Royal College: Emergency Medicine > Neurology > Flashcards

Neurology Flashcards

This deck covers Chapters 91-99 in Rosens, comprising all of neurology. (101 cards)

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1
Q

What are the NINDS-recommended stroke evaluation time targets in potential tPA candidates?

A
  • Door to MD = 10 minutes
  • Door to CT = 25 minutes
  • Door to CT read = 50 minutes
  • Door to tPA = 60 minutes
  • Access to NSx = 120 minutes
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2
Q

List 6 indications for CT scan of first time seizure.

A
  1. Focal deficit
  2. Persistently altered LOC
  3. Fever
  4. Trauma
  5. Persistent H/A
  6. Cancer history
  7. OAC
  8. HIV
  9. Age >40
  10. Partial complex seizure

I scan all first-time seizures…

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3
Q

Differentiate dementia and pseudodementia.

A

Pseudodementia

  • Usually rapid onset
  • Previous psychiatric history
  • Social skills intact
  • Attention preserved

Dementia

  • Gradual, progressive onset
  • Impaired memory, judgment, and executive function
  • Patient is often unaware of deficits
  • Poor attention and concentration
  • Typically irreversible (e.g., Alzheimer’s disease)
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4
Q

What does the CSF look like in GBS?

A
  • High protein
  • Mild pleocytosis
  • Normal CSF does NOT rule out GBS
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5
Q

Describe the clinical syndrome of PCA stroke.

A
  • Homonymous hemianopsia
  • Memory impairment (hippocampus)
  • Visual agnosia
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6
Q

Define a myasthenic crisis.

List 5 drugs that may exacerbate MG. List 4 other triggers.

A
  • Respiratory failure

Drugs

  1. Prednisone
  2. BB
  3. CCB
  4. Lidocaine
  5. Procainamide
  6. Clindamycin
  7. Phenytoin

Other

  1. Medication changes
  2. Infection
  3. Aspiration
  4. Surgery
  5. Pregnancy
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7
Q

List 8 contraindications for tPA in STROKE.

A

Brain

  1. Hemorrhagic transformation
  2. Previous ICH
  3. AVM
  4. Brain cancer
  5. Stroke within 3 mo
  6. Closed head injury within 3 mo
  7. CNS surgery within 3 mo

Hematologic

  1. OAC
  2. Plt <100
  3. INR >1.7
  4. Heparin use

Other

  1. Arterial puncture non-compressible
  2. Severe uncontrollable HTN
  3. Glucose <2.8
  4. Active bleeding
  5. Bleeding diathesis
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8
Q

Differentiate the following diseases based on (a) strength, (b) DTRs, (c) sensation, and (d) wasting:

  • Myelopathy
  • Motor neuron disease (ALS)
  • Neuropathy
  • Neuromuscular junction disease
  • Myopathy
A
  • Myelopathy
  • Strength - / DTR + / Sens N / No wasting
  • Motor neuron disease (ALS)
  • Strength - / DTR + / Sens N / Wasting
  • Neuropathy
  • Strength - / DTR - / Sens - / Wasting
  • Neuromuscular junction disease
  • Strength fatigued / DTR N / Sens N / No wasting
  • Myopathy
  • Strength - / DTR N / Sens N / Wasting
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9
Q

Name and describe a scale to grade the severity of Bell’s palsy.

A

House Brackmann Scale

  1. Normal
  2. Mild. Eye closes. Symmetrical at rest.
  3. Moderate. Eye closes. Asymmetrical at rest.
  4. Mod-Severe. Eye can’t close. Asymmetrical at rest.
  5. Severe. Eye can’t close. Only twitches.
  6. Complete paralysis
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10
Q

List 6 signs/symptoms associated with Bell’s palsy.

A
  1. Dry eye
  2. Overflow of tears on the cheek
  3. Taste change
  4. Ear pain
  5. Hyperacusis
  6. Perception of ipsilateral sensory change
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11
Q

Define status epilepticus.

