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103 Cards in this Set
- Front
- Back
What is this?
Rapid onset of fluctuating global confusion with disturbances of attention, sleep and activity vary from extreme lethargy to hyperactivity. |
delirium
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What kind of hallucination may people with delirium experience? (visual or auditory)?
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Visual.
*Auditory hallucinations are associated with schizophrenia or other mood disorders. |
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What are the four most important yet often missed symptom descriptions of delirium?
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- confusion
- sudden onset - inattention - fluctuating course |
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What criteria would make the diagnosis of delirium? (4)
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1. acute onset, fluctuating course of mental status change
2. Inattention 3. Disorganized thinking 4. altered level of consciousness Diagnosis requires 1 and 2 with either 3 or 4 |
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What are some causes of delirium? (5)
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1. Drugs
2. alcohol 3. infections 4. metabolic disorders 5. CV disorders |
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What drugs would cause delirium? (8)
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1. sedatives/hypnotics
2. benzodiazepines 3. anticholinergics 4. antidepressants 5. antiparkinsonian agents 6. analgesics: opioids 7. Digitalis preparations 8. steroids |
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What kind of cardiovascular diseases would cause delirium?
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MI
subacute bacterial endocarditis dysrhythmias hypertensive encephalopathy Stroke/ TIA subdural hematoma cerebral vasculitis |
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What are some common infections that would cause delirium?
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- septicemia
- pneumonia - UTI: sometimes may not be real UTI, maybe poor hygiene or old age. - systemic viruses |
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Which of the following is the most common cause of delirium?
A. Drugs B. Infections C. Degenerative diseases D. Metabolic disorders E. Cardiovascular diseases |
A.
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What are some metabolic disorders that may cause delirium?
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- fluid/electrolyte imblaance
- hepatic failure - renal failure - respiratory failure - thyroid disorders - glucose abnormalities - heart stroke or hypothermia - nutritional deficits |
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Could neoplasm (either intracranial or extracranial) cause delirium?
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Yes, but less common.
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Could head injury, surgery or burns cause delirium?
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Yes, but less common.
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Could environmental deprivation or overstimulation cause delirium?
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Yes, but less common.
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A patient who has functioning well cognitively, but quickly develops problems of intellectual functioning or attention. It is ____ until proved otherwise.
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Delirium.
1. make syndrome diagnosis 2. make etiological diagnosis: history, PE, labs... 3. treat causative disease 4. treat symptoms. |
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Which type of intelligence is better in the elderly population? (fluid or crystallized)
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crystallized intelligence: access to material gained from experience.
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Does this require medical attention?
Slower learning, vulnerable to distraction. |
No. Normal aging, short-term memory is more vulnerable to distraction.
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Does this require medical attention?
confusion, disorientation. |
Yes. These represent pathology that demands clinical attention.
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Does this require medical attention?
emotional and behavioral symptoms of memory impairment. |
Yes. These represent pathology that demands clinical attention.
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List some symptoms associated with memory that require medical attention.
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- confusion
- disorientation - emotional and behavioral symptoms |
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Which drugs should you used to calm extremely agitated delirious patients?
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Low dosage antipsychotics:
haloperidol risperidone |
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What is this?
Acquired impairment of cognitive capacity in areas of memory, logical thinking, abstraction, and other aspects of higher cortical functioning. |
Dementia
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Is development of dementia always insidious?
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Yes.
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What is this?
Memory loss aphasia apraxia agnosia disturbance in planning, organizing, sequencing, abstraction |
Dementia
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Is level of consciousness impaired in patients with dementia?
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No.
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Delirium may coexist with dementia. Can you make diagnosis of dementia in a delirious patient?
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No.
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What is pseudodementia?
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A syndrome in which features of dementia are mimicked by functional disturbances.
It is not dementia and it often accompanies depression, also in schizophrenia, mania. And it is treatable. |
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Delirium or dementia?
symptom develop abruptly. |
delirium.
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Delirium or dementia?
symptom develop insidiously. |
dementia
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Delirium or dementia?
impaired attention. |
delirium or advanced stage dementia.
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Delirium or dementia?
fluctuating consiousness. |
delirium or advances stages of dementia.
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Delirium or dementia?
incoherent speech. |
delirium.
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Attention and wakefulness are always preserved in _____. (delirium or dementia)
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dementia
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Depression or dementia?
clear onset, rapid progression. |
depression
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Depression or dementia?
insidious onset, slow progression. |
dementia
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Depression or dementia?
exaggerate deficits. |
depression
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Depression or dementia?
minimize deficits. |
dementia
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Depression or dementia?
variable performance. |
depression
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Depression or dementia?
consistent performance |
dementia
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Depression or dementia?
little effort. |
depression
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Depression or dementia?
struggle to perform. |
dementia
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What is the most common cause of dementia?
