Psych Exam 2

Front 1

Cognitive Disorders show impairments in function having to do with?

Back 1

memory
judgement
attention
language

Front 2

what exam do we do to evaluate congnitive disorders to obtain a gross estimation of cognition?

Back 2

the mini mental state exam (MMSE)

Front 3

what is another name for MMSE?

Back 3

The folstein test

Front 4

What is the Folstein/MMSE used for?

Back 4

30 pt questionnaire test used to assess cognition

-- screens for dementia
10 min: math, memory, orientation

Front 5

on the MMSE what object do you ask the patient to copy?

Back 5

Intersecting pentagons. all ten angles must be present two must intersect to score 1 pt.

Front 6

Can educational backrground affect the results of the MMSE?

Back 6

yes

Front 7

what is the normal score for MMSE

Back 7

>27 out of 30 is normal

23-26 is borderline
normal value corrected for degree of schooling and age.
low scores correlate with dementia

Front 8

A score of __ or less generally suggests dementia but may also be found in acute confusion, schizophrenia or severe depression.

Back 8

22

Front 9

what does an MMSE score of less than 24 mean?

Back 9

may indiate demntia in some patients who are well educated (no excuses for doign badly) and who do not have schizo, severe depression or acute confusion

Front 10

scoring with individuals with dementia of alzheimer's type are?

Back 10

20-26 : mild dz
10-19: moderate
<10 : severe

Front 11

along with routine CBC, lytes, etc, what other lab tests do you want to run on people with suspected cognitive disorders?

Back 11

LFT, VDRL, thyroid, B12, heavy metal tests

Front 12

Alteration (fluctuating) level of consciousness. Associated with altered attention and cognition
Rapid Onset
May be reversible (not always)
Always due to a medical/surgical cause – including medications!

Back 12

Delirium

Front 13

What are the top locations where we would see delirium?

Back 13

highest is surgical ICU
Coronary ICU
then ten med and surgical units

Front 14

what condition is ALWAYs due to medical or surgical cause?

Back 14

delirium

Front 15

Pts with delirium and ____ at increased risk for complications in any clinical situation

Back 15

agitation

Front 16

what is the most widely used bedside rating scale for diagnosing delirium

Back 16

Confusion assessment method (CAM)

Front 17

Most significant elements of the diagnosis of delirium are?

Back 17

inattention and broad fluctuations of sx

Front 18

What is not considered an essential element fo the dx of delieruium?

Back 18

orientation

Front 19

A state marked by
Agitation
Physical aggression
Violence
Hyper-attentiveness (inability to suppress responses to environment or to internal states)
Emotional lability

Back 19

patient are described as having hyperactive delirium

Front 20

State reflects inability to attend in sequential fashion to demands of environment and marked by
Withdrawal
Lack of involvement in or communication with environment
Bland or flat affect
Depressed level of consciousness that is short of frank stupor

Back 20

quiet delirium

Front 21

what are 3 motor sx that patients with delirium can present with?

Back 21

dysarthria (difficulty articulating)
difficulty swallowing
gait disturbances

Front 22

What is the mnemonic to remember Delirium?

Back 22

Bird
imagine a bird trapped inside a bldg.
B- broad fluctuations
I- Inattention
R- rapid onset
D- due to medicine or surgery tx

Front 23

what 3 affective sx might you see in someone with delirium?

Back 23

Dysphoria
Lability
Anxiety

Front 24

what has a worse outcome, sub-syndromal delirium or mild delirium?

Back 24

sub-syndromal because you don't pick up on it and treat it

Front 25

what are the 3 steps important in the DDx of delirium?

Back 25

1. r/o life threatening causes WWHHHIMP
2. r/o impact of meds
3. continue to look for cause

Front 26

what presents more acutely, delirium or dementia?

Back 26

delirium
dementia pts level of attention not as severely affected

Front 27

pts. with delirium superimposed on dementia have how much more risk of mortality at 12 months?

Back 27

2x

Front 28

what does WWHHHIMP, mnemonic we use for DDx of delirium stand for?

Back 28

WWHHHIMP
1. wernicke's encephaopahty
2. withdrawal states after discontinuation of drug use
3. Hypertensive encephalopathy
4. Hypoxia
5. Hypoglycemia
6. ICB
7. Meningitis
8. Poisons

Front 29

what are the two mnemonics we use for ddx of delirium?

Back 29

I WATCH DEATH
WWHHHIMP

Front 30

what does the DDx mnemonic for delerium - I WATCH DEATH stand for?

