Cognitive Disorders

Question 1

tremor, extrapyramidal sx, frontal dizziness, ad sluggish pupillary reflexes

Answer 1

tertiary syphillis

Question 2

What 2 tests are a part of every initial psychiatric workup

Answer 2

Venereal Disease Research Lab Test (VDRL) and TSH

Question 3

waxing and waning change in a patient’s level of consciousness

Answer 3

Delirium

Question 4

Causes of delirium

Answer 4

Alcohol/Drugs toxicity or withdrawl, Electrolyte imbalance, Iatrogenic, Oxygen hypoxia, uremia, Trauma, Infection, Poisons, Seizures, Stroke (AEIOU TIPS)

Question 5

Risk factors for delirium (9)

Answer 5

Advanced age, preexisting brain damage (dementia, CVA), prior history of delirium, alcohol dependence, diabtes, cancer, sensory impairment or blindness, malnutrion and male gender

Question 6

2 typical sx of delirium

Answer 6

Visual hallucinations and short attention span

Question 7

clinical manifestation of delirium

Answer 7

disorientation to time and place rarely person, language distrubances, changes in speech, perceptual disturbances, disturbance in psychomotor activity, emotional disturbance, inability to shift attention appropriately

Question 8

Most common finding in delirium

Answer 8

impairment in recent memory

Question 9

delirium plus hemiparesis or other focal neuro signs and sx

Answer 9

CVA or mass lesion

Question 10

delirium plus elevated blood pressure plus papilledema

Answer 10

hypertensive encephalopathy

Question 11

delirium plus dilated pupils plus tachycardia

Answer 11

drug intoxication

Question 12

delirium plus fever plus nuchal rigidity plus photophobia

Answer 12

meningitis

Question 13

delirium plus tachycardia plus tremor plus thyromegaly

Answer 13

throtoxicosis

Question 14

which drug class is avoided in treating delirium because it will often exacerbate the delirium

Answer 14

benzos

Question 15

impairment of memory and cognitive function without alteration in the level of consciousness

Answer 15

Dementia

Question 16

What should you do if a patient presents with dementia but has a normal CT scan?

Answer 16

order a complete metabolic panel and MRI

Question 17

Reversible dementia accompanied by depressed mood and lethargy is commonly caused by

Answer 17

hypOthyrodism (elevated TSH)

Question 18

dementia with stepwise increase in severity plus focal neuro signs

Answer 18

Multi-infarct dementia

Question 19

Dementia plus cogwheel rigidity plus resting tremor

Answer 19

Lewy body dementia or Parkinson disease

Question 20

dementia plus gait apraxia plus urinary incontinence plus dilated cerebral ventricles

Answer 20

normal pressure hydrocephalus

Question 21

Dementia plus obesity plus coarse hair plus constipation plus cold intolerance

Answer 21

hypothyroidism

Question 22

Dementia plus diminshed position and vibration sensation plus megaloblasts on cbc

Answer 22

Vitamin b12 deficiency

Question 23

Dementia plus tremor plus abnormal LFTs plus kayser fleisher rings

Answer 23

wilson disease

Question 24

dementia plus diminished position and vibration sensation plus Argyll Robertson Pupils (Accomadation Response present but response to light absent)

Answer 24

neurosyphilis

Question 25

most common type of dementia

Answer 25

Alzheimer

Question 26

Alzheimer affects which gender more?

Answer 26

Women (3x more)

Question 27

Neurotransmitter disturbance seen in Alzheimer

Answer 27

Decreased ACh due to a loss of noradrenergic neurons in basal ceruleus and decreased choline acetyltransferase

Question 28

What other changes are seen in alzheimers besides for decline in cognitive function?

Answer 28

personality change, mood swings and paranoia

Question 29

Motor and sensory impairment in alzheimer disease is seen when?

Answer 29

late in the course of the illness

Question 30

How do you diagnose Alzheimer disease

Answer 30

Clinical Diagnosis

Question 31

Major susceptiblity gene for alzheimer

Answer 31

Apolipoprotein e4 (APOe4)

Question 32

Treatment for Alzheimer

Answer 32

Cholinesterase inhibitors (tacrine, donepezil, rivastigmine, galantamine) and NMDA antagonist (Memantine)

Question 33

Chronically progressing dementia with multiple small infarcts

Answer 33

Vascular dementia

Question 34

Risk factors for Vascular Dementia

Answer 34

Hypertension, Diabetes, Strokes, APOe4, and being Male

Question 35

A stroke in what lobe of the brain can lead to sx of schizophrenia, bipolar I disorder, and depression

Answer 35

Frontal Lobe

Question 36

Step wise deterioration of cognitive function

Answer 36

Vascular Dementia

Question 37

Tx for Vascular Dementia

Answer 37

No Cure or truly effective treatment, cholinesterase inhibitors and antihypertensive medications (to prevent onset of vascular dementia)

Question 38

Pathological aggregation of alpha-synuclein in the brain, primarily in the basal ganglia

Answer 38

Lewy Body Dementia

Question 39

progressive cognitive decline, waxing and waning of cognition, visual hallucinations (vivid, colorful, well formed images of animals and people), paranoid delusions, parkinsonism, sensitivity to neuroleptics and REM sleep disorder

Answer 39

Lewy Body Dementia

Question 40

Onset of dementia within 12 months of parkinsonism sx

Answer 40

Lewy body Dementia

Question 41

Onset of dementia over 12 months of parkinsonism sx

Answer 41

Parkinson disease dementia