-
antiobiotic coverage for neonatal meningitis?
-
Antibiotic coverage for adult meningitis?
-
antibiotic coverage for elderly meningitis?
-
When do you do a ct scan before a lp ?
- cases of elevated ICP:
- focal neurological defect- seizure/motor defect
- papilledema--elevation of optic disc
- hematoma
- brain tumor
- bleeding diathesis
- cardiopulmonary instability
-
-
Rx for fungal meningitis?
intrathecal
-
Stain for cryptococcal meningitis?
india ink
-
what are teh picorna viruses?
- polio
- echo
- rhino
- coxsackie
- hav
-
Test for West nile virus?
IgM
-
Rbc in csf without history of trauma?
HSV encephalitis
-
meningitis + change in mental status?
encephalitis
-
Rye syndrome?
Hepatoencephalitis
-
Test to rule out Brain Abcsess?
MRI
-
3 examples where steroids are given to decrease inflammation?
- meningitis
- brain abcess
- pcp
-
From where would you isolate the polio virus?
-
What drugs are contraindicated in migraines with auras?
OCP
-
Cluster headache treatment?
100% oxygen
-
migraine headhache prophylaxis?
- ccb
- bb
- anti depressants tca
-
What drug has less anti- ach effect?
- nortryptilline
- amitryptilline has more anti-ach effect
-
Tyramine causes these types of headaches?
migraines
-
what type of headache would an obese woman with papilledemia have?
pseudotumor cerebri
-
headache and extraocular muscle palsy
cavernous sinus thrombosis
-
headache after sex?
post coital cephalagia
-
Diagnostic pseudotumor cerebri?
- csf pressure more than 200 mmHg
- exclusion of masses with CT or MRI
-
Pseudotumor cerebri inciting agebnts?
- vit a excess
- corticosteroid withdrawal
- tetracycline
-
Rx for PTC?
- acetazolamide
- serial lumbar punctures
- csf shunt to the peritoneum
-
Trigeminal neuralgia Rx
carbamezapine
-
headache worse with bending over?
sinus headache
-
sequale for post meningitis?
- hearing loss
- mental retardtion
- seuizures
-
In which hematoma can you perform an LP?
Subarachnoid hematoma
-
In which brain hemorrhage do you prophylax against seizures?
parenchymal
-
-
Which drugs lower the seizure threshold?
- Buproprion
- Tramadol
- INH
- Imipenem
-
What seizure has the 3 cycle/sec spike and wave pattern?
absence--ethosoxuamide
-
1st line for tonic clonic?
- valproate
- phenytoin
- carbamezapine
-
1st line for absence?
2nd line?
-
1st line for status epilecpticus?
-
stevens johnson syndrome
- lamotrigenie
- phenobarbital
- phenytoin
- antibiotics- sulfa, penicillins
- allopurionl
-
what 2 anticonvulsants cause blood dyscrasia?
- carbamezapine
- ethosuxamide
-
what 3 conditions cause a cherry red spot in the eye?
- retinal artery occlusion
- nieman picks
- tay sachs
-
what 2 anticonvulsants cause folate deficiency?
- carbamezapine
- valproic acid
-
high alpha feto protein?
- ntb
- gastroschisis
- omphaloccele
-
low alpha feto protein?
down syndrome
-
What is the pharmacologic treatment for Cerebral palsy motor movements/
- muscle relaxants---
- dantrolene
- baclofen
- botulinum toxin
-
BP medications in ischemic stroke?
- labetalol
- nicardapine
- no nitroprossuide
- ni nitroglycerin
-
hemorrhagic stroke bp goals?
- >140
- labetalol
- nitroprosside
-
sah meds and bp goals?
- 140
- labetalol
- nimodipine
- no nitroprosside
- no nitroglycerin
-
toxicity of TCA?
- coma
- convulsions
- cardiotoxicity
- anticholinergic effects
-
Rx for CV toxicity caused by TCA?
NaHCO3
-
LIthium causing nephrogenic DI?