A

Seizure activity >5 min

2 seizures without recovery between

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12
Q

What is the triad of carotid dissection? How do you treat it?

A
  1. Unilateral headache
  2. Horner’s
  3. Contralateral hemispheric signs

Treatment

  • tPA if associated with stroke
  • Heparin if thrombus with dissection
  • Anti-platelets otherwise
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13
Q

List 6 risk factors for SAH.

A
  1. PCKD
  2. FHx
  3. Cocaine
  4. HTN
  5. Smoking
  6. Connective tissue disorder
  7. Alcoholism
  8. Coarctation
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14
Q

List the 4 diagnostic criteria for dementia (major neurocognitive disorder).

A

From DSM-5:

  1. Evidence of significant cognitive decline from a previous level of performance in one or more cognitive domains:
    * Learning and memory
    * Language
    * Executive function
    * Complex attention
    * Perceptual-motor
    * Social cognition
  2. Cognitive deficits interfere with independence in ADLs/IADLs
  3. Do not occur exclusively in the context of delirium
  4. Not better explained by another mental disorder (eg, major depressive disorder, schizophrenia).
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15
Q

What is the ABC/2 technique in ICH?

A

Take measurements widest area of bleed (A x B)

Count the number of slices (10 mm) that blood is present (C)

(A * B * C) / 2 = volume of blood

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16
Q

What is your BP target is SAH?

A
  • Before aneurysm is secured: sBP < 140 mmHg
  • After aneurysm is secured: AHA recommends sBP < 160 mmHg or MAP < 110 mmHg
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17
Q

Describe the clinical syndrome of MCA stroke.

A
  • Contralateral weakness: Face/Arm > Leg
  • Contralateral sensory loss: Face/Arm > Leg
  • Contralateral hemianopsia
  • Gaze preference toward the lesion
  • Aphasia
  • Neglect
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18
Q

What are the CSF findings in a patient with MS?

A
  • Pleocytosis
  • Elevated gamma globulin levels
  • Oligoclonal bands of IgG
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19
Q

What are the three major ‘columns’ of the spinal column and what is their function?

A
  1. Spinothalamic - pain/temp
  2. Corticospinal - motor
  3. Posterior column - proprioception/vibration/touch
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20
Q

List 4 seizures that require ‘specialized therapy’ (not just benzos).

A
  1. Hyponatremia
  2. Hypoglycemia
  3. Hypocalcemia
  4. Eclamptic
  5. Isoniazid
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21
Q

What are your BP targets in ICH? What trial provided evidence on this?

A

ICH

  • BP should be lowered to 140-160 mmHg

​Interact-2: 2013

  • 2800 patients –> Drop BP to 140 in first 6 hours
  • Negative outcome but at p= 0.06 (mortality)
  • Positive for a reduction in disability

ATACH 2

  • Stopped early because of futility
  • Supposed to be 180 vs 140, but was ~140-120
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22
Q

What is an abnormal CSF lactate?

What is an abnormal CSF glucose:serum glucose?

A
  • CSF lactate >3.5
  • Glucose CSF:Serum <0.33
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23
Q

Provide the Hunt and Hess classification scale for SAH.

A
  • 0 = Intact
  • 1 = Mild H/A
  • 2 = Severe H/A, nuchal rigidity
  • 3 = Confused
  • 4 = Hemiparesis
  • 5 = Posturing
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24
Q

List 8 causes of delirium.

