dementia

Question 1

65 y/o M with 6 mo h/o confusion episodes, disorientation, VHs of children playing in his room. Hallucinated images are fully formed, colorful, vivid and pt has little insight into their nature. No AH. Wife says he is normal between episodes. Exam: Normal language, memory, mod diff with trails test, mild diff with serial subtractions, mild symmetric rigidity and bradykinesia. Brain MRI unremarkable. CSF, routine labs and UDS normal. Diagnosis: (7x)

Answer 1

LEWY BODY DEMENTIA

Question 2

When combined with functional neuroimaging, which of the following biomarkers is most likely to identify those geriatric pts with mild cognitive impairment most at risk for developing Alzheimer’s disease? (7x)

Answer 2

E-4 APOLIPOPROTEIN E ALLELE

Question 3

80 y/o with VH and worsening gait, episodic confusion, disturbed sleep, fighting in sleep, bilateral rigidity, masked facies. Levodopa/carbidopa improved movement temporarily. Diagnosis? (4x)

Answer 3

DEMENTIA WITH LEWY BODIES

Question 4

80 y/o pt with Alzheimer’s is brought in for increasingly combative behavior. Daughter would like to keep the pt at home if possible. What interventions would be most helpful in this situation? (3x)

Answer 4

ASSESSING FOR CAREGIVER BURNOUT

Question 5

91 y/o hospice pt w/ cachexia, end stage dementia, and renal impairment has stopped eating and drinking. What comfort measure would be most appropriate? (3x)

Answer 5

FREQUENT SMALL SIPS OF WATER

Question 6

Which of the following is the most specific factor for distinguishing delirium from dementia of the Alzheimer type? (2x)

Answer 6

FLUCTUATING AROUSAL

Question 7

Neurocognitive functions most likely to show decline in people over 65 years of age? (x2)

Answer 7

INFORMATION PROCESSING SPEED

Question 8

Over the course of several months, a 46 yo pt w no past psych hx becomes emotionally labile/irritable. Pt undergoes personality changes, is observed to laugh inappropriately when neighbor kids taunt stray cat. Within 2 yrs pt is convinced all food has germs. Memory is preserved. Pt is no longer able to work/live independently. Neuropsych testing shows impaired language/attn. (2x)

Answer 8

FRONTOTEMPORAL DEMENTIA

Question 9

Excess activation of which receptor contributes to cell death in Alzheimer dx?

Answer 9

NMDA

Question 10

Test that differentiates Alzheimer’s from frontal-temporal dementia

Answer 10

SINGLE PHOTON EMISSION CT SCAN

Question 11

Neurocog d/o with fluctuating rate of progression, visual spatial impairment and early unilateral resting tremor and increased muscle tone.

Answer 11

DEMENTIA WITH LEWY BODIES

Question 12

Confabulation is:

Answer 12

UNCONSCIOUS FILLING IN OF MEMORY GAPS

Question 13

What test is most helpful to distinguish dementia vs delirium

Answer 13

EEG

Question 14

Suggests delirium rather than dementia:

Answer 14

CLOUDING OF CONSCIOUSNESS

Question 15

85 yo patient with hx of dementia admitted for agitation becomes more confused and angry. What lab should you get?

Answer 15

UA

Question 16

Picture of tau staining for pt with progressive dementia. Dx?

Answer 16

ALZHEIMER’S

Question 17

80yo p/w insidious forgetfulness f/b progressive language impairment 2yr later with difficulty using common tools/appliances. Dx?

Answer 17

ALZHEIMER’S DISEASE

Question 18

Which cancer treatment may be followed by a subcortical dementia due to a leukoencephalopathy with onset after 6 months post-treatment?

Answer 18

WHOLE BRAIN RADIATION

Question 19

A pt who has been receiving dialysis tx for years has become more disoriented, has memory loss. Physical exam normal, nursing staff report that pt has begun to have seizures. Blood lab testing shows no obvious etiology, neurodiagnostics show no suggestive findings. What most likely accounts for this presentation?

Answer 19

DIALYSIS DEMENTIA

Question 20

FTD with mutation in chromosome 17 is assoc with abnormal intraneuronal deposition of which protein?