- HTC--any nephrogenic DI
- Amilioride--lithium
-
what is acute dystonia?
tardive dyskinesia?
- torticollis rx--anti cholinderic--benztropine
- tardive dyskinesia--repetitive facial movemnts--grimacing--change to low potency or atypical
-
what are low potency anti psychotics?
- thioridazine
- chlorpromazine
-
What illegal street drug can cause parkinsons?
MPTP--side product in the production of meperidine(opiod)
-
MAO B inhibitor for parksinons?
selegiline
-
Ergot dopamine agonist/>?
bromocriptine
-
used as a rescue drug for sudden akinetic episode?
apomorphine
-
non ergot dopamine agonists/?
- bromocriptine
- ropenirole
- rotigotine
-
-
antimuscarinic used in parkinsons for tremor?
- trihexphenydyl
- benztropine
-
used in mild parkinsons disease and increases dopamine release
amantadine
-
Presentation of ALS?
- 80% assymmetric weakness of hands, shoulder, pelvic girdlses
- 20%-dysarthia, dysphagia
-
Drug for ALS?
Riluzole--decreases glutamate excitatory toxicity
-
Rx for huntington?
tetrabenazine and other neuroleptics for the chorea movements
-
What do you seen in dementia caused by picks disease?
- personality changes- innappropriate behavior
- frontotemporal
-
lewy body dementia?
- parkinsoniona symptoms
- + dementia
- visual hallucinations
-
WHAT ARE the drugs for alzheimers?
- memantine--NMDA receptor antagoinst
- donepezil
- rivastigimne, galantamien
-
What causes bilateral bells palsy?
-
Albuminocytologic dissociation is seen where?
GBS
-
Rx for GBS?
- plamapharesis
- IV immnoglobuin
-
Deep brain stimulation works how for parkinsons?
inactivates thalamus..the inhbitor of movement
-
best initial step in ruling out a fatal cause of a headache?
- tumor with focal neurological findings-- ct
- sah-- ct
- Temporal Arteritis-- steroids
-
how does sah present?
like sudden meningitis with 50% of people loosing consciesness
-
what pft test determines who should go to the icu?
fvc
-
best initial rx for gbs?
ivig
-
which is more efficacious, ivig or plasmapharesis?
equal
-
does combining ivig and plasmapharesis make a difference?
no difference
-
best initial test for gbs?
most accurate test for gbs?
-
how are affected eyes in mg?
- ptosis
- extraocular muscles
-
eaten lambert syndrome is associated with what malignancy?
small cell carcinoma
-
what antibiotics block neuromuscular transmission and resembles mg?
aminoglycosides
-
best initial test for mg?
ach ab test
-
alternative best initial test for mg?
endrophonium-tensilon test
-
most accurate test for mg?
emg
-
initial rx for mg?
pyridostigmine or neostigmine
-
if pyridostigmine and neostigmine dont work, next best step?
if that step doesnt work?
- thymectomy if <60 or beyond puberty
- steroids
- azathiprine
- cyclosporine
- cyclophosphamide
-
if respiratory symptoms present in mg , what do u do?
-
most accurate test for lambert eaton syndrome?
emg studies
-
-
best initial and accurate test for ms?
mri
-
if mri is inconclusive for ms, what is the best step?
oligoclonal bands
-
rx for acute severe ms?
steroids
-
disesae modifiying drugs in ms?
-
bladder hyperactivity rx?
oxybutinin
-
rx for urinary retention?
bethenachol
-
dementia vs delirium?
delirium is lack of sensory
-
-
-
lewy body dementia?
dementia + parkinsons symptoms
-
picks dz?
- social appropriatness
- and then
- memory
-
how does CJD presetn?
- rapid progression of dementia to death
- myoclonus jerks
-
most accurate test for cjd?
csf fluid showing 14-3-3
-
which dementia has hallucinations?
lewy body dementia
-
rx for alzeheimrs?
- donepezil
- rivastigmine
- galantamine
-
drug for mild parkinsons <60 yo and >60?
