question

hemorrhagic stroke, in hosp, day 4, repeat CT no more bleeding stable, DVT ppx?

answer

ok give sub q heparin b/c high risk dvt

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multiple sclerosis-related fatigue Tx?

answer

Amantadine and modafinil are used as symptomatic treatments of multiple sclerosis-related fatigue.

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Apraxia

answer

Apraxia is the inability to perform a previously learned skilled motor task despite intact motor and sensory systems, clear comprehension, and full cooperation. Apraxia involves a lesion of the dominant parietal lobe and is a defining clinical feature of Parkinson-plus syndromes; it may also be a presenting feature of a neurodegenerative disease, such as Alzheimer disease or corticobasal degeneration.

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ideomotor apraxia

answer

patient has a clear concept of the proposed action but cannot execute it

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topiramate and zonisamide SEx:

answer

Both topiramate and zonisamide are associated with an increased risk of calcium-containing kidney stones and thus should be avoided in patients with a history of such stones.

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normal pressure hydrocephalus (NPH) triad

answer

gait impairment, urinary incontinence, and cognitive change MRI 1st: see large ventricle then spinal tap and shunt

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pregnant women with migraine

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Acetaminophen, combined with metoclopramide or ondansetron for relief of the nausea and vomiting that can accompany migraine

question

tic disorder consisting of several motor tics when Tx: what Tx

answer

only when the disorder impairs a patient's social, academic, or occupational function or causes psychiatric comorbidities. Disabling and disruptive tics are treated with drugs that block dopamine receptors, such as: clonidine, pimozide, and haloperidol,

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postconcussion syndrome

answer

headache, fatigue, sleep disturbances, difficulties with concentration and memory, and emotional lability with an increased tendency for depression, anxiety, and irritability. MCC for military personnel

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Cryptogenic stroke

answer

ischemic strokes occur without a well-defined etiology and are labeled as cryptogenic the majority of ischemic strokes are due to cardioembolism, large vessel atherothromboembolism, small vessel occlusive disease, or other unusual mechanisms

question

Cryptogenic stroke w t d next

answer

prolong cardiac monitor due to 25% have Proximal Afib

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Restless legs syndrome

answer

common movement disorder Treatment with dopamine agonists or opiates can alleviate symptoms.

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The Romberg test

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test for ataxia and proprioceptive loss in which the patient stands with his or her feet together and eyes closed. If the patient sways or loses balance, the test is considered positive

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the best means to predict the risk of future falls in a patient with a history of backward falls.

answer

The pull test

question

juvenile myoclonic epilepsy

answer

infrequent convulsive seizures that are often provoked by alcohol or sleep deprivation.and can also experience absence seizures and myoclonic seizures that are worse in the morning.

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multiple sclerosis-related spasticity. Tx:

answer

Tizanidine, baclofen, and cyclobenzaprine all good

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neuroleptic malignant syndrome (NMS). MCC meds triger:

answer

Two MCC Drugs: haloperidol and fluphenazine central dopamine type 2 receptor blockade: pt present parkinsonism soon start or abrupt stop, but can start any time actually

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NMS present with

answer

hyperthermia diaphresis labile bp arrythmia muscle rigidity (parkinsonium, anti dopamine effect) seizure cognitive impair rhabdomyelisis

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NMS tx

answer

dopamine agonist bromocriptine can reverse the syndrome muscle relaxant dantrolene can inhibit the excessive muscle contractions Benzo for agitation

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serotonin syndrome

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confusion, myoclonus, shivering, and diaphoresis triggered by an overdose of serotoninergic medication or by the concurrent use of a serotonin reuptake inhibitor and a monoamine oxidase inhibitor.

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Malignant hyperthermia

answer

inherited skeletal muscle disorder characterized by a hypermetabolic state precipitated by exposure to volatile inhalational anesthetics (halothane, isoflurane, enflurane, desflurane, and sevoflurane) and the depolarizing muscle relaxants succinylcholine and decamethonium. Increased intracellular calcium leads to sustained muscle contractions with skeletal muscle rigidity, tachycardia, hypercarbia, hypertension, hyperthermia, tachypnea, and cardiac arrhythmias. Rhabdomyolysis and acute kidney injury can develop.

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partial and generalized epilepsy in elder pt 1st line Tx

answer

•Lamotrigine is a first-line drug for treating partial and generalized epilepsy that is well tolerated, has the highest rate of retention, and has the best efficacy among older patients.

