Dementia and Cognitive Disorders Flashcards
1
Q
Items 1–3
An 82-year-old man has 6 months of worsening memory loss. His fam-
ily is concerned, and he is taken to a physician. Following an extensive
evaluation and neuropsychological testing, he is diagnosed with dementia.
- The most common cause of dementia in the general population is
a. Epilepsy
b. Vascular disease
c. Alzheimer’s disease
d. Parkinson’s disease
e. Head trauma
A
c. Alzheimer’s disease
2
Q
- His physician believes that the patient has Alzheimer’s disease.
Which of the following is most characteristic of the brain in patients with
Alzheimer’s disease?
a. Neuronal loss in the cerebral cortex
b. Demyelination in the cerebral cortex
c. Posterior column degeneration
d. Neuronal loss in the cerebellar cortex
e. Pigmentary degeneration in the hippocampus
A
a. Neuronal loss in the cerebral cortex
3
Q
3. In the dementia associated with Alzheimer’s disease, the EEG will usually show a. Spike-and-wave discharges b. Periodic frontal lobe discharges c. Focal slowing d. Generalized background slowing e. An isoelectric record
A
d. Generalized background slowing
4
Q
- A 55-year-old man has steep decline in his cognitive abilities over a
3-month period. Initial testing is nondiagnostic. He continues to progress
and develops myoclonus and a left hemiparesis. Eventually he dies of an
aspiration about 8 months after the onset of symptoms. In the diseases that
cause dementia, myoclonus is usually most evident in
a. Alzheimer’s disease
b. Creutzfeldt-Jakob disease
c. Parkinson’s disease
d. Huntington’s disease
e. Pick’s disease
A
b. Creutzfeldt-Jakob disease
5
Q
- The brain of the adult with trisomy 21 (Down syndrome) exhibits
many of the histopathologic features of which of the following?
a. Tay-Sachs disease
b. Friedreich’s disease
c. Pick’s disease
d. Parkinson’s disease
e. Alzheimer’s disease
A
e. Alzheimer’s disease
6
Q
Items 6–8
An 80-year-old man has a history of 2 years of progressive gait distur-
bance and incontinence, which had been attributed to old age and prostatism.
Within the past 3 months, he has been forgetful, confused, and withdrawn. His gait is short-stepped, and he turns very slowly, almost toppling over. He has a history of head trauma from 30 years ago. His CT scan is shown below.
- The most likely diagnosis is
a. Alzheimer’s disease
b. Creutzfeldt-Jakob disease
c. Progressive multifocal leukoencephalopathy (PML)
d. Normal-pressure hydrocephalus
e. Chiari malformation
A
d. Normal-pressure hydrocephalus
7
Q
- The patient undergoes lumbar puncture. Forty milliliters of fluid are
removed. Three hours later, he is able to walk unassisted and turns well.
Spinal fluid would be expected to show
a. No abnormalities
b. Elevated protein
c. Low protein
d. Atypical lymphocytes
e. Low glucose
A
a. No abnormalities
8
Q
8. The patient undergoes ventriculoperitoneal shunt placement. He is discharged 2 days later, his gait and cognition much improved. The following morning, his wife finds him lying in bed, very confused and complaining of a headache. He is unable to walk. The surgeon who performed the procedure is concerned that these new symptoms are due to a. Chemical meningitis b. Subdural hematoma c. Epidural hematoma d. Seizures e. Bacterial ventriculitis
A
b. Subdural hematoma
9
Q
Items 9–11
A 67-year-old man has a history of progressive memory loss for 2
years. His examination is otherwise normal. A diagnosis of Alzheimer’s disease
is made.
9. Which of the following medications may retard the progress of this patient’s deterioration? a. Donepezil b. L-dopa c. Risperidone d. Prednisone e. Vitamin B12
A
a. Donepezil
10
Q
10. Which of the following medications may reduce the chances of his being placed into a nursing home? a. Vitamin B12 b. Vitamin E c. Estrogen therapy d. Amantadine e. Haloperidol
A
b. Vitamin E
11
Q
11. Language testing is most likely to uncover which of the following deficits? a. No abnormalities b. Mutism c. Conduction aphasia d. Transcortical sensory aphasia e. Transcortical global aphasia
A
d. Transcortical sensory aphasia
12
Q
Items 12–17 For each clinical scenario, choose the most likely diagnosis. a. Transient global amnesia b. Normal-pressure hydrocephalus c. Alzheimer’s disease d. Parkinson’s disease e. Creutzfeldt-Jakob disease f. Vitamin B12 deficiency g. Hypothyroidism h. Huntington’s disease i. Rett syndrome j. Multi-infarct dementia k. General paresis l. Temporal lobe epilepsy
- A 73-year-old man steps out of the shower on a Saturday evening
and is unable to remember that he and his wife have tickets to a play. He
asks her repeatedly, “Where are we going?” He appears bewildered, but is
alert, knows his own name, speaks fluently, and has no motor deficits. He
has no history of memory disturbance, and after 8 h returns to normal.
A
a. Transient global amnesia
13
Q
- A 50-year-old woman began complaining of double vision and
blurry vision 3 months ago and has since had diminishing interaction with
her family, a paucity of thought and expression, and unsteadiness of gait.
Her whole body appears to jump in the presence of a loud noise. An MRI
scan and routine CSF examination are unremarkable.
A
i. Rett syndrome
14
Q
- A 2-year-old girl developed normally until the past year. She has
since become unable to speak or otherwise communicate with her parents,
sits in a chair, and makes nearly continuous wringing movements with her
hands. She also has episodes of breath holding alternating with hyperventilation.
A
e. Creutzfeldt-Jakob disease
15
Q
- A 17-year-old girl develops mild dementia, tremor, and rigidity. Her
father died in his fourth decade of life of a progressive dementing illness
associated with jerking (choreiform) limb movements. On exposure to
Ldopa,
she becomes acutely agitated and has jerking limb movements.
A
h. Huntington’s disease