A

I WATCH DEATH

  1. Infection
  2. Withdrawal
  3. Acute metabolic (acidosis, lytes, organ failure)
  4. Trauma
  5. CNS disease (bleed, tumour, seizure, CVA)
  6. Hypoxia
  7. Deficiencies (B12, Thiamine)
  8. Environmental (hypo/hyperthermia)
  9. Acute vascular (HTN, MI, CVA)
  10. Toxins
  11. Heavy metals
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25
What nerve roots does the **sciatic nerve** arise from? What are the 2 main branches? What are the symptoms of sciatic mononeuropathy?
* L4-S3 * Tibial/Common peroneal * Flail foot, can't flex knee, can't feel below knee
26
List 3 treatments for a **myasthenic crisis**.
1. Prednisone 2. IVIG 3. PLEX 4. Airway management * FVC \<20 * MIP \<30 * MEP \<40
27
What is the most common cause of **bilateral CN7 paralysis**?
**Lyme** Borrelia burgdorferi Ixodes tick
28
**Differentiate** Tick paralysis from GBS and Botulism.
**Tick Paralysis** * Toxin injected by tick decreases ACh release * **Ascending** paralysis * **Ocular** findings **Botulism** * C. botulinum toxin prevents ACh release * **Descending** paralysis **GBS** * Demyelinating * **Ascending** paralysis * **Ocular** muscles spared
29
What are the diagnostic criteria for **migraine with aura**?
2+ attacks with 3+ of: * 1+ reversible aura symptom * 1+ aura symptom over 4 minutes * No aura \>60 min * Headache during or after aura
30
What is the agent involved in **botulism**? What is the mechanism? List 3 causes. Treatment?
**Clostridium botulinum** * Presynaptic inhibition of ACh release **Causes** 1. Food 2. Wound 3. Infantile 4. Iatrogenic **Treatment** * Airway management * Equine antitoxin * BabyBIG if infantile * PenG 3M units IV q4h if wound
31
List 8 causes of **toxin-induced seizure**.
**OTIS CAMPBELL** * **O**ral hypoglycemics, Oleander, Organophosphates * **T**heophylline, TCAs * **I**nsulin, Isoniazid * **S**ympathomimetics * **C**amphor, CN, CO, Cocaine * **A**SA, Anticholinergics * **M**ethanol * **P**CP, Pesticides * **B**arbiturate/Benzo W/D, Bupropion, Botanicals * **E**thanol W/D * **L**ead, Lithium * **L**idocaine
32
What is the **ABCD2** score?
**ABCD2** * **A**ge \>60 * **B**P (HTN hx) * **C**linical (Sens/Speech/Motor) * **D**uration (\<10m/10m-60m/\>60m) * **D**iabetes Used to predict CVA at 48h following TIA
33
List the 4 types of **GBS**.
1. Acute inflammatory demyelinating polyradiculopathy 2. Acute motor axonal neuropathy 3. Acute motor and sensory axonal neuropathy 4. Miller Fisher syndrome
34
List 5 ischemic changes on CT **following stroke**.
1. Hyperdense artery sign 2. Loss of grey-white differentiation 3. Effacement of sulci 4. Loss of insular ribbon 5. Mass effect 6. Hypodensity Subtle findings as early as 3h post Usually, 6h before more obvious
35
List 7 reversible causes of **dementia**.
1. Hydrocephalus 2. CNS lesion 3. Heavy metal poisoning 4. Depression 5. Hypothyroidism 6. B12 deficiency 7. Medication-induced
36
Describe 7 steps in the management of a **SAH**.
1. HOB 2. ICP management 3. BP \<140-160 4. NSx 5. CCB prophylaxis (Nimodipine) 6. Seizure prophylaxis 7. Normothermia 8. Antiemetics 9. Neuroprotective intubation, if necessary
37
What is the clinical triad of **Wernicke's encephalopathy**?
1. Encephalopathy 2. Eye findings (nystagmus, ophthalmoplegia) 3. Ataxia
38
