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Alzheimers Disease definition & how many stages
Progressive disorder of brain which affects memory, thought and language, 4 stages
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Stage 1 Alzheimers
Onset, slower, easily angered
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Stage 2 Alzheimers
Supervision needed with detailed activities, train of thought is lost easily
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Stage 3 Alzheimers
Marked Personality Change, Depression
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Stage 4 Alzheimers
Cant recognize anyone, urinary incontinence, absent memory
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Tension type headache lasts how long, where is it located and what is quality?
30 minutes to 7 days. Bilateral location. Pressing not pulsatile
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Migraine without Aura lasts for how long, where is it located, what is quality?
4 hours to 72 hours. Unilateral. Pulsating, plus one or more of: nausea, vomiting, photophobia and phonophobia.
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Migraine with Aura has what characteristics?
Aura develops over 4 minutes. Dread, anxiety, fatigue, nervousness. GI upset, visual or olfactory alteration. + FHx will be noted in many cases.
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Cluster headache had what characteristics?
Headaches occur in a cluster of headaches. Last several weeks to months. Often wakes you up out of sleep. Hot poker behind one eye. Runny eyes, ptosis, and nasal stuffiness can occur on ipsilateral side
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What headache is a sinus headache?
A cluster headache.
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What headaches are more common in men?
Cluster headaches are more common in men
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What headache can cause nasal stuffiness and conjunctival injection?
Cluster headache. Due to histamine component implicated in these headaches.
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What headaches can be unilateral?
Cluster. Migraine can be unilateral, and sometimes bilateral
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What are some headache triggers?
MSG, cheeses, ETOH, chocolate, stress, perfume, hunger,
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What are some examples of rescue therapy in headaches?
Opioids, antiemetics, short course of corticosteroids
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What are the migraine specific medications?
Triptans (selective serotonin receptor agonists), and Ergot derivatives
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Prophylactic controller drugs in headache prevention?
Beta Blockers, Calcium Channel Blockers, TCAs, anti-epileptic drugs such as Gabapentin and Valproate. Lithium can be given for cluster headaches.
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Treatment of cluster headaches can include this non-pharmaceutical type of medical treatment?
High flow oxygen
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When considering head imaging in neuro problem or headache, what are you looking for that is appropriate for MRI?
Tumor
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When considering head imaging in neuro problem or headache, what are you looking for that is appropriate for CT scan?
Hemorrhage, either acute or chronic.
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What is the best choice for an abortive migraine medication in someone with angina?
Ibuprofen. Cannot use Ergotamine or Triptans in angina patient because they have vasoactive effects.
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Complication of giant cell arteritis?
Blindness
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What is Giant cell arteritis?
Autoimmune disorder causing systemic vasculitis of medium to large vessels. Typically age 70.
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How is Giant Cell arteritis treated and for how long will therapy be?
Long term corticosteroid therapy, often 6 to 18 months long. High dose prednisone 80 mg per day.
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Corticosteroids cause ulcers in the stomach, duodenum or both?
Stomach. Add Cytotec or a PPI. Not a localized irritation, more a systemic irritation by thinning out protective layer in stomach.
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What medications should you add when you start people on corticosteroid therapy?
Stomach protection. Bone demineralization protection by adding bisphosphonate and calcium and vitamin D.
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Classic Giant cell arteritis happens in what patient population?
Older women, aged 70
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What does Romberg test?
Cerebellar function
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What reflex number documents normal reflex?
2+
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What is symptoms of acute bacterial meningitis?
Acute onset of very high fever, severe headache, stiff neck, meningeal irritation signs, purple petechia rash, nausea, vomiting, photophobia
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What does Kernigs sign check for and how it is elicited?
Tests for meningeal irritation. Supine position, bend up knee and then try to straighten lower leg. If resistance to leg straightening due to inflamed lumbar root will have pain at hamstring.
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What does Brudzinskis sign test for and how is it elicited?
Meningeal irritation if when supine patient head is lifted up into flexion, the legs also come up in attempt to relieve irritation
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What does temporal arteritis affect?
Medium to large arteries, systemic inflammatory process
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What if temporal arteritis is left untreated? Untoward effect?
Blindness
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What are the symptoms of temporal arteritis?
Tender or nodular, pulseless vessel especially in temporal artery area with sever unilateral headaches and scalp tenderness. Can have acute vision changes of loss, or diplopia, or eye pain. Amaurosis fugax.
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What is amaurosis fugax?
Temporary, transient blindness of one eye
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What is often see along with Temporal arteritis?
Giant cell arteritis and polymyalgia rheumatica often found together
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How is temporal arteritis diagnosed?
Gold Standard: Temporal artery biopsy, or may do color doppler
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Trigeminal Neuralgia, what does it affect? Symptoms?
CN 5, irritation, compression and inflammation. Headache
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What is the concern for herpes zoster infection of CN 5?
