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Clinical Med - Neurology > Dementia / Delirium / Movement Disorders > Flashcards

Dementia / Delirium / Movement Disorders Flashcards

1
Q

_________ _____ is a more profound deficit that includes disorientation, bewilderment, and difficulty following commands.

A. Confusional State
B. Lethargy
C. Obtundation 
D. Stupor
E. Coma
A

A. Confusional State

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2
Q

________ is a state similar to lethargy in which the patient has a lessened interest in the environment, slowed responses to stimulation, and tends to sleep more than normal with drowsiness in between sleep states.

A. Confusional State
B. Lethargy
C. Obtundation 
D. Stupor
E. Coma
A

C. Obtundation

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3
Q

______ is a state of unarousable unresponsiveness

A. Confusional State
B. Lethargy
C. Obtundation 
D. Stupor
E. Coma
A

E. Coma

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4
Q

________ consists of severe drowsiness in which the patient can be aroused by moderate stimuli and then drift back to sleep.

A. Confusional State
B. Lethargy
C. Obtundation 
D. Stupor
E. Coma
A

B. Lethargy

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5
Q

____ means that only vigorous and repeated stimuli will arouse the individual, and when left undisturbed, the patient will immediately lapse back to the unresponsive state

A. Confusional State
B. Lethargy
C. Obtundation 
D. Stupor
E. Coma
A

D. Stupor

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6
Q

______-__ syndrome is a rare form of paralysis due to injury to the anterior brainstem with sparing of the RAS.

These patients will be awake and aware, but limited in their ability to communicate.

A

Locked-In Syndrome

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7
Q

A ______ state, or severe ______, are both syndromes that inhibit the patients ability to respond appropriately due to limited brain impairment

A

Catatonic State

Abulia

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8
Q

In locked-in syndrome, patients will often have a ________ gaze.

A

Vertical

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9
Q

T/F: Abulic patients will have occasional spontaneous purposeful movements.

A

True

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10
Q

Which portion of the neurological examination is helpful when evaluating and differentiating coma, catatonic state, or neurologically brain dead?

A

Cranial Nerves

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11
Q

Should a comatose patient be capable of pushing the examiner’s hand away when they’re introducing painful stimuli?

A

No, this reaction would not be consistent with coma

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12
Q

In what clinical settings are patients most likely to experience delirium?

A
  1. ICU Admission (70%)
  2. Post-Op (10-50%)
  3. Hospice (42%)
  4. SNF (16%)
  5. ED (10%)
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13
Q

Delirium is often secondary to _________.

A

Infection

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14
Q

What common conditions result in delirium?

A
  1. Dehydration, Electrolyte Imbalance
  2. Infection (UTI)
  3. Withdrawal
  4. Hypoglycemia
  5. Post-op states
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15
Q

Would you expect to see focal neurological findings in a patient with delirium?

A

No, typical they have non-focal neurological findings

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16
Q

T/F: Excited Delirium is the lest common type of delirium

A

False

It is the most common..

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17
Q

Other than lab work, what tests/procedures could you preform if there was no obvious or determined cause of the patient’s delirium?

What may these things rule out?

A
  1. EEG (r/o seizures)
  2. LP (r/o meningitis)
  3. MRI (Infarcts, Leptomeningeal Disease)
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18
Q

How is delirium managed?

A

Treat Underlying Cause

Supportive Care

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19
Q

What ‘method’ is used to diagnose and evaluate delirium?

A

Confusion Assessment method (CAM)

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20
Q

What are preventative measures taken to help prevent or limit delirium?

A
  1. Orientation Protocols
  2. Stimulation
  3. Sleep Aids
  4. Early Mobilizations (limit Restraint Use)
  5. Avoid Problematic Medications
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21
Q

How can you differentiate delirium from dementia?

A

Delirium: Rapid Onset, Reversible

Dementia: Gradual decline and deterioration of cognitive function

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22
Q

When taking a good history and physical on a patient being worked up for dementia, it is important to establish what?

A

A baseline cognition

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23
Q

What is the most common form of dementia?

Second most common form?

A

First: Alzheimer’s Disease

Second: Vascular Dementia (ie: CVA)

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24
Q

Dementia is diagnosed using what?

A

Mini-Mental Status Exam

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25
Q

< 9 on the MMSE would be considered _______ (Mild/Moderate/Severe) dementia.

A

Severe

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26
Q

21 - 26 on the MMSE would be considered _______ (Mild/Moderate/Severe) dementia.

A

Mild

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27
Q

10-20 on the MMSE would be considered _______ (Mild/Moderate/Severe) dementia.

A

Moderate

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28
Q

What is the preferred imaging modality when evaluating for dementia?

A

MRI

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29
Q

What labs are important to order when working up a patient for possible dementia?

A
  1. CBC
  2. CMP
  3. B12
  4. Thyroid Function
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30
Q

Mild Cognitive Impairment is often, but NOT always, a ________ for AD.

