urgent step in cord compression management?

Steroids to decrease the pressure

Tx for proneal N palsy?

No Tx

Tx for Radial N Palsy?

Splint+ anti inflammatory meds

Tx for facial N palsy?

Steroids

Other locations involved in facial N palsy other than face?

- 2/3 ANT tongue | - ears( Hyperacusis )

What is reflex sypathetic Dystrophy?

Excruciating burning pain by light touch of the prevoiuse injured organ. NSAIDS/ Gabapantin/ Surgical Sypathectomy

MTB3- Neurology Flashcards

(50 cards)