Ophthalmic branch of CN 5 affected with herpes can cause blindness
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What is another name for Aseptic meningitis?
Viral
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Point of entry for acute bacterial meningitis?
Direct or droplet via the nose or throat. Or AOM or ABRS can lead to meningitis
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Treatment of choice for bacterial meningitis?
Third generation cephalosporin such as cefdinir, Rocephin PLUS chloramphenicol for BBB penetration
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What is prophylaxis for those in close contact with bacterial meningitis?
Rifampin or Rocephin
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What WBC is predominantly seen in Bacterial Meningitis CSF sample?
Neutrophils. WBC >1,200
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What WBC is predominantly seen in Viral Meningitis CSF sample?
Lymphocytes
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What Glucose level is predominantly seen in Bacterial Meningitis CSF sample?
Lower glucose. Bacterial love to eat up the sugar
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What Glucose level is predominantly seen in Viral Meningitis CSF sample?
Normal
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What Protein level is predominantly seen in Viral Meningitis CSF sample?
- Elevated protein
- What Protein level is predominantly seen in Bacterial Meningitis CSF sample?
- Normal
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What is incubation period for meningitis?
3-4 days
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What is a scotoma?
Blind spots in vision, associated with migraine aura
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What portion of the brain do the Aura symptoms originate?
Cerebral cortex or from brain stem
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What are 5HT1 agonists?
Triptan drugs for abortive migraine therapy.
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What are 5HT1 drugs not to be mixed with?
Do not give Triptans with Ergotamine, or within 2 weeks of MAOI drugs
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How do 5HT1 agonists work?
Allow for increased uptake of serotonin, they are selective serotonin receptor agonists
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Why are 5HT1 agonists contraindicated with MAOI drugs?
Can cause serotonin syndrome due to excessive availability of serotonin.
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What is Cafergot?
Caffeine and Ergotamine combo medication that is potent vasoconstrictor.
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What kind of headache resembles a TIA?
Focal Migraines cause stroke like symptoms. Often these people are at a higher risk for stroke. Avoid estrogens or clot promoting agents in these people
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What treatment is good for a PMS migraine prophylaxis?
A phasic oral contraceptive with a 7 day per month off week from pills.
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What is another name for Trigeminal Neuralgia?
tic douloureux
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Difference between Naproxen (Naprosyn) and naproxen sodium (Aleve)?
Naproxen sodium has quicker onset of action
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Side effect of chronic Fioricet use?
Caffeine, butalbital, and Tylenol. Causes rebound headaches if chronic use.
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What is signs of trigeminal neuralgia?
Unilateral headache caused by impingement or inflammation of trigeminal nerve. CN 5
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What characteristic pain can clue you into diagnosis of trigeminal neuralgia?
Sharp shooting pain on one side of face, triggered by food, cold foods, cold air. Causes lancinating pain that lasts for seconds then stops when irritant ceases.
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Treatment for trigeminal neuralgia can include?
Tegretol, TCAs, botox injections
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All headaches are unilateral except one?
Tension are bilateral
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What is Bells Palsy?
CN 7 unilateral facial paralysis affecting motor branch of CN 7
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Common noted symptoms of Bells Palsy?
Unilateral loss of facial expression, difficulty chewing, and decreased taste
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What is medication treatment for Bells Palsy?
High dose corticosteroids x10 days then wean. Acyclovir if herpes is suspected. Eye lubricant and patch. Early treatment is essential to speed progression to normal
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What is anisicoria?
Unequal pupils
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Cranial nerves responsible to move the eye ball around?
CN 3, CN 4, CN 6
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Cranial nerves for taste?
CN 7, and CN 9
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CN 10,the vagus nerve provides why type of regulation to what organs?
Parasympathetic regulation by slowing heart rate, digestive rate, blood pressure
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Kinesthetic sensation and how is it tested?
Position sense. Tested by moving toe and asking if up or down with pt eyes closed
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Graphesthesia sensation and how is it tested?
Draw letters on palm
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Stereognosis sensation and how is it tested?
Place small OBJECT in hand and ask to identify it
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What is Ageusia?
Loss of taste or inability to discriminate taste
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What does walking heel to toe asses?
Proprioception. Which controls balance, posture, coordination
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What is a Fugue State?
Carry on activities and then later cannot recall them
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Lesion of what cranial nerve causes diplopia,
Diplopia, double vision, is caused by problem with cranial nerve 3
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What headache symptom timing is indicative of increased ICP?
Worse headache upon awakening
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What medications can cause headaches?
Estrogen, Progesterone, Vasodilators
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What is the goal for relief of headache in prophylactic headache treatment?
Minimize headache incidence by half
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What neuroleptics are indicated in the treatment of migraines?
Neuroleptics (first generation antipsychotics) such as Prochlorperazine (compazine) or Promethazine (phenergan) are given for anti emetic properties
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What is the definition of Multiple Sclerosis?
