Psych - Cog D/o

Front 1

NT most commonly implicated in delirium

Back 1

ACH (decrease)

Front 2

common metabolic causes of delirium (6)

common infectious causes (4)

common WD states?
common intox states?

Back 2

low Na, O2, Glc
High CO2, Ca, BUN

pneumo, meningitis, uti, sepsis

WD: benzos and etoh
intox: antichol /organophosphates and benzos and ABs and meperidine

Front 3

Incidence of delirium in 65 and older population

Back 3

10-15%

Front 4

major ddx between delirium and dementia

Back 4

onset-dilirium: hrs to days
onset - dementia = wks to yrs

course, delirium: fluctuates w/in a day lasting hrs to weeks
course, dementia: stable during day, progressive over wks to years

identified ppt w/ delirium
non necessarily with dementia (not req)

Front 5

toxins that cause delirium

Back 5

CO and organophosphates

Front 6

key features of delirium:
1-4

can you have hallucinations/delusion here?

Back 6

1. disturbance of consciouslness (arousal and attn)

2. altered cognition (memory, orientation, language, perception)

3. dev over hrs to days

4. substance induced

absolutely!!

Front 7

major etiology underlying dementia

Back 7

neuronal loss 2/2 infarct, low O2, or hydroceph or infection

Front 8

incidence of dementia after age 65? 85?

Back 8

2-4%

20%

Front 9

characteristics of dementia (3)

Back 9

1. memory impairment (can't recognize familiar o bjects or recall names - think short term memory loss)

2. cognition deficits (agnosia, aphasia, apraxia)

3. disturbed executive function

Front 10

during MSE, pt answers "i don't know" to many questions, then when pressed, may answer question correctly

this is characteristic of ____

Back 10

pseudodementia 2/2 depression

Front 11

progression of dementia may occur abruptly 2/2 what conditions?

Back 11

head trauma
vascular insult

Front 12

most common cause of dementia (>50%)?

RFs

Pathology?

Mortality?

Back 12

alzheimers dementia

RF: familial, Down's, prior head trauma, increasing age

Path: cortical atrophy, NF tangles, amyloid plaques, glanulovacuolar degen, loss of basal forebrain cholinergic nuclei

Death: 8-10yrs post dx

Front 13

causes dementia that primary affects the white matter and cortex

Back 13

HIV

Front 14

most commmon cause of dementia in young men

Back 14

head trauma

Front 15

dementia of PD

incidence?

characteristic sx?

Back 15

lewy body dementia

20-60% of PD pts

slowed thinking

Front 16

Dementia producting caudate atrophy?

most common age at onset?

inheritence pattern?

most prominent sx?

Back 16

Huntington's Dementia

mid 30s

AD, chrom 4

emotional lability

Front 17

dementia with frontotemporal degeneration?

onset?

Back 17

Pick's disease

50-60s

Front 18

dementia that responds poorly to psychotrophic drugs

Back 18

frontotemporal degeneration or Pick's dz

Front 19

dementia
myoclonus
abnl eeg

dz?
onset?

Back 19

CJD
onset 40-60

Front 20

Reversible causes of dementia (7)

Back 20

NPH
Thiamine def
folate def
B12 def
Niacin def
HIV
neurosyph

Front 21

4 acetylcholinesterase inhibitors approved for Alzheimers dementia?

which is hepatotoxic

Back 21

tacrine (hepatotoxic)
rivastigmine
donepaezil
galantamine

Front 22

amnestic d/o are caused by ______ which ddx them from dissociative d/o

how is memory in this d/o?

how are they different from delirium and dementia?

Back 22

general medical conditions or substance

they have memory loss (inability to recall previously learned info or retain new info)

amnestic d/o have no cog deficits

Front 23

5 common causes of amnestic d/o

path?

Back 23

head trauma
hypoxia
HSV enceph
PCA infarct
ETOH (Korsakoff)

damage mamillary bodies, fornix, hippocamp

Front 24

most common causes of dementia (3)

Back 24

alzheimers (50%)
vascular dementia (20%)
major depression/pseudodementia

Front 25

drugs that commonly cause dementia like sx

Back 25

etoh (chronic and acute)
phenothiazines
anticholinergics (benztropine)
sedatives (barbs and benzos)

Front 26

dementia with stepwise increase in severity

dx?
tx?

Back 26

multi-infarct dementia

CT/MRI

Front 27

dementia + cogwheel rigidity + resting tremor

dx?
tx?

Back 27

lewy body dementia/parkinsons dz

clinical dx

Front 28

dementia + ataxia + urinary incontinence + dilated cerebral ventricles

dx?
tx?

Back 28

NPH

CT/MRI

wet, wobbly, wacky

Front 29

dementia + obesity + coarse hair + constipation + cold intolerance

dx?
tx?

Back 29

hypothyroidism

T4
TSH

Front 30

dementia + tremor + abnl LFTs + kayser fleischer rings

dx?
tx?

Back 30

Wilson's Dz (onset between 5-35)

ceruloplasmin

Front 31

dementia + diminished position and vibration sensation + megaloblasts on CBC

dx?
tx?

Back 31

Vit B12 deficiency

serum B12

Front 32

dementia + diminished position and vibration sense + pupils that accomodate but dont constrict to light

Back 32

neurosyphilis

CSF fluorescent trepnemal antibody absorptoin test (CSF FTA-ABS or CSF VDRL

Front 33

what is the hallmark of delirium?

does dementia have LOC?

Back 33

waxing and waning consciousness

no

Front 34

tx of delirium

Back 34

1st line = quetiapine
also can use haldol PO/IM but do not use IV unless on cardiac monitor -- can cause torsades

Front 35

answer delirium, dementia or both for the following:

affects immediate memory
affects recent memory
affect long term memory
reduced awareess

eeg changes?

Back 35

delirium
both
dementia
delirium

delirium (fast waves, gen slowing)

Front 36

pt can't copy a picture...this is called ____. this plus memory impairment would be _____?

which psychotic sx are common here?

Back 36

apraxia

alzheimers

paranoia

Front 37

difference between cortical and subcortical dementia -- which are these?

Back 37

cortical dementia = marked decline in intellectual function = Alzheimers, Picks/FTD, CJD

subcortical = more affective and movement sx = Huntingtons, Parkinsons, NPH, multi-infarct dementia

Front 38

delirum + hemiparesis or other focal neuro sx

dx?
test?

Back 38

CVA or mass lesion

Brain CT/MRI

Front 39

delirium + elevated BP + papilledema

Back 39

Hypertensive encephalopathy

Brain CT/MRI

Front 40

Delirium + dialted pupils + tachy

Back 40

drug intox

urine tox screen

Front 41

delirium + F + nuchal rigidity + photophobia

Back 41

Meningitis

test = LP

Front 42

Delirium + Tachy + tremor + thyromegaly

Back 42

Thyrotoxicosis

T4/TSH