Answer 20

TAU

Question 21

A doc meets with a pt and family to discuss treatment of pt’s mild Alzheimer’s disease. There are no other neurological or psychiatric symptoms or findings. The most appropriate course of action would be to:

Answer 21

BEGIN CHOLINESTERASE INHIBITOR TREATMENT

Question 22

74 y/o, right-handed patient presents with significant memory loss, expressive aphasia, and left plantar extensor response. The most likely diagnosis is:

Answer 22

VASCULAR DEMENTIA

Question 23

Earliest evidence of cell loss in pts with Alzheimer’s Dz typically occurs in which of the following areas of the brain?

Answer 23

ENTORHINAL CORTEX

Question 24

74 y/o F suspicious, poor ADLs, personality changes, most likely dx:

Answer 24

PICK’S DISEASE

Question 25

Protein mutation associated with Alzheimer disease in people younger than 60 yo

Answer 25

AMYLOID PRECURSOR

Question 26

80 y/o pt w/ no prior psych hx, more forgetful, having difficulty with ADLs. However, pt is able to conduct routine social activities so that casual acquaintances don't notice abnormalities. What is the dx?

Answer 26

ALZHEIMER DEMENTIA

Question 27

Neurofibrillary tangles in Alzheimer's are composed of:

Answer 27

HYPERPHOSPHORYLATED TAU PROTEINS

Question 28

80 y/o Alzheimer's with increasingly combative behavior. Family wants to keep at home. Give what medication?

Answer 28

HALDOL

Question 29

Dementia characterized by personality change, attention deficit, impulsivity, affect lability, indifference, perseveration, and loss of executive function. Assoc. with dysfunction in what area of the brain?

Answer 29

FRONTAL LOBE

Question 30

Early stage HIV type I associated dementia as compared to early onset dementia has which of the following deficits?

Answer 30

DECREASED PROCESSING SPEED

Question 31

Which meds have best results for treating agitation in dementia?

Answer 31

ANTIPSYCHOTICS

Question 32

Amyloid precursor protein in what cognitive disorder?

Answer 32

ALZHEIMER'S DZ

Question 33

Most common cause of dementia in pts > 65 yrs of age:

Answer 33

ALZHEIMER'S DZ

Question 34

Characteristic MRI scan finding in Alzheimer disease:

Answer 34

REDUCED HIPPOCAMPAL VOLUMES.

Question 35

Known risk factors for dementia:

Answer 35

AGE, FAM HX, FEMALE, DOWN'S SYNDROME

Question 36

Pt with vascular dementia typically has neuropathological changes assoc with:

Answer 36

BASAL GANGLIA

Question 37

An 82-yo pt has falls, ophthalmoplegia, parkinsonism and progressive dementia. Autopsy shows:

Answer 37

TAU POSITIVE NEUROFIBRILLARY TANGLES

Question 38

65 y/o is brought to the ED with disorientation and mild agitation, and is experiencing vivid VH of several children playing inside the house. Two similar episodes in the past, normal in between episodes. Normal language and memory, normal CN, mild symmetric rigidity and bradykinesia, no deficits. MRI, drug screen, CSF normal:

Answer 38

DEMENTIA WITH LEWY BODIES

Question 39

A med that is most likely to slow the progression of vascular dementia:

Answer 39

ASPIRIN

Question 40

Best rationale for using cholinesterase inhibitors in pts with Alzheimer:

Answer 40

TO REDUCE NEUROPSYCH SYMPTOMS

Question 41

The most important tool for evaluation of early and moderate dementia:

Answer 41

MMSE

Question 42

Dementia rather than depression in regards to memory has

Answer 42

NAMING DEFICITS (RATHER THAN IMPAIRED NONVERBAL INTELLIGENCE)

Question 43

Bilat loss of neurons in the CA1 segment of the hippocampus is the most common histologic finding in patients with:

Answer 43

ALZHEIMER DEMENTIA

Question 44

Patient is Alzheimer's dementia in clinic. Patient's daughter is frustrated with having to care for her mother more and is considering removing her from her church group because of it. What is the most initial response by the psychiatrist?

Answer 44

TELL HER TO CONTINUE GOING TO HER CHURCH GROUP

Question 45

PET scan shows bitemporoparietal hypoperfusion in early stages of which dementia?

