AOBNP Neurology & Psychiatry flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Thrombolysis window

Intravenous alteplase or tenecteplase can be given up to 4.5 hours after ischemic stroke onset; beyond that, mechanical thrombectomy may be considered up to 24 hours with imaging selection.

Status epilepticus first-line

Benzodiazepines (lorazepam IV or midazolam IM) are the initial treatment for convulsive status epilepticus, followed by a second-line antiepileptic such as fosphenytoin, valproate, or levetiracetam.

McDonald criteria

Diagnostic criteria for multiple sclerosis requiring dissemination in space (≥2 of 4 CNS regions) and time; CSF oligoclonal bands can replace the time criterion.

Myasthenia gravis antibodies

Anti-acetylcholine receptor antibodies are positive in about 85% of generalized myasthenia gravis; MuSK antibodies occur in a subset of seronegative patients.

Parkinson disease cardinal signs

Bradykinesia plus either rigidity or resting tremor; levodopa-carbidopa is the most effective symptomatic treatment, but long-term use causes motor fluctuations and dyskinesias.

Migraine triptan contraindication

Triptans are contraindicated in patients with ischemic heart disease, uncontrolled hypertension, or history of stroke because of their vasoconstrictive effects.

Normal pressure hydrocephalus triad

Gait disturbance, urinary incontinence, and cognitive impairment; imaging shows ventriculomegaly out of proportion to cortical atrophy; shunt surgery may improve symptoms.

Guillain-Barré syndrome treatment

IVIG or plasmapheresis speeds recovery; corticosteroids alone are not effective; monitor vital capacity because respiratory failure is a major complication.

Serotonin syndrome triad

Mental status changes, autonomic hyperactivity, and neuromuscular abnormalities (clonus, hyperreflexia); caused by serotonergic drugs; treat with cyproheptadine and supportive care.

Neuroleptic malignant syndrome

Fever, rigidity, autonomic instability, altered mental status, and elevated creatine kinase after antipsychotic use; stop the drug, give supportive care, and consider dantrolene or bromocriptine.

Alcohol withdrawal treatment

Benzodiazepines are first-line for seizures and delirium tremens; give thiamine before glucose to prevent Wernicke encephalopathy; use symptom-triggered therapy with CIWA-Ar.

Opioid use disorder maintenance

Buprenorphine or methadone maintenance reduces cravings and withdrawal; naltrexone is an alternative after detoxification; naloxone reverses overdose.

Panic disorder first-line

SSRIs and cognitive-behavioral therapy are first-line; benzodiazepines may be used short-term but carry dependence risk; avoid caffeine and other triggers.

Bipolar mania treatment

Acute mania is treated with lithium, valproate, or atypical antipsychotics; antidepressant monotherapy can induce mania and is avoided.

Treatment-resistant schizophrenia

Clozapine is indicated after failure of at least two antipsychotic trials; monitor for agranulocytosis and myocarditis with regular blood counts.

Major depression first-line

SSRIs, SNRIs, or bupropion are first-line pharmacotherapy; psychotherapy is equally effective for mild to moderate depression; augmentation with atypical antipsychotics or lithium for partial response.

Multiple sclerosis relapse treatment

High-dose intravenous methylprednisolone (e.g., 1 g daily for 3–5 days) shortens acute relapses but does not alter long-term disability; plasma exchange may be used for steroid-refractory severe relapses.

Tension-type headache

Bilateral, pressing, mild to moderate headache without nausea or photophobia; treated with NSAIDs or acetaminophen; chronic form may benefit from amitriptyline.

Cluster headache treatment

Acute attacks: high-flow oxygen and subcutaneous sumatriptan; prophylaxis with verapamil, galcanezumab, or short course of corticosteroids.

Alzheimer disease pharmacotherapy

Cholinesterase inhibitors (donepezil, rivastigmine, galantamine) for mild to moderate; memantine (NMDA antagonist) for moderate to severe; no disease-modifying therapy proven.

Delirium management

Identify and treat underlying cause; nonpharmacologic measures first; antipsychotics (e.g., haloperidol) used cautiously for severe agitation; avoid benzodiazepines except in alcohol withdrawal.

Lithium toxicity

Symptoms include tremor, ataxia, confusion, seizures; risk factors include dehydration, NSAIDs, ACE inhibitors; treat with hydration and hemodialysis for severe cases.

SSRI discontinuation syndrome

Dizziness, nausea, fatigue, and paresthesias after abrupt cessation; more common with short half-life SSRIs (paroxetine, sertraline); taper gradually.

Postpartum depression treatment

Breastfeeding-compatible SSRIs (sertraline, paroxetine) are first-line; psychotherapy is effective; severe cases may require hospitalization or electroconvulsive therapy.

ADHD pharmacotherapy

Stimulants (methylphenidate, amphetamines) are first-line; nonstimulants (atomoxetine, guanfacine, clonidine) are alternatives; monitor growth and cardiovascular effects.

Autism spectrum disorder

Core features: persistent deficits in social communication and restricted, repetitive behaviors; treatment is behavioral and educational; medications target irritability or hyperactivity.

Wernicke encephalopathy

Caused by thiamine deficiency; triad of ophthalmoplegia, ataxia, and confusion; treat promptly with IV thiamine to prevent Korsakoff syndrome.

Intracerebral hemorrhage management

Reverse anticoagulation, control blood pressure (systolic target ~140 mm Hg), and consider surgical evacuation for cerebellar hemorrhage >3 cm or worsening neurological status.

Transient ischemic attack

Transient focal neurological deficit without infarction; urgent evaluation for stroke risk; start antiplatelet and statin; carotid endarterectomy for symptomatic severe stenosis.

Bacterial meningitis treatment

Empiric third-generation cephalosporin plus vancomycin; add ampicillin for Listeria in neonates, elderly, or immunocompromised; dexamethasone before or with first antibiotic dose reduces hearing loss.

Electroconvulsive therapy indications

Severe major depression with psychosis or catatonia, treatment-resistant depression, acute mania, and catatonia; most effective for severe mood disorders.

Obsessive-compulsive disorder treatment

SSRIs (often higher doses) and exposure and response prevention are first-line; clomipramine is an alternative; antipsychotic augmentation for refractory cases.