Neurology high-yield concepts for USMLE Step 3 from Archer USMLE Step 3/ Instructor : Dr.Red For the high-yield lectures, please visit www.ccsworkshop.com

1. Neurology Archer USMLE Step3 Reviews www.CcsWorkshop.com Archer Slides are intended for use with Archer USMLE step 3 video lectures. Hence, most slides are very brief summaries of the concepts which will be addressed in a detailed way with focus on High-yield concepts in the Video lectures. These slides are only SAMPLES

19. Meningitis

22. Meningitis

24. Meningitis – Emperical therapy Predisposing Factor AGE Common Bacterial Pathogens Antimicrobial Rx <1 month Streptococcus agalactiae, Escherichia coli, Listeria monocytogenes, Klebsiella species Ampicillin plus cefotaxime or ampicillin plus an aminoglycoside 1 - 23 months Streptococcus pneumoniae , Neisseria meningitidis, S. agalactiae, Haemophilus influenzae, E. coli Vancomycin plus a third-generation cephalosporin 2- 50 years N . meningitidis, S. pneumoniae Vancomycin plus a third-generation cephalosporin >50 years S. pneumoniae, N. meningitidis, L. monocytogenes , aerobic gram-negative bacilli Vancomycin plus ampicillin plus a third-generation cephalosporin

25. Meningitis – Emperical therapy Predisposing Factor HEAD TRAUMA Common Bacterial Pathogens Antimicrobial Rx Basilar skull fracture S. pneumoniae, H. influenzae, group A -hemolytic streptococci Vancomycin plus a third-generation cephalosporin Penetrating trauma Staphylococcus aureus, coagulase-negative staphylococci (especially Staphylococcus epidermidis), aerobic gram-negative bacilli (including Pseudomonas aeruginosa ) Vancomycin plus cefepime, vancomycin plus ceftazidime, or vancomycin plus meropenem  YOU ARE Adding an antipseudomonal antibiotic. Postneurosurgery Aerobic gram-negative bacilli (including P. aeruginosa ), S . aureus , coagulase-negative staphylococci (especially S. epidermidis) Vancomycin plus cefepime, vancomycin plus ceftazidime, or vancomycin plus meropenem CSF shunt Coagulase-negative staphylococci (especially S. epidermidis), S. aureus, aerobic gram-negative bacilli (including P. aeruginosa ), Propionibacterium acnes Vancomycin plus cefepime,c vancomycin plus ceftazidime,c or vancomycin plus meropenem

26. Fall Prevention - Elderly

33. Headaches Migraines Tension headaches Cluster Headaches Temporal arteritis Chronic daily headache Analgesic Rebound Headache Post Traumatic Headache Menstrual Migraine Sinusitis

34. Migraines

37. Post-test Probabilities of Migraine Based on the Number of Migraine Features on History Compared to a Reference Standard of Headache Expert Neurologist Clinical Evaluation Result Pretest Probability (%)† 20 50 80 0, 1, or 2 migraine symptoms* 5 15 50 3 migraine symptoms* 75 94 99 4 or 5 migraine symptoms* 90 96 >99

40. Migraines – Drug Rx

41. Acute Migraine Rx

45. Cluster Headaches

50. Trigeminal Neuralgia

55. Tension Headache

58. Chronic Daily Headache Rebound Headaches Analgesic overuse headaches Chronic Migraine

60. CDH – d/d Primary Headaches Headache Duration > 4hrs Headache Duration < 4hrs Chronic (transformed) migraine Strictly unilateral-prominent autonomic features(SUNCT) Chronic tension-type headache Cluster headache New daily persistent headache Paroxysmal hemicrania Hemicrania continua Trigeminal neuralgia Cough headache Benign exertional headache Headache associated with sexual activity

66. Benign Intracranial Hypertension Pseudotumor Cerebrii

69. Bell’s Palsy

76. Multiple Sclerosis

81. Revised McDonald Criteria for Diagnosis of MS

82. Definition of positive MRI—3 out of 4 of the following: 1 gadolinium-enhancing lesion or 9 T2 hyperintense lesions if no gadolinium-enhancing lesion; 1 or more infratentorial lesions; 1 or more juxtacortical lesions; 3 or more periventricular lesions. Note: A spinal cord lesion can be considered equivalent to an infratentorial lesion in the brain. Thus, an enhancing spinal cord lesion is considered to be equivalent to an enhancing brain lesion, and individual spinal cord lesions can contribute together with individual brain lesions to reach the required number of T2 lesions. Clinical (Attacks) Objective Lesions Additional Requirements to Make Diagnosis 2 or more 2 or more None; additional evidence desirable but must be consistent with MS 2 or more 1 Dissemination in space by MRI or positive CSF and 2 or more MRI lesions consistent with MS or further clinical attack involving different site 1 2 or more Dissemination in time by MRI or second clinical attack 1 (monosymptomatic) 1 Dissemination in space by MRI or positive CSF and 2 or more MRI lesions consistent with MS AND Dissemination in time by MRI or second clinical attack 1 (progression from onset) 1 One year of disease progression (retrospectively or prospectively determined) AND Two of the following: a) Positive brain MRI (nine T2 lesions or four or more T2 lesions with positive visual evoked potentials) b) Positive spinal cord MRI (two focal T2 lesions) c) Positive CSF

87. Myasthenia Gravis

95. ALS

101. Neurosyphilis Refer to ID slides under “Syphilis”

102. Delirium Refer to Psychaitry Slides

103. Dementia

121. END Questions?

122. Seizure disorders

123. Parkinson disease

124. Narcolepsy and cataplexy

125. insomnia

126. Guilliane-barre syndrome

127. Peripheral neuropathies