Cognitive DO

Question 1

What percentage of medically admitted patients exhibit delirium?

Answer 1

10-30%

Question 2

What type of hallucinations are common in delirium?

Answer 2

Visual

Question 3

MC finding in delirium?

Answer 3

Impairment in recent memory

Question 4

Delirium + focal neurologic s/s: Dx and confirmatory test?

Answer 4

CVA or mass lesion; Brain CT/MRI

Question 5

Delirium + elevated BP + papilledema: Dx and confirmatory test?

Answer 5

HTNsive encephalopathy; Brain CT/MRI

Question 6

Delirium + dilated pupils + tachycardia: Dx and confirmatory test?

Answer 6

Drugs; urine tox screen

Question 7

Delirium + fever + nuchal rigidity + photophobia: Dx and confirmatory test?

Answer 7

Meningitis; LP

Question 8

Delirium + tachycardia + tremor + thyromegaly: Dx and confirmatory test?

Answer 8

Thyrotoxicosis; T4/TSH

Question 9

What major class of drugs in CI in delirium because they can paradoxically exacerbate it?

Answer 9

BNZs

Question 10

2 MCCs of dementia?

Answer 10

AD > vascular dementia

Question 11

Dementia + normal CT. What test(s) should you order next?

Answer 11

MRI + complete metabolic panel

Question 12

Work-up for reversible causes of dementia?

Answer 12

CBC
Electrolytes
TFTs
VDRL/RPR
B12/folate
Brain CT or MRI

Question 13

Dementia + stepwise deterioration + focal neuro signs: Dx and confirmatory test?

Answer 13

Multi-infarct dementia; CT/MRI

Question 14

Dementia + cogwheel rigidity + resting tremor: Dx and confirmatory test?

Answer 14

Lewy body dementia or PD (depends on timeline); clinical dx

Question 15

Dementia + gait apraxia + urinary incontinence + dilated ventricles: Dx and confirmatory test?

Answer 15

NPH; CT/MRI

Question 16

Dementia + obesity + coarse hair + constipation + cold intolerance: Dx and confirmatory test?

Answer 16

Hypothyroidism; TSH/T4

Question 17

Dementia + decr vibration/position sense + megaloblastic anemia: Dx and confirmatory test?

Answer 17

B12 deficiency; serum B12 (although I think world/FA for step 1 said methylmalonic acid levels are better)

Question 18

Dementia + tremor + abnormal LFTs + copper rings around the eyes: Dx and confirmatory test?

Answer 18

Wilson dz; ceruloplasmin

Question 19

Dementia + decr vibration/position sense + Argyll Robinson pupils: Dx and confirmatory test?

Answer 19

Neurosyph; CSF FTA-ABS or CSF VRRL

Question 20

MMSE: dysfunction present under what score?

Answer 20

<25

Question 21

Describe EEG in delirium vs dementia

Answer 21

Normal in dementia

Fast waves or generalized slowing in delirium

Question 22

Neurochemical problems in AD?

Answer 22

Loss of noradrenergic neurons in basal ceruleus + decr choline acetyltransferase–> decr Ach

Question 23

AD: how long from dx to death?

Answer 23

10 yr

Question 24

3 genes linked to early onset AD?

Answer 24

Presenelin I or II; APP

Question 25

Senile plaques and neurofibrillary tangles are found in what 2 other conditions besides AD?

Answer 25

Down syndrome

Normal aging

Question 26

Gross brain findings in AD?

Answer 26

Diffuse atrophy w/ enlarged ventricles + flattened sulci

Question 27

Which correlates w/ severity of dementia in AD: neuritic plaques or neurofibrillary tangles?

Answer 27

Plaques

Question 28

Cholinesterase inhibitors are indicated for what severity of AD?

Answer 28

Mild-moderate

Question 29

NMDA antagonists are indicated for what severity of AD?

Answer 29

Moderate-severe