Neurology 1

Question 1

simple and complex partial seizures; and secondary generalized

Answer 1

carbamazepine (tegretol)- drug of choice
also: 
topirmate (topramax)- one associated w/ weight loss
phenobarbitol
lamictal

Question 2

drugs for tonic clonic

Answer 2

carbazepine (tegretol) used first line or with dilantin(phenetoin)
Lamotrigine (Lamictal) (add on)
Gabapentin (Neurontin) (adjunct)
Phenobarbital

Question 3

absence seizures

Answer 3

Ethosiximide (Zarontin) – first line
Valproic acid (Valproate, Depakote)
Preferred if patient has concurrent tonic/clonic
Lamotrigine (Lamictal)

Question 4

myoclonic seizure

Answer 4

Gabapentin (Neurontin)

Lamotrigine (Lamictal)

Question 5

myoclonic and tonic

Answer 5

Valproic Acid  (Valproate, Depakote)
Clonazepam (Klonopin)

Question 6

Levetiracetam (Keppra)

Answer 6

generalized or focal seizures
dose 1000-3000 mg qd or bid
steady state achieved in 2 days
side effects: 
Somnolence
Ataxia
Headache
Behavioral Changes

Question 7

Carbamazepine (Tegretol):

Answer 7

inhibits Na channels which inhibits release of NorEpi
800-1200 mg (start at 200 mg bid)
monitor cbc, lft
Warnings: Serious and sometimes fatal dermatologic reactions to include toxic epidermal necrolysis (TEN) and Stevens-Johnson Syndrome (SJS)

Question 8

phenytoin(dilantin)

Answer 8

Alters Na+, K+ and Ca2+ conductance, membrane potentials
300-400 mg
IV dilantin pt must be on cardiac monitor
Warning: Cardiovascular risk associated with rapid infusion
side effects: Gingival hypertrophy, hirsutism, coarsened facial features, megaloblastic anemia

Question 9

Valproic Acid (Depakote

Answer 9

increases gaba

WARNING: Life threatening adverse reactions. Hepatotoxicity

Question 10

Lamotrigine (Lamictal)

Answer 10

250 mg bid

Effective in the treatment of children with newly diagnosed absence seizures.

Question 11

Gabapentin (Neurontin):

Answer 11

300 -1200 mg po tid

side effects somnolence

Question 12

Topiramate (Topramax):

Answer 12

Start at 25 mg/day and then taper up for 6 weeks for up to 400 mg
this is the one that ppl come in for weight loss

Question 13

what drugs need to check lft

Answer 13

valproic acid, carbamazepine or felobamate

Question 14

status epileticus

Answer 14

give thiamine in case of alcoholics
D50W- 25-50 mL in case hypoglycemia
midazolam 2.5 mg IM or 5 mg IV or diazepam 10 mg IV
need to get phenetoin in quick cause those are only short term meds 18-20 mg (need cardiac monitoring for phenytoin)
if seizure continue
Phenobarbital: loading dose of 10-20mg/kg IV by slow or intermittent injection (50mg/min)
Respiratory depression and hypotension common

Question 15

Atarax (Hydroxyzine

Answer 15

sleep med
10-25 mg qHs
Contraindications:  
Pregnancy
Seizure disorder
Liver disease
Kidney disease
Side Effects:  tremors, confusion, seizures,

Question 16

Lunesta (Eszopiclone)

Answer 16

Dose:
2-3 mg po immediately before bed
1mg po qhs for elderly
Contraindicated:
Alcohol or CNS depressant use
History of substance abuse
Pregnancy Category C

Question 17

Rozerem (Ramelteon)

Answer 17

melatonin agonist

8mg po 30 mins prior to bedtime on empty stomach

Question 18

yore’s first line sleep med

Answer 18

melatonin

atarax (hydroxyzine)

Question 19

what does narcolepsy have low levels of

Answer 19

hypocretin

this promotes wakefulness

Question 20

multiple sleep latency

Answer 20

sleep disorder diagnostic tool. It is used to measure the time elapsed from the start of a daytime nap period to the first signs of sleep called sleep latency. The test is based on the idea that the sleepier people are, the faster they will fall asleep.

