Neuromusculoskeletal Ii-Exam 2 (Dr. Bozoki)

Front 1

What observation helps distinguish between dementia and delirium?

Back 1

Level of consciousness.

Front 2

What are the characteristics of active delirium?

Back 2

Hallucinations, Agitation

Front 3

What are the characteristics of passive delirium?

Back 3

Apathy, Withdrawal, Lack of Response

Front 4

What are the 2 hallmark features of delirium?

Back 4

Fluctuating alertness and inattention.

Front 5

What is the hallmark feature of an Alzheimer's patient who is asked to draw a clock?

Back 5

-Concrete or literal interpretation of the instructions***
(Patient put #'s on the clock in the opposite path, and the numbers are not aligned well along the margins of the circle)

Front 6

Involved in differential diagnosis for delirium:
-A form of depression that produces prominent mental slowing and to some degree disexecutive trouble (i.e.difficulty with multi-tasking)
-Patients often complain of having early Alzheimer's Disease rather than a mood disturbance
-Neurologic testing and a good history will elicit some key features that will help in diagnosis.

Back 6

Pseudo-Dementia

Front 7

Involved in differential diagnosis of delirium:
-Meds that the patient is taking
-Laboratory studies

Back 7

Toxic and Metabolic Disturbances

Front 8

Involved in the differential diagnosis of delirium:
-Syphilis
-HIV

Back 8

CNS Infection

Front 9

Involved in the differential diagnosis of delirium:
-uncovered when structural scan is done
-includes: stroke, hydrocephalus, or mass

Back 9

Structural Damage

Front 10

What types of effects may be observed when dementia drugs are given to a patient?

Back 10

Iatrongenic effects-a drug induced delirium can be superimposed onto a dementia that already exists

Front 11

What score on the MMSE correlates well with the presence of dementia?

Back 11

24 out of 30
(But does not differentiate between dementia and delirium)

Front 12

When the patient has only had Alzheimer's Diseae for a short period of time, is MRI or CT helpful?

Back 12

NO

Front 13

Does Alzheimer's exhibit gradual or rapid progression?

Back 13

gradual

Front 14

What type of memory loss in Alzheimer's is the most prominent symptom?

Back 14

recent, episodic memory

Front 15

What is the most significant neurological finding in an Alzheimer's patient?

Back 15

Cognitive Impairment.

Front 16

In Alzheimer's imaging, during a later stage, what structures are reduced to 1/3 of their original volume?

Back 16

hippocampus and mesiotemporal lobe

Front 17

What functional imaging method is especially useful to help diagnose Alzheimer's in the beginning stages of the disease?

Back 17

PET

Front 18

What are the vast majority of Alzheimer's patient's treated with, that results in no change or only a modest improvement?

Back 18

cholinesterase inhibitor

Front 19

What type of dementia occurs with multiple focal strokes and is easy to diagnose?

Back 19

Vascular Dementia.

Front 20

The following are characteristics of what disease?
1.Sudden onset, step-wise decline
2.focal motor, sensory,reflex changes
3.abnormal structural imaging (infarct, ischemia): MRI
4.Hachinski Ischemic Scale Score

Back 20

Vascular Dementia

Front 21

What type of dementia has the following characteristics:
1.More insidious
2.Insidiously progressive, not stepwise
3.MRI shows extensive confluent white matter abnormalities on T2 and FLAIR imaging
4.Autosomal dominant disease CADASIL produces this type of dementia
5.The metabolic syndrome (diabetes,HTN,hypercholesteremia, &smoking) will also produce this type of dementia

Back 21

Atypical Vascular Dementia

Front 22

What illness has the following symptoms?
1.Dementia
2.Parkinsonism
3.Fluctuating Alertness/Attention
4.Visual Hallucinations
(Faster progression, shorter survival)

Back 22

Dementia with Lewy Bodies

Front 23

1.When do hallucinations occur in Alzheimer's Disease?
2.When do hallucinations occur in Dementia with Lewy Bodies?

Back 23

1.During the later stages of the disease
2.During the early stages of the disease

Front 24

What is the traid for normal pressure hydrocephalus?

Back 24

1.Gait Disorder
2.Mild Dementia
3.Urinary Incontinence

Front 25

What is normal pressure hydrocephalus caused by?

Back 25

Problem with reabsorption of CSF and consequent fluid accumulation in adjacent white matter

Front 26

What types dementias first present to the psychiatrist as "late adult schizophrenia"?

Back 26

Frontal Lobe Dementias

Front 27

Clincially, what is the most rapdily progressive dementia?

Back 27

Creutzfeldt-Jakob Disease

Front 28

Startle myoclonus, ataxia, and EOM abnormalities are caused by what disease?

Back 28

CJD

Front 29

What tests are preferred over autopsy when diagnosing CJD? Why?

Back 29

EEG and CSF, b/c autopsy could spread the prion particle.