Back 30

I - infection - syphillis, meningities
W-withdrawal from drugs, eton
A - acute metabolic acidosis, alkalosis, lyte disturbances
T - toxins
C - CNS pathlogies
H - hypertension, hypoglycemia
D - deficiencies b12, niacin, thiamine
E - endocrine issues
A -
T - trauma
H - heavy metals, lead,

Front 31

asterixis was first described by Adams and Foley in pts with?

Back 31

severe liver failure and ecephalopathy

Front 32

what is asterixis?

Back 32

brief, arrhythmic interruption of sustained volunatary mm contraction causing brief lapses of posture. bilateral usually

Front 33

brief warrhythmic interruptions of sustained voluntary muscle contraction causing brief lapses of posture. It is bilateral but can be asymmetrical

Back 33

asterixis

Front 34

when are possible situation in which we will see asterixis?

Back 34

1. drowsy/stuporous pts
2. metabolic encephaopathies
3. decompensated cirrhosis or acute hepatic failure
also in
4. renal failure, azotemia
5. CO2 toxicity
6. Wilson's dz

Front 35

what pre existin disorder can cause poor identification of delirium?

Back 35

pre-existing Axis 1 psychotic dx

Front 36

Quietly delirious patients frequently misidentified as

Back 36

depressed

Front 37

60% of patients with delirium have sx of

Back 37

dysphoria
and 52% have active thoughs of suicide

Front 38

Patients with a significant delirium risk burden in hospital who presents with ACUTE suicidal ideation should be considered ?

Back 38

delirious until proven otherwise

Front 39

is consciousness impaired in delirium or dementia?

Back 39

delirium

Front 40

is demntia reversible?

Back 40

very rarely

Front 41

cannot draw 2 or 3 dimensional forms

Back 41

contructional apraxia

Front 42

dx of dementia is made by?

Back 42

1. memory impairment
2. one or more of the following:
- aphasia
- apraxia
- agnosia
- impaired executive functioning
3. decrease in fnx from baseline
4. deficits must be clinically significant
5. deficits cannot occur exlusively during an episode of delirium
6. cannot be accounted for by another DSM IV dx (alzheimers, CVD dzs)

Front 43

failure to recognize or identify objects despite intact sensory function)

Back 43

agnosia

Front 44

overall incidence of dementia is equal in men and women however men experience less cases of what kind?

Back 44

less rates of alzherimers dz
but higher rates of vascular dementia

Front 45

In alzheimers what do we see intracellulary and extracellulary?

Back 45

intracellulary fibrilary tangles
extracelluarly senile plaques

Front 46

what is the MC type of dementia?

Back 46

alzheimers type

Front 47

what lobes does alzheimers primarily affect?

Back 47

parietal, temporal

Front 48

are these early or late stage signs of dementia - alzheimers dz?
loss of short term memory
word-finding and naming difficulty
develop apraxias

Back 48

early stage

Front 49

are these early or late signs of dementia?
judgment becomes impaired
may develop personality changes
disturbed sleep-wake patterns

Back 49

later stages

Front 50

what psychiatric sx often prominent in alzheimers?

Back 50

depression
delusions
hallucinations
Agitation is frequent

Front 51

If an individual with alzheimers has a family history of depression, he is at increased risk for developing ________ during course of disease with dementia

Back 51

major depressive episodes during course of dz

Front 52

Belief that a friend, family member, or acquaintance been replaced by an identical-looking imposter

Back 52

capgras syndrome

Front 53

what is the MC personality change seen in dementia?

Back 53

apathy

Front 54

Belief that there is an unseen individual living in the home

Back 54

phantom boarder syndrome

Front 55

whats more prevalent in dementia? visual or auditory hallucinations?

Back 55

visual . esp in AA and those with severe stages of illness

Front 56

what are common behavioral and psychological sx of dementia? (BPSD)

Back 56

"Wadds"
weight loss
Apathy
Delusions
Disihibtion
Sleep disturbances

Front 57

what are risk factors of alzheimers disease?

Back 57

age
family hx
hx of head trauma
down's

Front 58

what are the 3 chromosomes linked to development of early onset alzheimers?

Back 58

1. Trisomy 21
2. Chromosome 14
3. Chormosome 1

Front 59

what is the vulberability gene associated with alzheimers?

Back 59

Apo-E4 allele

Front 60

Apo - E4 allele is also associated and presents risk for what dzs?

