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43 Cards in this Set
- Front
- Back
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Should pharmacotherapy be initiated in patient with an episode of unprovoked seizure?
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Quit answer is NO. Look at other risk factors, s.a. underlying neurologic causes, abnormal EEG.
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How do you treat menstrally related migraine?
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Evidence support the use of mefenamic acid for perimenstrual prophylasix. Start 2 days prior to the onset of flow, or 1 day prior to the expected onset of HA.
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Should pharmacotherapy be initiated in patient with an episode of unprovoked seizure?
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Quit answer is NO. Look at other risk factors, s.a. underlying neurologic causes, abnormal EEG.
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How do you treat menstraully related migraine?
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Evidence support the use of mefenamic acid for perimenstrual prophylasix. Start 2 days prior to the onset of flow, or 1 day prior to the expected onset of HA.
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After a single seizure, what factors has a greater risk for future seizures?
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Todd paralysis. status epilepticus on presentation, age >65 or abnormal findings.
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How do you treat epidural spinal cord compression?
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It required immediate therapy with IV corticosteroids follow by decompressive surgery and radiation therapy.
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What are the presenting signs of intracerebral hemorrhage?
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Classic presentation of sudden onset of neurologic deficit with symptomatic progression of sx over min to hours. s.a. HA, vomiting, HTN and impaired LOC.
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What are the dx imaging for pt with suspected intracerebral hemorrhage?
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The definitive diagnostic study is CT or MRI.
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What are the presenting signs of ischemic stroke?
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severe focal neurologic dysfunction but generally does not worsen as rapidly as in pt with intracerebral hemorrhage.
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What is Lambert-Eaton myasthenic syndrome?
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Is a neuromuscular junction d/o caused by calcium channel on the presynaptic nerve. In most pt, antibody to the P/Q-type calcium channel receptor.
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What is Myasthenia gravis?
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It is an autoimmune d/o that has antibody against the acetylcholine receptor, resulting in neuromuscular transmission failure.
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What are some of the signs of Myasthenia gravis?
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ptosis, blurred vision or diplopia, dysphagia. Dx by EMG, repetitive nerve stimulation.
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What is used to treat mild Alzheimer disease?
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MMSE 21-25, use acetylcholinesterase inhibitor such as; donepezil, rivastigmine, and galantamine.
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What is used to treat moderate to severe Alzheimer disease?
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MMSE <20. use Memantine. can be use alone or together with an acetylcholinesterase inhibitor.
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What test you should use in evaluating trigeminal neuralgia?
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MRI of the brain.
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How do you treat myasthenic crisis?
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Plasma exchange. Myasthenic crisis is characterized by severe muscle weakness, enough to intubate.
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What type of HA is common in the outpatient setting?
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approx 90% have migraine in the outpt setting.
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What is the sx of partial seizure with 2nd generalization?
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sensory, motor, autonomic or psychic phenomena w/wo altered awareness followed by generalized tonic clonic activity.
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What is the management of thunderclap HA?
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Its a potential neurologic emergency. Require urgent imaging either MRA or CT angiography after NCCT for bleed.
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what are the sx/sx of multiple system atrophy?
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It is a sporadic heterogeneous, neurodegenerative disorder; impairment in autonomic system, extrapyramidal and cerebellum systems
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What is the management of nonconvulsive status epilepticus?
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Continuous EEG.
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How to treat acute dystonic reaction?
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acute dystonic reaction: torticollic, buccolingula or opisthotonic (trunk or entire body spasms). Meds that block dopamine receptors s.a. prochlorperazine. Tx is with benztropine or diphenhydramine.
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How to treat acute carotid dissection?
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acute carotid dissection: unilateral HA with Horner syndrome. Treatment is heparin.
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How do you treat fatigue related to MS?
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Adequate rest and exercise can help. Amantadine has showed in some studies to reduce MS associated fatigue.
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How do you treat migraine during pregnancy?
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Metoclopramide is category B. shown to be effective.
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How to treat functional decline in pt with advance Alzheimer disease?
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NMDA receptor antagonist; Memantine is the 1st line tx.
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what is the treatment for primary progressive multiple sclerosis?
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No treatment have been shown to be effective. There for physical therapy may be use to alleviate some sx.
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What is paroxysmal hemicrania?
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one of the trigeminal autonomic HAs. 1st division of CNV, sx; lacrimination and rhinorrhea, intermittent duration and episode frequency.
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What is the treatment for essential tremors?
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first line medication include propranolol, primidone, gabapentin, and topiramate.
clonazepam is considered 2nd line for refractory essential tremors. |
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How to treat epileptic patients with liver disease?
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Avoid hepatically metabolized meds. Levetiracetam, gabapentin and pregabalin can be used.
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What are some sx of Lewy body dementia?
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Dream-enactment behavior, cognitive decline, parkinsonism and visual hallucinations. May also have orthostatic hypotension,
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What is the treatment for paroxysmal hemicrania?
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Indomethacin
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What is the treatment for perioperative stroke?
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intra-artrerial clot extraction. Because rtPA is contraindicated in recent (within 14 days) surgical patients.
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What is the initial treatment for idiopathic intracranial hypertension?
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Acetazolamide is the first choice in patient without visual field acuity impairment.
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What is the BP goal in stroke patients who have received rtPA?
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SBP below 180 and DBP <105 for 24 hrs after rtPA treatment. IV labetalol or nicardipine are the first line.
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What is Bell's Palsy?
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reflexive rolling upwards of the globe during eye closure, selective paralysis of he orbicularis oculi due to a facial neuropathy.
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What is the treatment of Parkinson dz in younger pt? <65
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dopamine agonist; pramipexole or ropinirole as the initial tx
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What is the treatment of Parkinson dz in older pt? >65
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Levodopa, a precursor of dopamine.
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What is use of OCP in women with migraine with aura?
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The use of OCP is contraindicated in women with migraine with aura. (ACOG)
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What is neuromyelitis optica (NMO)?
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Severe demyelinating disease of CNS, distinct from from MS. Should be tested for NMO-IgG antibody. NMO involves multiple levels, where as MS involves one segment.
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How do you manage medically refractory partial epilesy?
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referral to epilepsy surgery
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What is the most imminent danger after subarachnoid hemorrhage?
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Rebleeding
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What medication is/are use for treating lactating women with migraine who is not responding to OTC meds?
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frovatriptan/sumatriptan.
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