What are **BP targets** in stroke if you want to give tPA and if you don't want to give tPA? Name 3 agents that can be used to lower BP in this setting.
* No tPA = \<220/120 * tPA = \<185/110 * During tPA = \<180/105 **Drugs** 1. Labetalol 2. Hydralazine 3. Enalaprilat 4. Nicardipine 5. Nitroglycerin
39
Draw the **Circle of Willis**.
40
What nerve roots does the **median nerve** arise from?
* C5-T1 * AIN (Galeazzi injury) * Just proximal to wrist, palmar sensory branch comes off
41
Explain the **DAWN Trial**: * Study Design * Population (4) * Intervention * Outcome Measure (2) * Results
* **Study Design** * Multicenter, prospective RCT * **Population** * Seen well 6-24h previous * Age ≥18 * Ischemic stroke * Failed tPA therapy * NIHSS ≥10 * Pre-stroke mRS \<2 * Anticipated life expectancy ≥6 months * **Intervention** * Randomized 1:1 to EVT or not * **Outcome Measure** * Modified Rankin Score * Functional independence * **Results** * EVT group did better
42
List 5 medications and doses used to **stop a seizure**.
**First-Line** * Lorazepam 0.1 mg IV * Diazepam 0.2 mg IV * Midazolam 0.2 mg IV **Second-Line (note all 20 mg/kg)** * Phenytoin 20 mg/kg * Fosphenytoin 20 mg/kg * Phenobarbital 20 mg/kg * Valproate 20 mg/kg **Third-Line** * Propofol 1-2 mg/kg * Midazolam infusion 0.05-2 mg/kg/hr
43
List 2 treatments for **GBS**.
1. IVIG 2. PLEX
44
Name 10 non-infectious causes of **meningitis**.
1. Vaccine 2. NSAID 3. TMP-SMX 4. INH 5. IVIG 6. SLE 7. Radiation 8. Cancer 9. Autoimmune 10. Sarcoid
45
List 6 causes of **dementia**.
1. Alzheimer's 2. Parkinson's 3. Huntington's 4. CVA 5. Infectious 6. Repeated head trauma 7. Prions 8. Hydrocephalus 9. Mass effect (tumour, blood, pus)
46
List 8 host factors that predispose someone to **meningitis**.
1. Age \<5y 2. Age \>60y 3. Male 4. Low SES 5. Military 6. Dorms 7. Splenectomy 8. Diabetes 9. IVDU 10. Alcohol
47
Describe a typical **cluster headache**. List 4 treatments.
**Symptoms** * Unilateral flushing/sweating * Red, tearing eye * Rhinorrhea/Nasal congestion * Clusters of brief severe pain, often retroorbital * Worse in men **Treatment** 1. High-flow oxygen 2. Triptans 3. Maxeran 4. Octreotide
48
Explain why a patient with **DM** has ptosis and a normal pupillary response.
Parasympathetic fibers on the outside of CN3 * If compression (by P.comm aneurysm), only this down Motor fibers on the inside of CN3 * If vascular disease, ischemia happens at the central part of the nerve.
49
What are the diagnostic criteria for **migraine**?
**POUND** * **P**ulsatile * **O**nset 4-72h * **U**nilateral * **N**ausea and/or Vomiting or Photo- AND Phonophobia * **D**isabling Need 5 episodes lasting 4-72h with 2 of the above
50
List 5 causes of **CN3 palsy**.
1. DM 2. Aneurysm 3. Herniation 4. Tumour 5. CVST 6. Trauma 7. GBS (Miller Fisher)
51
Describe a typical **tension headache**.
* Band-like squeezing * Temples/Neck * 30min - 7hr * Triggered by stress/poor sleep
52
What is the triad of **Miller-Fisher GBS**?
1. Ophthalmoplegia 2. Ataxia 3. Areflexia
53
List 4 inclusion criteria for the **Ottawa SAH rule**.
1. Age \>16 2. Non-traumatic 3. Peak intensity within 1 hour 4. GCS 15
54
List 6 DDx for **seizure**.
1. Syncope 2. Hypoglycemia 3. Hyponatremia 4. TIA 5. Narcolepsy 6. Motor Tics 7. Hyperventilate/Breath holding 8. GERD in babies 9. Conversion D/O