Chronic, demyelinating disorder of CNS
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What type of vision loss is noted in MS?
Monocular vision loss, diplopia, nystagmus, optic neuritis
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What are the two forms of MS and which is more common?
RRMS, Relapsing Remitting MS is the most common. Episodes nearly totally resolve in between exacerbations. Primary Progressive MS has cumulative neurological deficits.
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What does MRI reveal on MS?
Demyelinating plaques
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What things can worsen MS exacerbation?
Hot showers, fevers
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How is MS exacerbation treated?
High dose corticosteroids to shorten acute episodes
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What long term therapy options are there for MS patients?
Immunomodulator therapy with Interferon can significantly decrease exacerbation frequency and long term disability in RRMS. Immunosuppressive therapy. And Monoclonal antibody.
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What are the 6 cardinal signs of Parkinsons disease?
Resting Tremor, Rigidity, Bradykinesia, flexed posture, loss of postural reflexes, mask-like facies
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What is chemical change that happens in brain with Parkinsons disease?
Alteration in Dopaminergic pathway.
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What is treatment medications for Parkinsons disease?
Dopamine receptor agonists, Amantadine, COMT inhibitors, MAO B inhibitors, Anticholinergics.
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What is the role of anticholinergics in Parkinsons disease treatment?
To reduce tremor and restore acetylcholine dopamine imbalance. But undesirable side effects in elderly.
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What is examples of Dopamine Receptor Agonists used in Parkinsons?
Ropinirole (Requip) and Pramipexole (Mirapex). Provide neuroprotective effect with less side effects than Levodopa. Other DRA include Pergolide (permax) and Bromocriptine (Parlodel Cycloset)
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What happens with long term levodopa use greater than 5 to 10 years?
Develop dyskinesia. Often given with Carbidopa
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What are the noted extrapyramidal side effects of antipsychotics?
Akathisia, dystonia, parkinsonism movements.
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What is Akathisia?
Inability to stay still, continuous restless movement
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What is Dystonia?
Involuntary spasms, movements of face, arms, legs, neck
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What is parkinsonism movements?
Tremors, shuffling gait, drooling, rigidity
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What drugs are used to counteract extrapyramidal movements?
Anticholinergics, such as Cogentin or Artane. Dopaminergic agonists such as Amantadine
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What happens during a Parkinsons OFF period?
Occurs at end of Levodopa blood level when patient has difficult initiating movement or has uncontrolled movements
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What is typically the first sign of Parkinsons?
Resting tremor.
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What occurs in Myasthenia Gravis?
Autoimmune disorder with acetylcholine receptor antibodies. Is a neuromuscular junction disorder.
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What is Guillian-Barre disorder?
Rapidly progressive acute demyelinating disorder.
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What part of the nervous system does Guillain Barre affect?
Peripheral nervous system is affected in a rapidly ascending pattern. Reflexes are 0 to 1. Possible link to Viral respiratory infection, GI infection, CMV, HZV, General anesthesia
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What is Korsakoffs Syndrome and what causes it?
Chronic ETOH abuse causes dementia due to chronic Thiamine deficiency. May lead to permanent brain damage
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How long will urine be positive after smoking Marijuana?
30 days
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What is the Hallpike Maneuver used for?
Assessing peripheral vertigo. Series of head maneuvers to elicit vertigo
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What is noted in a Petit Mall seizure?
AKA Absence seizure. Often just blank stare 5 to 30 minutes and decreased level of consciousness
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What is noted in a myoclonic seizure?
One or more muscle groups cause brief jerking.
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What is noted in a tonic clonic seizure?
AKA Grand Mall seizure. Rigid Extension, followed by jerking. Positive Loss of consciousness. Bowel and bladder incontinence noted
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What is noted in a simple partial or focal seizure?
Awake state. Or Jacksonian seizure. Abnormal sensory, autonomic or psych behavior
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What is noted in a complete partial seizure?
Aura of unusual taste or smell. Hallucination. Vague stare and facial movement with muscle contraction and relaxation and autonomic signs. Can cause LOC
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How long can a TIA last?
Less than 24 hours
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What is the typical secondary prevention medication for person with TIA or CVA?
ASA or Aggrenox (ASA plus dipyridamole). If multivessel disease, give Plavix. Plus need statin
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Which C spine injury still allows you to maneuver a wheel chair?
C 6, can self transfer to chair. Definitely can use wheel chair in C7,C8 injury.
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What are the symptoms of Acute Serotonin Syndrome?
Shivering, diaphoresis, hyperreflexia, mental status changes, myoclonus
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What has the shortest half life of all the benzodiazepines?
Xanax. Best for elderly
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What tests for proper alignment of eyes?
Corneal light reflex. Will be unequal in strabismus
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What checks for the cardinal fields of gaze?
Check extraocular movements
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