A

Prodrome

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31
Q

A ____ scan if often useful in predicting the progressive of MCI.

You can often see atrophy in which lobe?

What pattern would be consistent with AD?

A

PET

Medial Temporal Lobe Atrophy

Hypometabolic Pattern

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32
Q

Carriers of what gene are more likely to progress to AD?

A

APOE4 Gene

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33
Q

What is the greatest risk factor to developing AD?

A

1st Degree FHx (10-30% increased Risk)

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34
Q

Other than a FHx of AD, what are additional risk factors to developing AD?

A
  1. Mutations that impact amyloid in the brain
  2. Trauma
  3. Environmental / Lifestyle
  4. T2DM
  5. HTN
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35
Q

Early onset AD, typically has an autosomal _____________ inheritance pattern that alter amyloid beta protein production

A

Dominant

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36
Q

Late onset AD often involves more complex genetics, the most firmly established is the _______ gene

A

APOE

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37
Q

T/F: Olfactory changes can be seen in patients with AD?

A

True

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38
Q

What are clinical features of AD?

A
  1. Memory Impairment
  2. Executive Dysfunction
  3. Neuropsychiatric Sx
  4. Sleep Disturbance
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39
Q

What may the MRI of a patient with AD show?

A

Reduced hippocampal volume

Medial Temporal lobe atrophy

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40
Q

What is the second most common form of dementia?

A

Dementia with Lewy Bodies

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41
Q

Dementia with Lewy Bodies needs to be differentiated from what movement disorder?

A

Parkinson’s Disease

42
Q

Dementia with Lewy Bodies has a _______ (faster/shorter) decline in cognitive function and a _______ (worse/better) prognosis

A

Faster

Worse

43
Q

_______ ________ is a neurodegenerative disease of the substantia nigra that primarily results motor symptoms

A

Parkinson’s Dementia

44
Q

What is the most common type of frontotemporal dementia?

A

Behavioral Variant

45
Q

____ _______ ________ is defined as the insidious onset and gradual progression of a language impairment (ie, aphasia) manifested by deficits in word finding, word usage, word comprehension, or sentence construction

A

Primary Progressive Aphasia

46
Q

What is the most common human form of prion disease?

A

Creutsfeldt-Jakob Disease

47
Q

Creutsfeldt-Jakob Disease is often described as __________ encephalopathy

A

Spongiform

48
Q

What may be seen on MRI in a Creutsfeldt-Jakob Disease patient?

A

T2 hyperintensities in the putamen and head of the caudate

Cortical ribbon

49
Q

What risk factors are associated with vascular dementia?

A
  1. Uncontrolled HTN
  2. HLD
  3. T2DM
  4. Heart Disease
50
Q

Vascular dementia is often described as a “_________” decline in cognitive function due to multiple “hits” on the brain.

A

Stepwise

51
Q

_______ _______ __________ is described as impaired CSF absorption that rests in large ventricles with a NORMAL opening pressure on LP

A

Normal Pressure Hydrocephalus (NPH)

52
Q

What are the THREE clinical features of NPH?

A
  1. Wet (Urinary Urgency/Frequency/Incontinence)
  2. Wacky (Cognitive changes)
  3. Wobbly (Gait Disturbance)
53
Q

How is NPH treated?

A

Ventriculoperitoneal (VP) shunt placement

54
Q

AMS patients with a GCS < 8 require what?

A

Intubation

55
Q

Huntington’s Disease is an autosomal _______ disorder.

It is an expansion of what trinucleotide?

On what gene?

A

Dominant

CAG Trinucleotide

HTT Gene

56
Q

What is the TRIAD of Huntington’s Disease?

A

Chorea
Progressive Dementia
Inheritance Pattern

57
Q

Would you expect a patient with Huntington’s Disease to have hyporeflexia or hyperreflexia?

A

Hyperreflexia

58
Q

What psychiatric symptoms may a Huntington’s Disease patient have?

A

Irritability
Depression
Mutism

59
Q

What may a MRI show on a Huntington’s Disease Patient?

A

Caudate Atrophy

60
Q

Although there is no known cure for Huntington’s Disease, what medication can be used to treat a patient’s Chorea?

A

Tetrabenazine

61
Q

Other than medications. what may a patient with Huntington’s Disease benefit from?

A
  1. PT/OT
  2. Speech Therapy
  3. Social Services
  4. Psychiatry
62
Q

What are the FOUR most common clinical features of Parkinson’s Disease?

A
  1. RESTING TREMOR
  2. Bradykinesia
  3. Rigidity ]4. Shuffling Gait
63
Q

T/F: All resting tremors are Parkinson’s until proven otherwise

A

True

64
Q

Would a Parkinson’s patient be more likely to be hypotensive or hypertensive?

Why would this be a problem?