55
Describe 2 ways to diagnose **myasthenia gravis** in the ED.
1. **Tensilon** * AChEi (max 10 mg) 2. **Ice pack** * 2 min on one eye Positive if 2mm difference in lid opening
56
Which GBS patients need **intubation**?
Usual reasons to intubate, plus: * FVC \<20 cc/kg * MIP \<30 cmH2O * MEP \<40 cmH2O
57
Describe the epidemiology, pathophysiology, and symptoms of **GCA**.
**Epidemiology** * Older women * PMR **Pathophysiology** * Large-vessel vasculitis **Symptoms** * Headache * Jaw/Tongue claudication * Constitutional symptoms * Visual symptoms
58
Describe and **differentiate** cauda equina and conus medullaris.
**Conus Medullaris** * Sudden * Bilateral * UMN * More back pain * Less radicular symptoms * More impotence **Cauda** is opposite.
59
Explain the components **FAST-ED scale**.
**F**ield **A**ssessment **S**troke **T**riage for **E**mergency **D**estination * **F**acial Palsy (normal/noticable) - 0/1 * **A**rm weakness (normal/drift/paralysis) - 0/1/2 * **S**peech (normal/slurred/severe) - 0/1/2 * Eye deviation (normal/partial/forced) - 0/1/2 * Neglect (normal/1 sens mod/complete) - 0/1/2 If \>=4 pts, likely to have IC/M1 clot
60
List 8 causes of **status epilepticus**.
1. Isoniazid 2. Hyponatremia 3. Hypoglycemia 4. Hypocalcemia 5. Eclampsia 6. CNS infection 7. CNS trauma 8. Cancer 9. AVM 10. Stroke 11. Hydrocephalus 12. Epilepsy 13. Toxic (OTIS CAMPBELL) 14. Alcohol withdrawal
61
What is the cut-off time for tPA in **ischemic stroke**? What are the 2 other inclusion criteria?
* tPA \< 4.5 hours * NIHSS \>3 * Age \>18
62
What are the 5 diagnostic criteria for **GCA**.
1. Age \>50 2. New-onset localized headache 3. Temporal artery pain 4. ESR \>50 5. Positive biopsy Diagnosed if 3+ (90%+ sensitive and specificity) Treat with Prednisone 1 mg/kg (max 60 mg)
63
List 3 mechanisms by which **NMJ** can diminish strength on repeated stimulation. Give an example of each.
1. **Decreased ACh release** * Botulism 2. **Blocked receptors** * Myasthenia gravis 3. **AChEi** * Organophosphates
64
How do you treat a **hyponatremic seizure** (dose)?
3% saline 2 cc/kg over 10-60 minutes
65
List 3 causes of **meningitis** in each of: * Bacterial * Viral * Fungal * Parasitic * Non-infectious
Many... * **Bacterial** * S. pneumoniae * N. meningitidis * H. influenzae * L. monocytogenes * **Viral** * HSV * West Nile * HIV * **Fungal** * Cryptococcus * Histoplasma * Blastomyces * Candida * **Parasitic** * Toxoplasma * Neurocysticercosis * Bartonella * **Non-infectious** * NSAIDs * Vaccine-related * IVIG * Cancer * SLE
66
What nerve root does the **ulnar nerve** arise from?
* C5-T1 * Mainly C7-T1
67
List 5 indications for **endovascular therapy** in stroke.
1. Age \>18 2. NIHSS \>6 3. ASPECTS \>6 4. IC/M1 clot 5. mRS 0 or 1 6. Groin puncture possible within 6h
68
List 4 causes of **complete sciatic mononeuropathy**.
1. Buttock hematoma 2. Penetrating trauma 3. Posterior hip dislocation 4. Deep IM injection
69
**Differentiate** UMN vs LMN findings.
**UMN** * Spastic paralysis * Increased tone * Increased reflexes * Babinski + * Rigid * Bulk preserved **LMN** * Flaccid paralysis * Decreased tone * Decreased reflexes * Babinski - * Fasciculations * Atrophy
70
List 5 reasons to do a **CT scan** before an LP in suspected bacterial meningitis.