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Primary degenerative diseases: 50%.
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Is dementia a syndrome or diagnosis?
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Syndrome. Still need to figure out the etiology!
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What do you test in a cognitive exam?
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1. Sensorium
- orientation: year, month, day, city - memory: 3 word test - cognitive capacity: calculation 2. Intellectual functioning |
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What are some criteria for diagnosis of a probable Alzheimer's disease?
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- deficits in at least 2 areas of cognition
- progressive worsening of cognition - no disturbance of consciousness - between age 40-90, usually after 65 - absence of other disease that could account for these deficits. |
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What are the 7 stages of Alzheimer's disease?
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1. normal
2. very mild: forgetfulness 3. mild: early confusional 4. moderate: late confusional 5. moderately severe: early dementia 6. severe: middle demetia 7. very severe: late demetia |
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Stages of Alzheimer's disease
Cannot survive without assistance Cannot recall major aspects of current life Disoriented |
Early dementia (5)
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Stages of Alzheimer's disease
unaware of all events severely disoriented may become delusional, agitated may become incontinent |
Middle dementia (6)
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Stages of Alzheimer's disease
loose verbal ability incontinent need assistance eating unable to walk |
Late dementia (7)
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Stages of Alzheimer's disease
some anxiety/denial family, coworker notice deficits |
Early confusional (3)
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What are the abnormal proteins in Alzheimer's disease?
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- beta amyloid: in neuritic plaques and neurofibrillary tangles (low)
- Tau protein: hyperphosphotylated tetramer, in neurofibrillary tangles. |
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What chromosome abnormalities are involved in amyloid aggregation in Alzheimer's disease?
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- Ch21: APP gene
- Ch14: presenilin-1 gene - Ch1: presenilin-1 gene - Ch19: ApoE gene |
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Which appears first (tangles or plaques)?
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Tangles
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What is in the amyloid core of neuritic plaques in Alzheimer's disease?
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Ig chains.
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Give 2 treatments for Alzheimer's disease.
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1. acetyl cholinesterase inhibitors
2. memantine: non-competitive NMDA receptor antagonist, block glutamate-induced activation of Ca++ channels. |
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What kind of therapy do you give to probable Alzheimer's disease with mild to moderate severity?
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cognitive enhancement therapy.
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A patient has memory impairment, aphasia, agnosia, apraxia, hyperreflexia, ataxia, and paresis. What is the syndrome?
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Vascular dementia: dementia criteria and signs indicative of cerebrovascular etiology.
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These are the features of ____.
abrupt onset stepwise deterioration fluctuating course spotty patchy deficits depression or emotional incontinence preservation of personality |
vascular dementia
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What are some risk factors for vascular dementia?
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Hypertension
smoking diabetes hypercholesterolemia other vascular disease |
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What is this?
Korsakoff psychosis/ Wernicke-Korsakoff syndrome short-term memory impairment no general loss of intellectual function |
Alcohol amnestic disorder
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What is this?
Global loss of intellectual abilities memory impairment disturbance in abstract thinking/judgement/personality no disturbance in conscious level |
Dementia associated with alcoholism
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What is the most common infectious agent causing dementia in the US?
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HIV
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What is this?
Depression, anxiety early trouble with short term memory apathy, lethargy, irritability, emotional lability unsteady gait, leg weakness, tremot, motor slowing |
HIV-associated minor cognitive/motor disorder (less severe form.
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The lower the CD4 counts, the ____ the rate of HIV dementia.
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Higher
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What is the triad of HIV dementia?
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motor
cognitive behavioral symptoms |
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What is a commonly used AChEsterase inhibitor to treat Alzheimer's disease?
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Donepezil (Aricept)
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What is the physical response to Donepezil for treating Alzheimer's disease?
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Initial improvement in cognition and followed by decline within 2 years.
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Female or male? Normal aging.
Earlier cortical atrophy and more white matter loss. |
Female
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What are some neuronal changes during normal aging?
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- smaller neurons and more dense
- less dendrites - neurofibrillary tangles, senile plaques, lewy bodies. - change in distribution and quantity of neurotransmitters. |
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Normal aging process.
Rank the following in decreasing amount of neurofibrillary tangles or senile plaques present. brainstem cerebral cortex deep gray matter hippocampus |
hippocampus
cerebral cortex deep gray matter brain stem |
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What is the component of the core in neuritic plaques?