- <60 benztropine
- >60 amantadine
-
rx for severe parkinsons<60 and
>60?
levidopa and carbidopa <60
-
side effect of levi and carbidopa?
on and off effect
-
when do u use comt inhibitors?
with levi and carbidopa, otherwise you dont
-
difference between levidopa nand pramipexole and bromocriptine?
levidopa is more potent
-
benign essential tremor vs parkinsons tremor?
bst--resting and movement tremor
-
cereberllar treomr?
occurs wtih action
-
rx for restless leg syndrome
-
next best test in a galactorrhea?
-
causes of hyperprolactinemia?
- hypothyroid
- cimetidine
- dopamine blockers
- adenoma of the pituitary
- pregnancy
-
drugs that decrease size of a prolactinoma and decrease prolactin?
-
what gives the bilateral carpal tunnel syndrome?
pituitary gh overproduction from an adenoma
-
dx for giganistims or acromegaly?
igf or somatomedins
-
most accurate test for gigantism?
mri
-
best initial test for pituitary adenomas?
altered hormone levels
-
rx for gigantism adenoma?
- octeotride
- dopamine agonists
-
dopamine agonists downregulate what pituatiry tumores?
- prolactinoma
- gh releasing adenoma
-
cause of hypopituitarism?
craniopharyngioma
-
dx of hypopituatirism?
low gh level after hypoglycemia or arginine stimulation
-
causes of hypopituatirism?
- axis severance
- tuberculosis
- sarcoidosis
-
pituitary apoplexy?
necrosis of the pituitary from an adenoma that wasnt treated completely
-
signs of meningitis with a prior pituitary adenoma?
pituitary apoplexy
-
sheehan syndrome?
necrosis of the pituitary
-
when is empty sella syndrome found?
when a ct is performed for other reason and it is an incidental finding
-
nephrogenic di?
- demeclocycline
- lithium
- hypercalcemia
-
causes of central di?
- infiltrative lesions
- malignancy
- sarcoid
- tuberculiod
-
rx for central di?
desmopressin intranasally
-
consider what in euvolemic hypnatremia?
SIADH
-
causes of siadh
- pulmonary diseases
- cns disease
- chlorpropramide
- vincristine
- vinblastine
- sertraline
-
rx for siadh?
- water restriction
- demeclocycline
-
severe confusion with hyponatremia rx?
hypertonic saline--the only time this is the rx
-
dx of primary hyperparathyrodism?
high pth
-
when is sx the answer for primary hyperparathyrodism?
-
3 causes of hypocalcemia?
- primary hypoparathyrodism
- hypomagnessemia
- vit d deficiency due to various conditions
-
why is magnesium needed to maintain normal calcium level?
- need mg to release pth
- need mg for osteoclasts to act normally
-
ekg finding with hypcalcemia?
ekg finiding with hypercalcemia?
-
how do you work up for hypocalcemia?
- look at phosphate if high then low pth--primary hypoparathyrodism
- if phosphate is low..then secondary hypoparathyrodism--vit d deficiency
look at magnesium
-
acute management for hypocalcemia?
- calcium gluconate iv
- then
- oral calcium
-
when do you look for vascular disease in type I diabetes and type II diabetes?
- type 1---5 years after the dx
- type 2---right away
-
Definition of diabetes?
Fasting blood glucose level of >126 on two different occasions 2 weeks apart
-
how do you follow diabetes state?
Hb1ac
-
Hb1ac of 6.5 is equivalent to what fasting blood glucose?
125
-
tight glycemic control controls what diabetic complications?
microvascular--retinopathy, nephropathy, neuropathy
-
what are the treatment modalities in type 2 dm?
- exercise and weight loss
- oral hypoglycemics
- insulin
-
side effect of sulfonylurea?
-
sulfonylurea in dm with kidney failure?
tolbutamide
-
MOa of metformin?
benefit?