1. Papilledema 2. Altered 3. Focal deficits 4. Seizure 5. Immunocompromised
71
List 5 causes of **mononeuropathy multiplex** (2+ named nerves in separate body parts).
1. Vasculitis 2. Diabetes 3. Cancer 4. HIV 5. Lyme 6. Sarcoid 7. Lead
72
What is the dose of **tPA in stroke**? How is it given?
0.9 mg/kg (max 90 mg) 10% bolus, 90% over 1hr
73
How do you diagnose **IIH (4)**? List 3 treatment options.
**Diagnosis** * Normal neuro exam +/- papilledema/field cut/CN6p * CT to rule out mass/CVST * LP with normal CSF * LP with opening pressure: * \>20 cmH2O (normal weight) * \>25 cmH2O (obese) **Treatment** * Stop offending agent (OCP) * Lower ICP (drain, lasix, acetazolamide) * Steroids * VP shunt if visual symptoms
74
List 6 conditions associated with **carpal tunnel syndrome**.
1. Pregnancy 2. Diabetes 3. Acromegaly 4. Scleroderma 5. RA 6. Amyloidosis 7. Obesity 8. Hypothyroidism
75
List the 5 types of **lacunar strokes**.
1. Pure motor 2. Pure sensory 3. Sensorimotor 4. Ataxic-Hemiparesis 5. Dysarthria-Clumsy Hand
76
Who should receive **chemoprophylaxis** for meningitis? What medication(s) and dose?
* Household contacts * Intimate contacts * HCWs with mucosal contact with secretions **N. meningitidis** * Ciprofloxacin 500 mg PO x1 * Rifampin 600 mg PO q12h x4 **H. influenzae** * Rifampin 600 mg PO daily x4
77
Should you give steroids in **meningitis**?
Yes! * Lower mortality in S. pneumoniae * Lower hearing loss in H. influenzae Dex 0.6 mg/kg IV
78
List 6 DDx for a ring-enhancing lesion on CT head.
1. **Bacteria** * TB/Listeria/Syphilis 2. **Parasitic** * Toxo/Amoeba 3. **Fungi** * Crypto/Coccidiomycosis 4. **Malignancy** * Lymphoma/Primary/Met 5. **Inflammatory** * SLE/MS/Sarcoid
79
What are the 5 diagnostic criteria for **delirium**?
**From DSM-5:** 1. Disturbance in attention and awareness 2. Develops acutely, is a change from baseline, and fluctuates over the day 3. Disturbance in cognition 4. Not explained by another preexisting, established, or evolving neurocognitive disorder 5. Due to medical condition, substance intoxication or withdrawal, or exposure to a toxin, or multiple etiologies
80
What are the 4 most common sites for **ICH**?
1. Putamen (44%) 2. Thalamus (13%) 3. Cerebellum (9%) 4. Pons (9%) 5. Other cortical areas (25%)
81
List 6 causes of **CVST**.
1. AOM 2. Sinusitis 3. Orbital cellulitis 4. Meningitis 5. Trauma 6. NSx procedures
82
What is the **Ottawa SAH** rule?
**ANT LEaF** * **A**ge \>40 * **N**eck pain/stiff * **T**hunderclap * **L**OC * **E**xertional * **F**lexion limited Investigate for SAH if any positive
83
List 10 **stroke mimics**.
1. Migraine 2. Hypoglycemia 3. Hyponatremia 4. Bell's palsy 5. SDH/EDH/SAH/ICH 6. CVST 7. HTN encephalopathy 8. CNS tumour 9. CNS abscess 10. Encephalitis/Meningitis 11. Seizure (Todd's paralysis) 12. Conversion disorder
84
List 5 **demyelinating polyneuropathies**.
1. GBS 2. AIDP 3. CIDP 4. Cancer 5. HIV 6. Hepatitis B 7. Diphtheria 8. Buckthorn
85
What is **Ramsay Hunt Syndrome**? How do you treat it?
Herpes zoster re-activation causing: Facial paralysis with ear pain and/or vesicular involvement * Valacyclovir 1g TID x10d * Prednisone 1 mg/kg x10d * Artificial tears
86
What is the pathophysiology of **myasthenia gravis**?
