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Step III
Step III - Neuro 4
| Question | Answer |
|---|---|
| What is the tx for listeria meningitis | Ceftriaxone + vanc and add ampicillin |
| Adolescent, military, terminal complement deficiency pt who has meningitis. Etio | Neisseria |
| Prophylactic tx for Neisseria meningitis contacts | Respiratory isolation for pt, rifampin/cipro for close contacts (anyone who possibly shares saliva w/ pt), none needed for medical staff/classmates/co-workers |
| Pt w/ fever and confusion over several hours | Encephalitis |
| MCC encephalitis | Herpes (pt does not have to have prior herpes infection) |
| What is the best initial test for encephalitis | CT head |
| Most accurate test for encephalitis | PCR CSF |
| What is the best initial tx for encephalitis | Acyclovir |
| Tx for encephalitis if acyclovir fails | Foscarnet |
| Fever, HA, focal deficits | Brain abscess |
| Brain abscess tx in HIV (-) pt | brain bx |
| Brain abscess tx in HIV(+) pt and etio | Toxoplasmosis; pyrimethamine + sulfadiazine x2wks then repeat CT head |
| Which brain lesion in HIV pt does not show ring enhancement and mass effect | PML |
| Tx for PML | None; raise CD count and disease goes away |
| Pt from Mexico w/ seizure | Neurocysticercsosis |
| What is the best initial tx for Neurocysticercsosis and what does it show | Head CT showing MULTIPLE 1cm cystic lesions +/- calcifications |
| Most accurate test for Neurocysticercsosis | Serology |
| Tx for Neurocysticercsosis | Albendazole + steroids |
| Pt c/o sudden HA, photophobia, stiff neck, LOC, no fever, focal deficits | SAH |
| What is the best initial tx for SAH | Head CT w/o (LP if CT shows no blood) |
| Most accurate test for SAH | LP |
| Leukocytosis can be elevated in intracranial bleeds as well as infections. How do you tell the difference | nL ratioof WBC: RBC = 1:500; if incr = infection |
| Tx for SAH | Angio to det location of bleed then surgical clip/Embolization to stop bleed. If hydrocephalus do ventric. Add PO nimodipine (CCB) to prevent stroke |
| Spine dx where location is nontender | LS strain |
| Spine dx where tender | Cord compression |
| Spine dx where tender + fever | Epidural abscess |
| Spine dx where pain w/ walking DOWNHILL | Spinal stenosis |
| What are the etio of syringomyelia | Trauma, tumor, congenital abnLs |
| Pt c/o capelike distribution loss of sensory and pain and temperature @ UE | Syringomyelia |
| Diagnostic study for syringomyelia | MRI |
| Tx for syringomyelia | Surgery |
| What is the best initial test for cord compression | MRI |
| Most accurate test for cord compression | Bx |
| What is the best initial tx for cord compression | Steroids |
| How is spinal stenosis and PAD similar and different | Same CC pain w/ walking; different where spinal stenosis pulses are INTACT |
| What neurological loss is found in ant cerebral aa infarcrion | Everything EXCEPT position and vibratory sense |
| Trauma to spine, ipsilat loss of position, vibratory sense, contralat loss of pain and temperature | Brown sequard |
| Idiopathic dz of BOTH UMN and LNM | ALS |
| Tx for ALS and MOA | Riluzole (-) accumulation of glutamate |
| Weakness is a sign of UMN or LMN lesion | BOTH |
| Spasticity is LMN or UMN | UMN |
| Fasciculations is UMN or LMN | LMN |
| Tx for diabetic peri neuropathy | Gabapentin/pregablin |
| What is the best initial tx for carpal tunnel | Splint |
| Tx for carpal tunnel after splint | Steroid injection |
| Wrist drop = what nerve palsy | Radial |
| Foot drop and inability to EVERT foot = what nerve palsy | Peroneal |
| What is the sensory presentation of Bell’s palsy | Facial hemiparesis upper and lower; loss of taste anterior 2/3 tongue, hyperaccusis, can’t close eyes at night |
| Etio of Bells palsy | Viral |
| Tx for Bell’s palsy | Acyclovir/valacyclovir + steroids |
| Pt had prior trauma/injury to ext. now c/o burning sensation w/ slightest touch to ext. Dx and tx | Chr pain syndrome aka regional sympathetic dystrophy; NSAIDs, gabapentin OR surgical sympathectomy |
| Tx for RLS | Ropinerole OR pramipexole |
| Most URGENT step in pt suspect of Guillain Barre and why | Peak inspiratory pressure (weakened diaphragmn as dz ascends, tells you if pt will have respiratory failure before it happens |
| Weakness w/ chewing/eating, droopy eye as day progresses | MG |
| What is the best initial tx for MG | Ach-R AB |
| Most accurate test for MG | clinical picture + Ach-R AB (more so than tensilon/edrophonium according to Kaplan) |
| What is the best initial tx for MG | pyridostigmine or neostigmine |
| Tx for MG is initial Rx does not work | Thymectomy in pt <60yo |
| Tx for MG if surgery and RX does not work | Prednisone |
| What is used to keep pt off steroids in MG | azathioprine and cyclosporine |
Created by:
DrINFJ
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