Dementia and head trauma

Question 1

What blood work should be done when working up a patient for dementia

Answer 1

CBC
CMO
TSH
Drug screen
Ammonia levels
Syphilis screen
Heavy metal screen

Question 2

What is the most common type of dementia

Answer 2

alzheimers dementia

Question 3

What is Alzheimers dementia

Answer 3

Progressive dementia cause by intracellular neurofibrillary tangles and extracellular plaques

Question 4

What are some Alzheimers dementia treatments

Answer 4

AChE inhibitors
-Donepezil, Rivastigmine

NMDA agonists
-Memantine

Question 5

What is the second most common type of dementia

Answer 5

Vascular dementia

Question 6

Which gender is at higher risk for vascular dementia

Answer 6

Men

Question 7

What is vascular dementia

Answer 7

Ischemia of the brain & lacunar infarcts

Question 8

What are some associated causes of vascular dementia

Answer 8

Hypertension
High cholesterol

Question 9

What are the 2 subtypes of vascular dementia

Answer 9

Cortical
Subcortical

Question 10

What is cortical vascular dementia

Answer 10

Speech difficulty
Loss of ADL
Confusion
Amnesia

Question 11

What is subcortical vascular dementia

Answer 11

Motor deficit
gait changes
urinary incontinence
personality changes

Question 12

What may be seen in labs for vascular dementia

Answer 12

Hyperlipidemia

Question 13

What may be given as treatment for vascular dementia to manage disease

Answer 13

States and anti platelets for treatment of hyperlipidemia and hypertension

Question 14

What is Lewey body dementia caused by

Answer 14

Deposits in nerve cells known as Lewy bodies in the midbrain, brain stem, and olfactory bulbs

Question 15

What are some side effects from Lewy body dementia

Answer 15

Delusions
visual hallucinations
anxiety

Question 16

What is frontotemporal dementia

Answer 16

Dementia caused by the degeneration of the frontal / temporal lobes

*pick disease

Question 17

What does frontotemporal dementia cause

Answer 17

Euphoria
apathy
disinhibition
compulsions

Question 18

What is pseudo dementia

Answer 18

Perceived memory loss with normal MOCA MRI and labs

Question 19

What generally causes pseudo dementia

Answer 19

Uncontrolled depression and anxiety

Question 20

How will you treat pseudo dementia

Answer 20

SSRIs and counseling

Question 21

What does GCS stand for

Answer 21

Glasgow coma scale

Question 22

What do you measure on a GCS

Answer 22

Eye open response
best verbal response
Best motor response

Question 23

How do you measure the eye opening response with GCS

Answer 23

4- Spontaneously
3- To speech
2-To pain
1-No response

Question 24

How do you measure best verbal response on a GCS

Answer 24

5-Oriented to time, place, person
4-Confused
3-Inappropriate words
2-Incomprehensible sounds
1-No response

Question 25

How do you measure best motor response on a GCS

Answer 25

6- Obeys command 5-Moves to localized pain 4-Flexion withdrawal to pain 3-Abnormal flexion (decorticate) 2-Abnormal extension (decerebrate) 1-No response

Question 26

If someone is dead, what is their GCS

Answer 26

3

Question 27

If a patient is comatose, what is their GCS

Answer 27

8 or less

Question 28

What is the highest score you can get on a GCS

Answer 28

15

Question 29

What accounts for 50% trauma deaths in children

Answer 29

Head trauma

Question 30

What are contra-coup injuries

Answer 30

Injuries that happen on the opposite side of impact

Question 31

Where do intracerebral hemorrhages occur

Answer 31

in the intraparenchymal space (will not touch the skull)

Question 32

What causes an intracerebral hemorrhage

Answer 32

Trauma AVM Hypertension

Question 33

What are the symptoms of an intracerebral hemorrhage

Answer 33

Headache N/V hemiplegia hemiparesis

Question 34

How do you treat an intracerebral hemorrhage

Answer 34

steroids to decrease edema antiepileptics possible surgical intervention

Question 35

If you are concerned someone has an intracerebral hemorrhage, would you preform an LP

Answer 35

NO! Can cause herniation

Question 36

what are some causes of a subarachnoid hemorrhage

Answer 36

Trauma AVM Cherry aneurysm

Question 37

What are some symptoms of a subarachnoid hemorrhage

Answer 37

Sudden "thunderclap" headache (usually unilateral) N/V

Question 38

What are meningeal signs of a subarachnoid hemorrhage

Answer 38

Photophobia confusion Neck stiffness

Question 39

What treatment can you use for a subarachnoid hemorrhages

Answer 39

Stool softeners Phenytoin Nimodipine (BP control)

Question 40

Where does an epidural hematoma occur

Answer 40

It is an arterial bleed between the skull and the dura

Question 41

What causes an epidural hematoma

Answer 41

Skull fracture damaging the middle meningeal artery

Question 42

What are the signs of an epidural hematoma

Answer 42

Headache N/V CSF fluid leak Focal neuro changes Coma *will have LOC and then regain it before losing it again

Question 43

What will an epidural hematoma look like on imaging

Answer 43

Convex bleed that doesn't cross the line in the temporal area

Question 44

What is a subdural hematoma

Answer 44

Venous bleed between the dura and the arachnoid from torn bridging veins

Question 45

What causes a subdural hematoma

Answer 45

Trauma

Question 46

What symptoms occur with subdural hematoma

Answer 46

Focal neuro symptoms severity varies

Question 47

What will be seen on imaging with a subdural hematoma

Answer 47

Concave bleeding that crosses suture lines

Question 48

What is a concussion

Answer 48

Traumatic brain injury causing alterations in mental status or LOC *neurons lose their neurotransmitters

Question 49

What are immediate symptoms of a concussion

Answer 49

amnesia confusion decreased coordination emotional changes disorientation

Question 50

What symptoms should never be included with a concussion

Answer 50

change in pupil size hemiparesis visual field deficit

Question 51

What CT findings should be seen with a concussion

Answer 51

none

Question 52

What do you give someone with mild headache symptoms

Answer 52

NSAID Excedrin

Question 53

What do you give someone with moderate headache symptoms

Answer 53

Triptan medications *target the blood vessels *cannot use it more than 10 days a month b/c of rebound migraines

Question 54

What do you give someone who is having severe migraines

Answer 54

Sumatriptan *can give a warming sensation of the throat

Question 55

What medication can be given to prevent migraine reoccurrance within three days of the initial migraine

Answer 55

IV Dexamethasone

Question 56

What is generally helpful in treating cluster headaches

Answer 56

oxygen prednisone taper