- stops gluconeogenesis in the liver
- stops absorption in gi tract
- glucose into muscle
- no weight gain
- no hypoglycemia
-
most common side effect of metformin?
gi disturbance
-
when do you not use metformin?
in kidney failure
-
moa of pioglitazone?
increases insulin sensitivity in fat and muscle
-
side effect of glitazones?
-
what are the short acting insluin?
-
old way of managing dm with insulin?
bid injections wiht regular and nph insulins
-
new and most efficacious way of managing dm type 1 with insulin?
long acting--glargine + rapid acting (lispro) or aspart
-
what causes dka
infections and other stress like infections
-
rx of DKA?
- insulin
- fluids--isotonic
- confirm ketones in blood
-
how do you know if dka is fixed?
- anion gap is back to normal
- hco3 goes back to normal
-
Rx of hyperosmolar hyperglycmic episode?
-
what nerve is commonly affected as a complication of diabetes?
cn 3
-
how do u pick up early diabetic nephropathy?
microalbuminuria
-
when do you give aceinhibitor in a aptient with diabetes mellitus?
- if a patient has
- microalbuminuria
- hypertension 130/80
-
when do you refer to opthalmologist in diabetes?
- type 1---5 years after and then 1 year thereafter
- type2---every year
-
what is the somogyi effect?
dawn effect?
- somogyi effect---hyperglycemia in the morning due to too much insulin at night
- dawn effect--hyperglycemia in the morning due to too little insulin at night
-
next best step in differentiating somogyi vs dawn effect?
cut back on insulin the person takes at night
-
what is a honeymoon period?
insulin needs in a diabetic decrease bc the pancreas is able to produce some insulin transiently
-
definition of hypoglycemia?
- hypoglycemia
- symptoms of hypoglycemia
- reversal of symptoms with sugar
-
rx for sulfonylurea induced hypoglycemia?
treat and observer for 24 hours bc sulfonylureas act for 24 hours
-
best test for septic arthritis?
sonogram
-
low potency neuroleptics?
- chlorpromazine
- thioridazine
-
high potency neuroleptics?
- haloperidol
- fluphenazine
- doperidol
- thiothiaxene
-
what should be done if the total cholesterol is <200?
>200?
- retest in 5 years
- check for lipid fractions if >200
-
what should be done if LDL is <130? and no cad risk factors?
130-160
>160?
- nothing
- exercise +diet
- Statins
-
what should be done if LDL >100 with cad risk factors?
stati
-
hypertiglyceride causes what?
pancreatitis
-
what binds c diff toxin?
cholestyramine
-
Rx for high TG?
- Omega 6 fatty acids
- fibrates
-
when is screening for lipids done?
-
when lfts are what shoudl you not give statins?
2x ULN
-
what is contraindicated in prinzmetal angina?
-
is reversible or irriversible iechemia a reason to do PCI and/or cabg?
reversible
-
who gets pci?
- all unstable/nstemi/stemi and
- stable angina that isnt controlled with medical therapy
-
rx for which conditions is diagnositc?
- fluconazole for esophagitis
- taxol for cns toxoplamsosis
-
nitroglycerin makes what 3 coniditions better?
- ischemia
- gerd
- esophageal spasm
-
what drugs are indicated post mi?
- aspirin
- bb
- acei
- statins
- spironolactone
-
rx for bb toxicity?
- glucagon
- atropine
- insulin with glucose
- calcium
-
when are pvcs considered vtach?
when are pvcs becoming an issue/?
- more than 3 in a row
- when there is 3 in a minute
-
side effects of amiodarone?
- hypothyrodism
- pulmonary fibrosis
- check pft, tft, lft
-
-
earliest ekg sign of chf?
LVH
-
best initial test for valvular heart disease?
best initial test for endocarditis lesions on the valves?
-
Carotid endartectomy is for whom?
- symptomatic and 70-90% stenosis
- asymptomatic and 80-90% stenosis
-
dx of pseudotumor cerebri?
rx?
- ct-negative
- LP---increased pressure
- acetazolamide
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