A

Hypotension

At higher risk for orthostatic hypotenison and ultimately at a higher fall risk

65
Q

What is Myerson Sign?

A

Sustained eye blinking in response to repetitive taping just above the nasal bridge

66
Q

Hypomimia is often seen in patients with Parkinson’s Disease…..

What is this?

A

Decreased facial expressions

67
Q

Parkinson’s Disease is a result of ___________ neurons in the ________ ______ located in the basal ganglia

A

Dopaminergic

Substantia Nigra

68
Q

What is the ‘Gold Standard’ for diagnosing Parkinson’s Disease?

A

Neuropatholgic Examination

69
Q

Could an MRI show no structural abnormalities in a Parkinson’s Patient?

A

Yes, this is why it is non-diagnostic in these cases

70
Q

Parkinson’s patients often have ______ _____ bodies present in their surviving substantia nigra neurons

A

Lewy Bodies

71
Q

What medication combination is the ‘mainstay’ for Parkinson’s Disease treatment?

A

Levodopa + Carbidopa

72
Q

What surgical procedure can be done to treat the tremors associated with Parkinson’s Disease?

A

Deep Brain Stimulation

73
Q

What are the major causes of mortality in Parkinson’s patients?

A

Fall with injury/Fracture

Aspiration PNA

74
Q

T/F: Essential Tremor is the most common movement disorder in the USA

A

True

75
Q

Are essential tremors more commonly unilateral or bilateral?

A

Bilateral

76
Q

Are essential tremors more like low frequency of high frequency?

A

High

77
Q

What are the TWO most common manifestations of an essential tremor?

A

Postural: Occurring with maintenance against gravity

Kinetic: Occurring with voluntary movement (ie: flexion/Extension)

78
Q

Are essential tremors sometimes improved with alcohol?

A

Yes

79
Q

If there was a suspected familial inheritance of essential tremors in a patient…..

would this more likely be autosomal dominant or recessive?

A

Dominant

80
Q

Although most essential tremors do not require treatment……

What medications can be used?

A

Beta-Blockers: Propanolol

or

Primidone

81
Q

A patient complaining of urges to move his legs followed by an unpleasant sensation that typically onsets at rest, worsens at night, and is relieved by movement may have what movement disorder?

A

Restless Leg Syndrome (RLS)

82
Q

Is primary RLS autosomal dominant or recessive inheritance pattern?

A

Dominant

83
Q

What conditions may secondary RLS be associated with?

A

Pregnancy

Anemia
Ferritin Deficiency
Renal Failure
Neuropathy

84
Q

RLS involves peripheral or central _________ dysfunction and abnormality in _____ metabolism

A

dopamine

Iron

85
Q

If RLS symptoms remain intrusive, what medications can be used for treatment?

A

Dopamine Agonists

Pramipexole
Ropinirole

86
Q

_________ is a movement disorder characterized by involuntary sustained or intermittent muscle contractions resulting in an abnormal posture or repetitive movements

A

Dystonia

87
Q

What is a common ‘feature’ of dystonia?

A

Sensory Tick

88
Q

Does early onset dystonia more commonly begin in the upper or lower extremities?

What may initially trigger this?

A

Lower Extremities

Initially, this can be triggered by vigorous physical activity

89
Q

Early onset dystonia can be hereditary……

This involves a mutation on what gene?

What chromosome?

A

Gene: TOR1A

Chromosome: 9q34

90
Q

Is hereditary dystonia autosomal dominant or recessive?

A

Dominant

91
Q

Does adult onset focal dystonia typically begin in the upper or lower extremities?

A

Upper extremities

92
Q

Cervical dystonia involves the muscles of what TWO areas?

A

Neck

Shoulders

93
Q

Blepharospasms involve muscles of what area?

A

Periocular Muscles

94
Q

Oromandibular, lingual, and facial dystonia involve muscles of what FOUR areas?

A

Jaw
Oral Muscles
Tongue
Facial Muscles

95
Q

Spasmodic dysphonia involves muscles of what area?

A

Laryngeal

96
Q

Are arms of legs more likely to be involved in limb dystonia?

A

Arms > Legs

97
Q

What is the most common form of isolated focal dystonia?

A

Spasmodic Torticollis

98
Q

In cervical dystonia, would you expect to see atrophic or hypertrophic SCMs?

A

Hypertrophic

99
Q

What is first line for dystonia treatment?

A

BoTox Injections

100
Q

What medication is used to treat dystonia most effectively in children?

A

Anticholingeric: Trihexyphenidyl

101
Q

Tetrabenazine (Dopamine Antagonist) can be used to relieve hyperkinetic movements in dystonia…..

However what disease MAY the cause?

A

Parkinson’s

102
Q

What is LAST LINE for dystonia treatment?

A

Deep Brain Stimulation

Clinical Med - Neurology (7 decks)

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