AOBNP Neurology & Psychiatry cheat sheet

Acute ischemic stroke: IV thrombolysis (alteplase or tenecteplase) within 4.5 hours of onset; mechanical thrombectomy for large vessel occlusion within 24 hours if imaging criteria met.

Status epilepticus: first-line benzodiazepines (lorazepam 0.1 mg/kg IV or midazolam IM), second-line fosphenytoin/phenytoin, valproate, or levetiracetam; refractory requires anesthetic doses of propofol, midazolam, or pentobarbital.

Multiple sclerosis: McDonald criteria require dissemination in space (≥2 of 4 typical CNS regions) and time; CSF oligoclonal bands can substitute for dissemination in time.

Myasthenia gravis: fatigable weakness, ptosis, diplopia; anti-AChR antibodies positive in ~85% generalized; treat with pyridostigmine, corticosteroids, azathioprine, or rituximab; crisis requires IVIG or plasmapheresis.

Parkinson disease: cardinal features are bradykinesia plus rigidity or resting tremor; levodopa-carbidopa is most effective; motor fluctuations managed with COMT inhibitors, MAO-B inhibitors, or deep brain stimulation.

Migraine: triptans contraindicated with cardiovascular disease; chronic migraine (≥15 headache days/month for >3 months) may benefit from CGRP monoclonal antibodies or onabotulinumtoxinA.

Normal pressure hydrocephalus triad: gait disturbance, urinary incontinence, cognitive impairment; ventromedial shunt can improve symptoms; imaging shows ventriculomegaly out of proportion to atrophy.

Guillain-Barré syndrome: ascending weakness, areflexia, albuminocytologic dissociation; treat with IVIG or plasmapheresis; avoid corticosteroids alone; monitor vital capacity for respiratory failure.

Major depressive disorder: first-line pharmacotherapy includes SSRIs, SNRIs, or bupropion; augmentation options include atypical antipsychotics (e.g., aripiprazole), lithium, or thyroid hormone; psychotherapy is equally effective for mild-moderate depression.

Bipolar I disorder: acute mania treated with lithium, valproate, or atypical antipsychotics; antidepressant monotherapy can induce mania; maintenance often requires mood stabilizer plus atypical antipsychotic.

Schizophrenia: first-line antipsychotics (e.g., risperidone, olanzapine, aripiprazole) for positive symptoms; clozapine for treatment-resistant (failure of ≥2 trials); monitor for agranulocytosis and myocarditis.

Serotonin syndrome: triad of mental status changes, autonomic hyperactivity, and neuromuscular abnormalities (clonus, hyperreflexia); caused by serotonergic agents; treat with cyproheptadine and supportive care.

Neuroleptic malignant syndrome: fever, rigidity, autonomic instability, altered mental status, elevated CK; stop offending agent, supportive care, dantrolene or bromocriptine.

Alcohol withdrawal: benzodiazepines are first-line for seizures and delirium tremens; thiamine before glucose to prevent Wernicke encephalopathy; CIWA-Ar guides symptom-triggered therapy.

Opioid use disorder: buprenorphine (partial agonist) or methadone (full agonist) for maintenance; naltrexone for relapse prevention after detoxification; naloxone for overdose.

Panic disorder: SSRIs and cognitive-behavioral therapy are first-line; benzodiazepines may be used short-term but carry dependence risk; avoid triggering agents like caffeine.