Question 21

meds for narcolepsy

Answer 21

modafinil (provigil)-1st line tx
armodafinil (nuvigil)
ritalin

Question 22

polysomnography

Answer 22

comprehensive recording of the biophysiological changes that occur during sleep. Includes EEG, eye movements (EOG) muscle activity (EMG) and heart rhythm (ECG), leg movement, tracheal noise, pulse oximetry, end tidal co2

Question 23

hallmark of Alzheimer’s

Answer 23

Amyloid-rich senile plaques
Neurofibrillary tangles
Neuronal degeneration

Question 24

most common cause of death in alzhemirs

Answer 24

aspiration pneumonia

infected decubital ulceratons

Question 25

meds for alzhemiers

Answer 25

``` cholinesterase inhibitors increase levels of Ach Donepezil (Aricept) 5 mg po at bedtime Rivastigmine (Exelon)‏ - 4.6mg/24hrs (max 9.5) Galantamine (Reminyl) NMDA receptor antagonist (mod to severe) decreases glutamate Memantine (Namenda)‏ (5mg po qday) ```

Question 26

criteria for vascular dementia

Answer 26

Cerebrovascular disease evident on history, examination and/or imaging. Along with: Onset of dementia within 3 months or (rapid onset) Abrupt, fluctuating or stepwise progression in dementia

Question 27

picks disease

Answer 27

subtype of frontal temporal dementia Characterized pathologically by the presence of Pick bodies (silver staining intracytoplasmic inclusions) in the neocortex and hippocampus.

Question 28

frontaltemporal dementia

Answer 28

personality changes preservation (say same phrases over and over) mutuism (inability to speak) • Insidious onset and gradual progression• Early decline in social/interpersonal conduct• Early impairment in personal conduct• Early loss of insight• Early emotional blunting

Question 29

normal pressure hydrocephalus

Answer 29

wet wacky wobbly can use miller fisher test (gait assessment before and after removal of 30 cc of CSF)

Question 30

lewy bodies dementia

Answer 30

Characterized by dementia accompanied by delirium, visual hallucinations, and parkinsonism. Other common symptoms include syncope, falls, sleep disorders, and depression.

Question 31

how to diagnosis lewy body

Answer 31

The central feature required for a diagnosis of DLB is progressive cognitive decline of sufficient magnitude to interfere with normal social or occupational function. Two of the following core features are essential for a diagnosis of probable DLB, and one is essential for possible DLB. Fluctuating cognition with pronounced variations in attention and alertness. Recurrent visual hallucinations that are typically well formed and detailed. Spontaneous motor features of parkinsonism.

Question 32

cjd

Answer 32

Dementia with rapid onset and deterioration Motor deficits Seizures

Question 33

causes of delirium

Answer 33

``` I WATCH DEATH infections withdrawl acute metabolic trauma cps pathology hypoxia defeciencies endcrinopathies acute vascular toxins or drugs heavy metals ```

Question 34

tx of delirium

Answer 34

haloperidol (haldol) | associated w/ torsades de points and qt prolongation so monitor on cardiac monitor

Question 35

tx of choice for delirium from drug or alcohol withdrawl

Answer 35

benzodiazepine

Question 36

ct indications

Answer 36

``` Skull and skull base, vertebrae (trauma, bone lesions) Ventricles (hydrocephalus, shunt placement) Intracranial masses, mass effects (headache, N/V, visual symptoms, etc.) Hemorrhage, ischemia (stroke, mental status change) Calcification (lesion characterization) ```

Question 37

ct angio indications

Answer 37

``` Atherosclerosis Thromboembolism Vascular dissection Aneurysms Vascular Malformations Penetrating trauma Evaluation of carotids ```

Question 38

indications for mri

Answer 38

``` Subacute and Chronic hemorrages Cerebral Infarct Primary and Metastatic Brain Tumors Intracranial Abcess Multiple Sclerosis and other Demyelinating Diseases New onset or refractory seizures Vasculitis ```

Question 39

cerebral angiography

Answer 39

Cerebral angiography is the gold standard for imaging the carotid arteries and evaluating cerebral aneurysms after subarachnoid hemorrage

Question 40

etiologies of coma

Answer 40

``` TBI Hypoxic-ischemic encephalopathy (HIE) Is generally seen during code when it took to long and eventually heart started but the brain was w/out o2 for too long Drug overdose Intracranial hemorrhage CNS infections Brain tumors ```

Question 41

coma breathing patterns

Answer 41

Cheyne-stokes: cyclic pattern, hypernea & apnea—seen patients w/ bilateral hemispheric or diencephalic insults Hyperventilation: injury to pontine or midbrain tegmentum (also seen in ????) Apneustic breathing: prolonged pause end of inspiration—indicates lesions to mid- and caudal pons Ataxic breathing: irregular in rate an tidal volume—damage to medulla

Question 42

Weakness, numbness, tingling or unsteadiness in a limb

Answer 42

lhermittes sign | MS