PIMP Neurology

Question 1

Treatment for myasthenia crisis

Answer 1

• Steroids
• Mestinon
• Immunomodulators (azathiprine, cyclosporine, mycophenolate)
• IVIG
• Plasmapheresis
• Thymectomy

Question 2

Diagnostic tests for myasthenia gravis

Answer 2

1. Tensilon test
2. Anti acetylcholine receptor antibodies
3. Ice pack test

*EMG,, nerve conduction studies, head imaging

Question 3

what medications are concerning for causing confusion

Answer 3

Benzodiazepines
Narcotics
Anticholinergics
Antipsychotics
Sleep Aids

Question 4

most common cause of meningiits in adolescents and young adults

Answer 4

Young adults/adolescents: Neisseria meningitidis

Presentation: neck stiffness, fever, malaise, headache, purpuric rash or hemorrhagic rash almost always meningococcemia caused by disseminated infection

Question 5

most common adult brain tumor

Answer 5

meningioma

Question 6

window for tPA in acute stroke?

Answer 6

Window for ischemic stroke is 3 hours, but now may get tPA up to 4.5 hours unless:

> 80 years old
History of diabetes and stroke
On anticoagulation

Question 7

what imaging should be done for suspected stroke?

Answer 7

CT scan first: much faster than an MRI and will let you rue out a bleed very quickly

*If no bleed a CT angio is often done to visual vessel occlusions

Question 8

Most common origin site of epilectic partial seizures

Answer 8

temporal lobe

Question 9

what is diagnostic criteria for parkinson’ disease?

Answer 9

1. bradykinesia plus at least one other of

2. muscular rigidity, rest tremor, or postural instability

Question 10

what is the test for neuromyelitis optica (NMO)

Answer 10

aquaporin-4 IgG antibodies

Question 11

treatment for cluster headaches?

Answer 11

Broken down into abortive and prophylactic management

1. Abortive: 100% oxygen, sumatripan, dihydroergotamine
2. prophylactic: Ca channel blockers (verapamil), lithium, valproci acid, and topomax

Question 12

Important parts of seizure history?

Answer 12

HPI Stuff: first seizure, seizure frequency, longest seizure free period, aura, setting, triggers, semiology, post ictal period, associated manifestations like tongue biting, bowel or bladder incocontinence

PMH: febrile seizures, head trauma, CNS infections, lyme disase, CNS surgery, tumor, stroke, diabetes (hypoglycemia)

Social stuff: medications, alcohol use, sleeping pills, anxiety pills, sexual active/pregnant, driving

Question 13

what testing should be done in a patient with suspected guillaine barre syndrome

Answer 13

Lumbar puncture and CSF analysis should show albuminocytological dissociation (high protein, low cells)

EMG should show non-uniform demyleination and conduction block

Question 14

what tests can establish the diagnosis of lambert-eaton syndrome

Answer 14

diagnosis suggested by progressive wweakness, especially of lower extremeties, absent reflexes, and slight improvement with repeated use

confirmation is with serologic measurement of anti calcium channel antibodies and characteristici incremental EMG response

Question 15

what is todd’s paralysis

Answer 15

Postictal phenomena consisting of a focal neurological deficit that occurs after a seizure. usually occurs in the same limb affected by the seizure

Question 16

most common side effect of topomax?

Answer 16

Decreased conitive function such as forgetfulness, impaired memory and language deficiits

*Word finding difficulties

Question 17

Important labs for neuropathy

Answer 17

TSH and free T4
B12
Folate
Blood glucose
a1C
Vit E

Question 18

Difference be epidural and subdural hematoma

Answer 18

Epidural: middle meningeal artery, lucid interval, skull fractrure, lens shapes, no crossing suture lines

subdural: bridging veins, crescent shaped, slow onset, chronic mental changes, crosses suture lines, falls without fracture

Epidural are caused by ligation of the middle meningeal artery, thus they have high pressure.