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Psych Shelf Exam > Cognitive Disorders > Flashcards

Cognitive Disorders Flashcards

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1
Q

What are the major causes of delerium?

A

AEIOU TIPS

  1. alcohol/drug toxicity/withdrawal
  2. electrolyte imbalance
  3. iatrogenic- anticholinergic, benzo, antiepileptic, bp meds, insulin, hypoglycemics, roids, nsaids, etc
  4. oxygen [hypoxia]
  5. uremia, hepatic encephalopathy
  6. trauma
  7. infection
  8. poison
  9. seizures, strokes
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2
Q

What is perseveration?

A

inability to shift attention appropriately making conversation difficult; repeating words or phrases

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3
Q

What is the most common finding in delerium?

A

impairment of recent memory

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4
Q

Delerium and hemiparesis or focal neuro signs/symptoms makes you think what? What should be ordered?

A

CVA or mass lesion

-get a CT of the brain or MRI

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5
Q

Delerium, elevated BP and papilledema makes you think what? What should be ordered?

A

hypertensive encephalopathy

- get brain CT/MRI

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6
Q

Delerium with dilated pupils and tachycardia point to what?

What should be ordered?

A

Drug intoxication– order a UDS

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7
Q

Delerium, fever, nuchal rigidity, photophobia points to what?
What is ordered?

A

meningitis

-order lumbar puncture

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8
Q

Delerium, tachycardia, tremor, thyromegaly points to what?

Order what?

A

thyrotoxicosis, order T4, TSH

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9
Q

What is first line treatment for delerium?

A
  1. supportive care with hydration, nutrition

2. haloperidol b/c PO,IM, IV

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10
Q

What is the only time benzos should be used in the treatment of delerium?

A

When the delerium is caused by benzo or alcohol withdrawal

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11
Q

What happens to the prevalence of dementia with age?

A

It doubles every 5 years
1.5 percent at 60
40 percent at 90

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12
Q

What should be ordered if a person presents with dementia but has normal CT?

A
  1. complete metabolic panel - hypothyroid, hypoxia, b12 def, wilson disease, lead toxicity
  2. MRI
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13
Q

Dementia with stepwise increase in severity, focal neuro deficits

A
  1. multi-infarct dementia

- order CT/MRI

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14
Q

dementia with cogwheel rigidity and resting tremor

A

lewy body dementia or parkinson disease

-clinical diagnosis

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15
Q

dementia with gait apraxia, urinary incontinence, dilated cerebral ventricles

A

normal pressure hydrocephalus

-ct/mri

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16
Q

dementia obesity coarse hair, constipation, cold intolerance

A

hypothyroidism

-T4, TSH

17
Q

dementia, diminished position and vibration sensation, megaloblasts on CBC

A

B12 deficiency

18
Q

dementia, tremor, abnormal LFTs, kayser-flescher rings

A

wilson disease

- ceruloplasmin

19
Q

dementia, diminished position/vibration sense, argyll-roberston pupils

A

neurosyphilis

-CSF FTA-ABS, VDRL

20
Q

What percent of patients with dementia have hallucinations/delusions?
What percent have depression or anxiety?

A

hallucinations/delusions is 30 percent

anxiety/depression is 40-50 percent

21
Q

How do you test orientation on MMSE? How many points is given?

A
  1. date, month, year
  2. state, city hospital

5 points each

22
Q

How do you test registration on MMSE? How many points is given?

A

repeat 3 words -3 points

23
Q

How do you test attention/calculation on MMSE? How many points is given?

A

Serial 7s, spell world backwards gets 5 points

24
Q

How do you test recall on MMSE? How many points?

A

name the 3 words 5 minutes later- 3 points

25
Q

What score on MMSE signifies dysfunction?

A

25 or lower

26
Q

What neurotransmitter change is seen with alzheimers?

A

decreased Ach due to loss of noradrenergic neurons in the basal ceruleus

27
Q

What is the major susceptibility gene for alzheimers?

A

apoe4

28
Q

What are postmortem findings in the brain for alzheimers?

A
  1. diffuse atrophy with enlarged ventricles and flattened sulci
  2. senile plaques with neurofibrillary tangles
29
Q

What 2 classes of drugs slow alzheimers prgression?

A
  1. cholinesterase inhibitors - tacrine, donepezil, rivastigmine, galantamine
  2. NMDA antagonists- memantine
30
Q

What are the core features of Lewy body dementia?

What drugs are they sensitive to?

A
  1. waxing and waning of cognition
  2. parkinsonism
  3. visual hallucinations

Sensitive to neuroleptics

31
Q

How do you differentiate lewy body dementia from parkinson disease dementia?

A

lewy body- dementia is within 12 months of parkinsonism symptoms

parkinson disease dementia- dementia after 12 months

32
Q

What drugs are used to treat the following associated with lewy body dementia?

  1. visual hallucinations
  2. cognition, apathy, psychomotor slowing
  3. delusions agitation
  4. REM sleep disorder
A
  1. cholinesterase inhibitors
  2. levodopa/carbidopa, stimulants, dopamine agonists
  3. atypical antipsychotics
  4. clonazepam
33
Q

What pathology is associated with FTD?

A

atrophy of frontal/temporal lobes

-neuronal loss, astrocytic gliosis in cortical layer II

34
Q

When does dementia occur in relation to th chorea for Huntington’s disease?

A

1 year before to 1 year after

35
Q

What are the major psychiatric manifestations of huntington’s disease?

A
  1. depression
  2. psychosis
  3. alcoholism

ultimately increased suicide rate

36
Q

What does an MRI of huntington disease show?

A

caudate atrophy

37
Q

A patient smells strange smells and has a sensation that objects are very small [lilliputian hallucination]. Then he loses consciousness and smacks his lips. What is the diagnosis?

A

temporal lobe epilepsy

38
Q

Dementia due to Parkinson disease is exacerbated by what medications?

A

antipsychotics

39
Q

How do you make the probable diagnosis of CJD?

A

1, rapidly progressive dementia (6-12 months)

  1. generalized sharp waves on EEG
    - myoclonus
    - cortical blindness
    - ataxia, EPS
    - muscle atrophy
    - mutism

Psych Shelf Exam (8 decks)

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