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- beta amyloid
- aluminosilicates |
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Normal aging process. Rank the following in decreasing amount of lewy bodies present.
dee gray matter cerebral cortex brainstem (midbrain, pons) |
brainstem (midbrain, pons)
cerebral cortex deep gray matter |
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What are the components of Lewy body?
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alpha-synuclein
ubiquitin parkin |
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Which cell inclusion has a center region with halo around it?
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Lewy bodies
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What is this?
Global impairment of intellect, reason and personality without impairment of consciousness. |
Dementia
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List the five microscopic features of Alzheimer's disease.
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- neuritic plaques
- neurofibrillary tangles - granulovacuolar degeneration - Hirano body (hippocampus) - amyloid angiopathy |
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Where is the gene of APP located?
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CH21
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What two enzyme would cleave APP into insoluble fragments?
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beta and gamma secretase
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Which chromosomes are involved in familial types of Alzheimer's disease?
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Down's syndrome (CH21): onset in 20s
Presenilin 1 (CH14): onset in 40s Presenilin 2 (CH1): onset in 40s Ch21: onset in 50s ApoE e4 (Ch19): onset in 60s, binds beta-amyloid |
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What is the clinical course in Pick's dosease?
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2-5 years, progressive dementia
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What are the components of neurofibrillary tangles?
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- hyperphosphorylated tau protein
- MAP2 - Ubiquitin - amyloid |
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What is this?
parkinsonian features early prominent visual hallucinations |
Dementia with lewy bodies
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What are some possible pathogenesis of Alzheimer's disease?
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loss of acetyltransferase
synaptophysin immunoreactivity amyloid burden loss of synapses |
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What is the genetic defect in Huntington's disease?
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CAG repeat (CH4)
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What is this?
impaired cognition no language deficits movements |
Huntington's disease
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If there is reduced levels of choline acetyl transferase and GABA in the basal ganglia, what disease would you suspect?
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Huntington's disease.
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When depression is also present with patient who has Alzheimer's disease, which type of drug should you avoid using?
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Tricyclic antidepressants
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What type of drugs should you use to treat irritation, agitation symptomatically in patients with Alzheimers?
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- 2nd generation antipsychotics
tradazone at bedtime anticonvulsants (carbamazepine, valporoate) - benzodiazepine only in acute severe agitation. |
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What is the 2nd most common cause of dementia?
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vascular dementia
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What is this?
rapid onset stepwise deterioration in cognition |
vascular dementia
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What is this?
ophthalmoplegia ataxia nystagmus memory impairment |
alcohol amnestic disorder (Wernick's encephalopathy)
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What might cause drug-induced parkinsonism?
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Dopamine antagonists
Merperidine contaminant MPTP (need MAO-B) |
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What is this?
pallor of substantia nigra and locus ceruleus loss of pigmented catecholaminergic neurons with gliosis |
Parkinson's disease
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What are some pathogenesis of Parkinson's disease?
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- alpha-synuclein gene mutation: lipid binding protein in lewy bodies
- parkin gene - UCH-L1: disubiquitin enzyme - DJ-1 (astrocytes) |
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What is this?
initial asymmetric weakness muscle atrophy weakness and spasticity no dementia |
ALS
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Male or female?
High ALS incidence. |
Male slightly
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Most ALS is sporadic. But which chromosome is involved in familial type ALS?
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21
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What is the cause of ALS?
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Multiple!
20%: SOD1 mutation (ch21) glutamate toxicity mitochondrial dysfunction autoimmunity |
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What is this?
GAA repeats (CH9) muscle weakness, difficulty in walking dysarthria areflexia impaired joint position, vibration |
Friedreich's ataxia
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What is this?
clubfoot, hammer toes, foot inversion gradual loss of sensation in extremities which may spread to trunk scoliosis |
Friedreich's ataxia
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In Friedreich's ataxia, what other symptoms might you see on top of motor signs?
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chest pain
HD: myocardial fibrosis, tachycardia carbohydrate intolerance diabetes |
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What is the pathogenesis of Friedreich's ataxia?
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GAA repeats -> low frataxin -> mitochondrial Fe accumulation -> mitochondrial dysfunction -> motor neuron and cardiac tissue.
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What mechanism does DRG degeneration occur in Friedreich's ataxia?
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secondary degeneration.
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What is this?
degeneration of: - posterior columns - corticospinal tracts - dorsal and ventral spinocerebellar tracts - spinal cord nucleus - cerebellum |
Friedreich's ataxia
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