32) Medical tx for Meniere’s dis? If fails?
33) Symptomatic tx for vertigo secondary to labyrinthitis? If severe?
34) Examples of reversible causes of dementia?
35) Examples of irreversible causes of dementia?
36) Early presentation of Pick’s dis?
37) Presentation of Creutzfeldt-Jakob dis?
38) Binswagner dis?
39) Tx for mild-moderate dementia? Other tx?
40) 32 yr female w/numbness & tingling of R hand began several days ago. Hx of seeing double 3 yrs ago for 2 days. Hyperactive reflexes bilaterally and inc spasticity in lower extremities. Dx?
41) What is Multiple sclerosis?
42) Triggers that exacerbate MS?
43) Most accurate test for MS?
44) Best initial test for MS?
45) Most sensitive test for MS?
46) If MRI is nonconfirmatory but MS suspicion still high, what test?
47) Tx for relapsing-remitting dis of MS?
48) Tx for secondary progressive dis of MS?
49) If cant tolerate IFN B1b, IFN B1a or glatiramer acetate?
50) Tx for primary progressive disease of MS?
51) Tx for acute exacerbation of MS?
52) Tx for MS pt w/ spasticity?
53) Tx for MS pt w/ nocturnal spasticity?
54) Tx for MS pt w/ bladder hyperactivity?
55) Tx for MS pt w/ Urinary retention?
56) Tx for MS pt w/ fatigue?
57) Tx for MS pt w/ erectile dysfunction?
58) What is Parkinson’s disease?
59) Parkinsonism + vertical gaze palsy?
60) Parkinsonism + prominent ataxia?
61) Parkinsonism + prominent orthostatic hypotension?
62) Parkinson pt w/ intact functional status (less bradykinesia) < 60 yrs, initial tx?
63) Parkinson pt w/ intact functional status (less bradykinesia)> 60 yrs, initial tx?
64) Parkinson pt w/ compromised function, initial tx?
65) Tx for late complications of carbidopa/levodopa (response fluctuations)?
66) Only drug that can arrest progression of Parkinson dis?
67) Surgical TX for Parkinson pt, when? Procedure?
68) Test of choice for diagnosing epilepsy?
69) Tx of status epilepticus?
70) When are first time seizures treated with long-term anticonvulsants?
71) First line tx for generalized tonic clonic seizure? If not a choice?
72) First line tx for absence seizures? If not a choice?
73) First line tx for partial seizures (complete/partial)? Acceptable alternatives?
74) Tx of choice for myoclonic and atonic seizures?
75) CNS SE of phenytoin?
76) Systemic SE of phenytoin?
77) SE of phenobarbitol?
78) SE of valproic acid?
79) SE of lamotrigine?


Ans
32) Low salt diet & diuretic. If fails: surgical decompression
33) Meclizine. If severe: diazepam
34) Hypothyroidism, Vit B12 def, Hep/uremic encephalopathy, CNS vasculitis, Syphilis, Brain abscess, Brain tumor, Meds (anticholinergic), Sleep apnea, Trauma, Subdural hematoma, NPH, Depression
35) Progressive multifocal leukoencephalopathy, Alzheimer’s dis, Dementia w/ Lewy bodies, Frontotemporal degeneration (Pick’s dis), Vascular dementia multiinfarct, Binswanger dis), Creutzfeldt Jakob dis
36) Personality changes w/visuospatial sparing
37) Dementia & myoclonus (aggressive wks-mo)
38) Subcortical white matter (slow)
39) Donepezil. Others: anticholinesterase inhibitors (rivastigmine, tacrine); discontinue if no improvement in 3-6 mo
40) Multiple sclerosis
41) Inflammatory dis of CNS white matter, multifactorial (infections, diet, climatic), focal areas of demyelination
42) Infection, trauma, post pregnancy (2- 3 mo after)
43) Brain MRI (inc T2 density, dec T1 density) Gandolinium enhance lesions till 2-6 wks after exacerbation
44) Brain MRI
45) Brain MRI
46) CSF (mild pleocytosis <50 cells, inc IgG oligoclonal band 70-90%pts)
47) Disease modifying agents: IFN B1b, IFN B1a, glatiramer acetate
48) IFN B1b &mitoxantrone
49) Methotrexate, cyclophosphamide, IVIG or azithropine
50) No disease modifying tx approved yet
51) 3 days of intense IV steroids-> oral steroids (taper over 4 wks) If severe & steroid unresponsive: plasma exchange
52) baclofen
53) tizandine, diazepam
54) oxybutynin
55) bethanechol
56) amantadine or fluoxetine
57) sildenafil acetate
58) Neurologic synd from def of neurotransmitter dopamine as consequence of degenerative, vascular or inflammatory changes in basal ganglia
59) Supranuclear palsy
60) Olivopontocerebellar atrophy
61) Shy Dragger synd
62) Anticholinergic meds
63) Amantadine
64) Carbidopa/levodopa
65) Sustained rel form of carbidopa/levodopa adding dopamine agonist, selegiline or COMT inhibitors or restriction of protein meal to night
66) Selegiline
67) Surgery for who cant tolerate or respond adequately to medical tx. Procedures: pallidotomy & thalamotomy
68) Electroencephalogram
69) Secure ABC, tx reversible causes, lorazepam or diazepam (potentiate GABA recept)-> seizure-> phenytoin or fosphenytoin (inhibit Na+ dependent AP)-> seizure -> phenytoin/fosphenytoin -> seizure -> phenobarbitol -> seizure-> phenobarbitol -> seizure -> midazolam or propofol
70) If Pt has abnormal neurologic exam, presented w/ status epilepticus, has strong family hx of seizures, or has abnormal EEG
71) Valproic acid (inc availability of GABA). If not a choice, pick lamotrigine (dec glutamate release)
72) Ethosuximide. Valproic acid
73) Carbamazepine & phenytoin. Valproic acid & lamotrigine
74) Valproic acid
75) Diplopia, dizziness & ataxia
76) Gum hyperplasia, lymphadenopathy, hirusitism, rash
77) Sedation, ataxia, rash
78) Ataxia, tremor, hepatotoxicity, thrombocytopenia, GI irritation, hyponatremia
79) Diplopia, ataxia, rash, Steven-Johnson syndrome