Back 60

parkisons, lewy body, and alzheimers

Front 61

what are the scales used to assess behavioral and psychological sx of dementia?

Back 61

1 .apathy
2. BEHAVE-D
3. CUSPAD
4. CERAD-BRSD
5. CMAI
6. CSDD
7. NPI

Front 62

Formerly referred to as multi-infarct dementia
Typically involves step-wise progression of cognitive deficits and associated focal signs
and symptoms

Back 62

VASCULAR DEMENTIA

Front 63

what are risk factors for vascular dementia?

Back 63

1. vasculitis
2. vascular disease
3. embolic dz (a.fib)

Front 64

is in a category of diseases called transmissible spongiform encephalopathys (TSEs)

Back 64

Creutzfeldt-Jakob

Front 65

what are the three kinds of CJD?

Back 65

1. hereditary
2. sporadic
3. acquired

Front 66

which CJD?

Most infrequent
Exposure to brain or nervous system tissue (medical procedures).
No evidence is contagious through casual contact with someone who has CJD.

Back 66

acquired

Front 67

which CJD?

Most common
No risk factors
85% of cases.

Back 67

sporadic

Front 68

replicating protein causing spongiform disease in CJD

Back 68

prion

Front 69

what is the prognosis for CJD?

Back 69

usually fatal by 6-12 months, no tx

Front 70

Autosomal Dominant Disease
Chromosome 4
Chance for development of disease in a person who has one parent with disease is 50%

Back 70

huntingtons

Front 71

what percent of huntington's patients develop dementia?

Back 71

90%

Front 72

Brain atrophy
Extensive involvement (atrophy) of basal ganglia and caudate nucleus

Back 72

huntington's dementia

Front 73

Course is progressive
Usually leads to death 15-20 years after the diagnosis
Suicide is common
Become bedridden and suffer

Back 73

huntington's

Front 74

in which type of dementia do you definitely not want to give antipsychotics to?

Back 74

lewy body dementia

Front 75

Parkinson-like symptoms
Extreme sensitivity to antipsychotic drugs
Visual Hallucinations
More marked response to cholinesterase inhibitors

Back 75

lewy body dementia

Front 76

Shares features of both Alzheimer's disease and Parkinson's disease
May have repeated falls
Common psychiatric symptoms include depression and systematized delusions

Back 76

dementia with lewy bodies

Front 77

Same brain distribution as with Alzheimer’s Dementia

Back 77

parkinsons

Front 78

Frontal lobe is predominately involved
See frontal signs of disinhibition
Relative preservation of cognition
May have Kluver-Bucy Syndrome (hypersexuality, hyperorality, placidity)

Back 78

picks dz

Front 79

Depression that presents with cognitive and memory impairment that resembles dementia

Back 79

pseudodementia

Front 80

what are the two methods of drugs for dementia?

Back 80

increase acetylcholine and decrease acetylchoinesterase in the brain
decrease the amount of stimulation at the NMDA receptors

Front 81

which drugs for dementia decrease acetylchoinesterase?

Back 81

1. tacrine
2. donepezil
3. revastigmine
4. galantamine

Front 82

what is the name of the NMDA inhibitor drug to tx dementail?

Back 82

memantine hydrochloride (Namenda)

Front 83

Broad category of disorders that includes wide variety of diseases and conditions that present with amnesia or loss of memory

Back 83

amnestic disorders

Front 84

what are the three types of amnestic disorders?

Back 84

1. due to medical condition (head trauma)
2. Due to substance
3. NOS

Front 85

what is the MC form of amnestic disorder?

Back 85

Thiamine deficiency associated with alcohol dependency

Front 86

Occurs in pts with hx of arachnoid insult-
Infection or bleeding affects ability to absorb spinal fluid
Can be seen with MRI or CT scan
Have sxs that resemble subcortical dementia
Can take years to manifest

Back 86

hydrocephalus

Front 87

Involves gradual process of ventricular enlargement that encroaches on surrounding tissue and vessels
Affects cognitive function

Back 87

hydrocephalus

Front 88

what is the triad of sx seen in hydrocephalus?

Back 88

wet, wacky and wobbly
1. urinary incontinence
2. psychomotor retardation
3. unsteadiness of gait

Front 89

what is the standard test for hydrocephalus?

Back 89

lumbar drain. 50-100cc for 3 days.

1/3 rule:
1/3 improve
1/3 stablaize
1/3 continue to decline