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Neuro OSCE

Terms in this set (34)

TTH
- ASA 325 q4-6 hrs or Tylenol 650 q4-6 hrs or Advil 400mg q4-6 hrs
- Chronic: Amitriptyline 10mg HS

Migraine
- Mild/Mod: Advil 800mg at onset, 600mg q4-6hrs. Metoclopramide 5mg (N/V). Hydration.
- Severe: Sumatriptan 25mg, repeat in 2-hrs one time
- ED: metoclopramide 10mg IV + Benadryl 50mg IV + Sumatriptan 6mg subq + IVF
- Pregnant: Tylenol + Raglan + IVF + IV mag

Cluster "prompt relief from acute attacks while using preventive therapy"
- Sumatriptan 6mg SC once, may repeat once after 1-hr
- O2 NRB @15L
- Intranasal lidocaine if they have bad HTN or CAD
- transitional: Prednisone 60mg x5 days, taper by 10 q3-days
- Long term PPx: Verapamil 80mg TID

Bell's palsy
- check for Lyme (EIA then WB)
- Prednisone: 60mg x5 days, then taper w/in 72-hrs?
- Valacyclovir 500mg x7 days

Seizure
- Topiramate 25mg BID
- Valproic acid 10 mg/kg/day in divided doses

Ischemic stroke

- Hemorrhagic stroke

Myasthenia gravis
- Acute: Mechanical ventilation + immune globulin (human) 400mg/kg IV x5 days
- Mild: Pyridostigmine
- Mod: Pyridostigmine + Prednisone 15-20mg PO, incr. q3-days until 60mg/day x2-3 months, then taper

Guillain-Barre
- 1st line: immune globulin (human) 400mg/kg/day IV x5 days (CI: IgA def)
- 1st line: plasma exchange 50 ml/kg every other day x7-14 days
- 20-30% need ventilatory support

- SAH

- EDH

- Meningitis

Dementia
- Donepezil: 5mg PO daily. Max: 10mg
OR
- Rivastigmine: 1.5mg PO BID
- Mod/Severe: Memantine 5mg PO daily. Max: 20mg

Parkinsons "symptomatic, no curative or disease modifying agents available"
- 1st line: Carbidopa/levodopa 100mg PO TID
- 2nd line: Pramipexole 0.125 mg PO TID
- 3rd line: Selegiline 5mg BID

- NPH

- Concussion

ETOH Withdrawal
- CIWA score, CAGE questionnaire
- Lorazepam 1-4mg PO/IV q10-15 min PRN
- Thiamine 100 mg IV daily
- Folic acid 1mg PO daily
- Mag 1-2g/hr
- Severe/ICU: dexmedetomidine 1 mcg/kg IV loading, f/b 0.2-0.7 mcg/kg/hr