Auto-Ab targeting nicotinic ACh receptors
87
List 8 complications of **meningitis**.
1. Seizure 2. Coma 3. Death 4. Hearing loss 5. Focal neuro deficits 6. DIC 7. Adrenal hemorrhage 8. CVST 9. Stroke 10. SIADH
88
What are the two branches of the **common peroneal nerve**? What are the motor/sensory findings?
* **Superficial nerve** * Everters * Lateral foot * **Deep peroneal nerve** * Ankle dorsiflexion * 1st dorsal webspace
89
List 6 risk factors for **Alzheimer's dementia**.
**Classic cardiac risk factors** 1. **HTN** 2. **DLD** 3. **DM** 4. **Smoking** 5. **FHx** 6. Age 7. Gender 8. Alcohol 9. Obesity 10. CVA 11. Depression 12. Sedentary 13. Low education 14. Traumatic brain injury
90
List 5 infectious organisms associated with **GBS**.
1. Campylobacter 2. Mycoplasma 3. EBV 4. CMV 5. Enterovirus
91
List 8 acute, emergent causes of weakness with possible **airway compromise**.
1. MG 2. LES 3. Tick paralysis 4. GBS 5. Botulism 6. Tetanus 7. Coral snake 8. Heavy metal poisoning 9. Polio 10. HyperMg 11. Hypophos 12. ALS 13. Organophosphate 14. Pufferfish
92
Name 5 types of **generalized seizure**.
1. Tonic-Clonic 2. Absence 3. Myoclonic 4. Clonic 5. Tonic 6. Atonic
93
**Differentiate** generalized and partial seizures.
**Generalized** * Both cerebral hemispheres * Unconscious **Partial** * One cerebral hemisphere * Simple vs Complex based on cognition
94
**Differentiate** Wernicke's and Broca's aphasia.
* Broca's = expressive (motor cortex) * Wernicke's = receptive (temporal lobe)
95
How would you treat **meningitis** in: * Neonate (\<1m) * Infant (1-23m) * Adult (2-50y) * Older Adult (\>50y)
* Neonate (\<1 mo) * Ampicillin + Cefotaxime * Ampicillin + Gentamycin * Infant (1-23 mo) * Ceftriaxone + Vanco * Adult (2-50 yr) * Ceftriaxone + Vanco * Older Adult (\>50 yr) * Ceftriaxone + Vanco + Ampicillin \*Consider dexamethasone and acyclovir
96
List 5 physical exam features of **GBS**.
1. Ascending paralysis 2. Loss of DTRs 3. Variable sensory findings 4. Sparing of anal sphincter 5. Urinary retention 6. Autonomic dysfunction (50%) 7. Sparing of ocular muscles (unless Miller Fisher)
97
Describe the clinical syndrome of **ACA stroke**.
* Contralateral weakness: Leg \> Arm * Contralateral sensory loss: Leg \> Arm * Apraxia (poor motor planning) * Bowel/Bladder incontinence * Primitive reflexes (suckle, grasp) * Impaired judgment
98
List 4 treatment options for **post-LP headache**.
1. Tylenol 2. IVF 3. Caffeine 4. Blood patch
99
List 8 treatments for **migraine**.
1. Tylenol 2. NSAIDs 3. Prochlorperazine 4. Metoclopramide 5. Triptans 6. Ergot 7. Opiates 8. Haldol 9. Magnesium 10. Propofol
100
What nerve root does the **radial nerve** arise from? How do you splint an acute radial nerve palsy?
* C5-T1 brachial plexus * C5-C7 mainly * The radial nerve innervates brachioradialis * Then bifurcates to PIN and sensory at the elbow * Volar splint in 60-degree extension
101
Provide a scoring system for predicting mortality with **ICH**.
**LAGII** * **L**ocation (Supra/Infratent) * **A**ge (\>80/\<80) * **G**CS (3-4/5-12/13-15) * **I**CH Volume (\>30 mL/\<30 mL) * **I**VH (Yes/No) ## Footnote * 2 pts = 26% mortality * 3 pts = 72% mortality * 4 pts = 97% mortality
Royal College: Emergency Medicine
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