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elderly recent car accident 4 day ago - LOC now mental cloudness, dizziness, neck and back muscle pain w t d next:

answer

CT head to r/o acute subdural hematomas s/o head trauma + cognitive impairment = need CT head

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posthypoxic (or postanoxic) myoclonus known as Lance-Adams syndrome

answer

powerful, shocklike muscle jerks; activation of symptoms with action or stimulation; and negative myoclonus MCC s/p cardiac arrest and delayed ROSC

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psychogenic nonepileptic seizures can be > 5min ddx with epileptic seizure mcc less than 5 min

answer

pt use to be refractory to multiple AEDs need in pt video EEG to capture the activity and to determine it is epileptic or non epileptic

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parkinsonism

answer

rigidity and bradykinesia, secondary signs, including a glabellar sign, increased saliva, facial masking, cramped handwriting, and decreased arm swing, hand writing became smaller and smaller

question

parkinsonism ddx:

answer

Parkinson's dz Wilson disease if young pt

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wilson disease

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failure of copper excretion in bile, which results in copper accumulation in the liver and brain Kayser-Fleischer ring and measurement of the serum ceruloplasmin level are the screening tests for Wilson disease

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azole, azithromycin, Protease Inhibitor

answer

block liver cyp450,increase statin toxi

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progressive supranuclear palsy the hallmarker is a kind of Parkinson-plus syndrome

answer

impairment of vertical eye movements, square wave jerks (couplets of inappropriate horizontal saccades), a supranuclear gaze paresis, facial dystonia, and axial rigidity. dementia, atremulous parkinsonism, and eye movement abnormalities over 2 years

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epidural spinal cord metastases with cord compression tx

answer

1st steroid 2nd surgery decompression better than radiation

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•Natalizumab is a disease-modifying therapy for multiple sclerosis SEx:

answer

central nervous system infection with the JC virus, resulting in progressive multifocal leukoencephalopathy. PML

question

•Tardive dystonia

answer

facial grimacing and akathisia, can be induced by dopamine receptor antagonists, such as metoclopramide and antipsychotic drugs. facial grimacing (a classic finding in tardive dyskinesia) and restlessness (akathisia) make the diagnosis of tardive dystonia certain

question

migraine prevention:

answer

amitriptyline, propranolol, timolol, divalproex sodium, and topiramate for migraine prevention.

question

transient ischemic attack

answer

ABCD2 scores (based on Age, Blood pressure, Clinical symptoms, Duration, and presence of Diabetes mellitus) are 3 or greater should be admitted to the hospital for evaluation

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compulsive behavioral syndrome of punding

answer

characterized by excessive, compulsive, repetitive complex activity that serves no essential purpose. Punding, like other compulsive or addictive behaviors (such as excessive gambling, shopping, Internet use, or hypersexual behavior), results from dysregulation of the brain's dopamine-dependent reward systems and can be caused by dopaminergic medication. The first step in treatment is usually a reduction of dopaminergic medication.

question

asian young seizure small meningeoma in ED what meds

answer

•In an Asian patient with the HLA-B*1502 allele, the risk of Stevens-Johnson syndrome is increased with exposure to carbamazepine, lamotrigine, oxcarbazepine, and phenytoin but not with exposure to levetiracetam(keppra)

question

diabetic amyotrophy

answer

a lumbar polyradiculopathy affecting primarily muscles of the thigh (L2 through L4 spinal levels) that classically presents with severe pain at onset followed by development of weakness and numbness over weeks to months.

question

main risk factors for rupture of cerebral aneurysms

answer

•The main risk factors for rupture of cerebral aneurysms are hypertension and tobacco use.

question

acute exacerbation of multiple sclerosis tx:

answer

•Intravenous methylprednisolone is an appropriate treatment of an acute exacerbation of multiple sclerosis.

question

dissection of the carotid artery

answer

Acute Neck Pain + Horner syndrome

question

lumbar plexus compression

answer

•In a patient with symptoms suggesting an acute L2-L4 lumbar plexopathy and painful hip extension (psoas sign), an abdominal CT scan is the most appropriate diagnostic test to rule out an iliopsoas hematoma.

question

interferon-beta therapy for MS SEx

answer

liver toxi need monitor LFTs q6 month

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spasmodic torticollis, a focal dystonia of the neck, and should be treated with

answer

botulinum toxin injections.

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•Trigeminal neuralgia Tx:

answer

first-line initial treatment is carbamazepine, with oxcarbazepine a reasonable alternative.

question

•Copper deficiency

answer

•Copper deficiency, which can be caused by zinc toxicity, nutritional deficiency, or malabsorption syndrome, can result in a myelopathy localizing to the posterior columns and bilateral corticospinal tracts.

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