Answer 45

ALZHEIMERS

Question 46

65 y/o pt brought in by family for gradual onset and very slow progression of mental confusion with respect to place and time, anomia, slowness of comprehension, neglect of personal hygiene and grooming, apathy, and alterations of personality and behavior, impairment of gait and upright stance, and prominent grasp and suck reflexes. Dx? The clock drawing test is a quickly administered and sensitive screen for:

Answer 46

FRONTOTEMPORAL DEMENTIA OR ALZHEIMER DEMENTIA

Question 47

65 y/o high school grad has a MMSE score of 23, this score would suggest which of the following:

Answer 47

DEMENTIA, MILD COGNITIVE IMPAIRMENT

Question 48

Individuals over 40yo with Down's syndrome frequently develop:

Answer 48

ALZHEIMER'S DZ

Question 49

HIV+ pt w/ memory loss, inattention, lack of motivation, & poor coordination. Normal LP. CT scan shows atrophy. MRI shows diffuse & confluent white matter changes in T2, w/o any mass effect or gadolinium enhancement. Dx?

Answer 49

HIV- ASSOCIATED DEMENTIA

Question 50

Binswanger disease has pseudobulbar state, gait disorder, AND:

Answer 50

DEMENTIA

Question 51

Clock drawing test is quickly administered and sensitive screen for which d/o?

Answer 51

ALZHEIMER'S DZ

Question 52

Brain of football player who died by suicide has findings typical of chronic traumatic encephalopathy, what is most typical pathology for this behavior?

Answer 52

TAUPATHY

Question 53

54yr old pt dies from rapidly progressing dementia associated with myoclonus, what is most likely finding at autopsy?

Answer 53

MICROVACUOLATION OF GLIA AND NEURONAL DENDRITES

Question 54

Psych eval of 82 y/o F with memory loss (mostly working memory): she frequently calls for help with bathroom but will urinate on herself (staff feel pt is doing this to get back at them). Pt frustrated with staff because she feels the sudden need to void without much warning and wishes the staff would arrive sooner because she's embarrassed about this. MSE significant only for mod memory loss, labs are normal. Which behavioral intervention should be attempted with pt?

Answer 54

SCHEDULE REGULAR VOIDING, INDEPENDENT OF PT REQUESTS, AND SUFFICIENTLY FREQUENT TO ELIMINATE THE ACCIDENTS

Question 55

Which is important when working w/ family members who are caregivers to pts w/dementia?

Answer 55

Work w/fam should enhance effectiveness of care to pt.

Question 56

What characterizes executive abilities in healthy individuals >65?

Answer 56

SHOW NO SIGNIFICANT CHANGE

Question 57

Fluent speech w preserved comprehension, inability to repeat statements is consistent with what type of aphasia?

Answer 57

CONDUCTION

Question 58

In normal aging, last cognitive abilities to decline

Answer 58

WORD KNOWLEDGE

Question 59

Medicare pays for hospice care when a physician declares that a patient has a maximum life expectancy of how long?

Answer 59

6 MONTHS

Question 60

Two days after bowel surgery, 53 y/o is delirious. Correctly draws a square when asked, but then continues to draw squares when asked to draw other shapes. MSE would reveal:

Answer 60

PERSEVERATION

Question 61

Cancer patient on chemo is disoriented and agitated. Afebrile VSS. Neg neuro exam. Poor attention, cog impairment. Held for observation. CT neg, EEG diffuse slowing. Treat with:

Answer 61

HALDOL

Question 62

78 y/o pt with Alzheimer's dementia living with spouse and daughter, starting to accuse the spouse of infidelity. On evaluation, he asserts that the spouse is unfaithful. He is alert and acts congenially with the spouse, he is on donepezil. Labs and medical workup is unrevealing of any disorder outside of dementia. Next?

Answer 62

ARRANGE FOR REGULAR EVALUATIONS OF THE PT AND REASSURE THE FAMILY.

Question 63

Family of 75 y/o pt is concerned about his safety b/c he has been forgetting to turn off stove. Psych MD suspects an evolving cognitive d/o. What is most likely to be the earliest impairment to occur in the pt?

Answer 63

INABILITY TO RECALL 3 WORDS AFTER A 3 MIN DELAY

Question 64

85 y/o nursing home pt w/ hx of dementia being more confused and screaming "fire" whenever the light next to the bed is turned on. Next step?

Answer 64

URINALYSIS

Question 65

Epigenetic drift has been postulated to contribute to what disorder?

Answer 65

LATE ONSET ALZHEIMER'S DISEASE