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MCM > Exam 2 -- MCM > Flashcards

Exam 2 -- MCM Flashcards

1
Q

What is the differential diagnosis for confusion?

A
  • Delirium
  • Dementia
  • Depression
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2
Q

What is normal aging?

A

Slowed processing that DOES NOT interfere with function

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3
Q

What are the domains of normal aging?

A
  • Attention: Can they focus?
  • Executive Function: Can they think clearly when it comes to higher level things?
  • Memory: Do they forget things?
  • Language: Word finding difficulties
  • Visuospatial: Forgetting where they are in space
  • Psychomotor: Changes in movement or speed of movement
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4
Q

What are the basic activities of daily living?

A
  • Dressing: Can they dress themselves? Can they pick out appropriate clothing for the season?
  • Eating: Can they pick up the food , put it in their mouth, AND chew and swallow
  • Ambulating: Can they get from point A to point B?
  • Transferring: Can they move from the chair to the toilet and/or bed?
  • Toileting: Can they do all steps of hygiene involved with toileting?
  • Hygiene: Can they bathe themselves?
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5
Q

What is the one basic ADL that an individual can need help with and still live independently?

A

Hygeiene

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6
Q

What are the instrumental activities of daily living? (IADLs)

A
  • Shopping
  • Housekeeping
  • Accounting
  • Food preparation/medications
  • Transportation
  • Telephone
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7
Q

What is delirium?

A

ACUTE disorder of attention and global cognitive function

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8
Q

What is the diagnosis criteria for delirium?

A

CAM Criteria:

  • Must have both acute onset and fluctuating course as well as inattention.
  • Must have either disorganized thinking or altered consciousness.
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9
Q

What are the types of Delirium?

A
  • Hypoactive: Lower levels of agitation
    - Most commonly missed
  • Hyperactive: High levels of agitation
    - Hardly ever missed
  • Mixed: Fluctuate between hypoactive and hyperactive
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10
Q

What is the etiology of delirium?

A

Dysfunction of multiple brain regions and neurotransmitter systems.
(exact cause is unknown, could be due to a possible cholinergic deficiency)

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11
Q

Why are older adults more vulnerable to delirium?

A

Age related changes in central neurotransmission, stress management, hormonal regulation, immune response

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12
Q

What are some of the known causes for the etiology of delirium?

A

Drugs – especially benzodiazepines & diphenhydramine
Eyes & Ears – lack of hearing aides and/or glasses
Low oxygen stats – due to MI, Stroke, PE
Infections – not just urinary
Retention – urinary retention or constipation
Ictal – post seizure
Undernutrition or under-hydration
Metabolic
Subdural – bleeding, etc

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13
Q

What’s the treatment for delirium?

A
  1. PREVENTION (key!!!)
  2. Treat the underlying causes
  3. Environmental modifications
  4. Rarely use antipsychotics
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14
Q

T/F: Delirium is irreversible.

A

False, it is reversible.

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15
Q

What are the nonpharmacologic strategies to prevent delirium?

A
  1. Reorientation
  2. Involve family in care
  3. Use of eye glasses and hearing aides
  4. Sleep protocol (turn lights on during the day, off at night, quiet room, etc.)
  5. Provide uninterrupted period for sleep
  6. Avoid physical restraints and immobilization
  7. Encourage mobility and self-care
  8. Ensure adequate hydration.
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16
Q

Why should antipsychotics be rarely used in treatment for delirium?

A

They mask the symptoms of delirium only and do not actually treat the underlying acute brain failure.

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17
Q

When should antipsychotics be used in treatment of delirium?

A

Only if the patient is severely agitated and is at risk of interruption of essential medical care or is posing a safety hazard for themselves or others.

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18
Q

What is dementia?

A

A progressive disease with a gradual onset with cognitive and behavioral symptoms that interfere with function, represent a decline in function, and cannot be explained by delirium or another psychiatric disorder

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19
Q

With dementia, what are things the cognitive or behavioral symptoms must do?

A

Interfere with function, represent a decline in function, cannot be explained by delirium or another psychiatric disorder

20
Q

What are the domains of delirium?

A

Memory, attention, executive function, language, visuospatial function, motor function, and behavioral changes

21
Q

What are the types of dementia?

A

Alzheimer’s disease, Vascular dementia, Lewy body dementia, frontotemporal dementia, alcohol related dementia, normal pressure hydrocephalous dementia, psuedodementia

22
Q

What is Alzheimer’s disease?

A

The most common type of dementia. It has a slow, insidious onset and gets progressively worse over time. It is represented by amnesia and either language presentation, visuospatial presentation, or executive dysfunction.

23
Q

What is vascular dementia?

A

Dementia as a result of small vascular events happening in the Brain. Occurs in a stepwise fashion and often occurs in individuals with some sort of vascular risk factor.

24
Q

What is Lew body dementia?

A

Dementia with Parkinsonian features such as rigidity, gait, etc.

25
Q

What is frontotemporal dementia?

A

Dementia characterized by personality changes

26
Q

What is alcohol related dementia?

A

Dementia due to high alcohol consumption

27
Q

What is normal pressure hydrocephalous dementia?

A

Dementia due to changes in the pressure of the brain

28
Q

What is psuedodementia?

A

Other disorders such as severe depression that is affecting cognition that is being masked by dementia

29
Q

What are the risk factors for dementia?

A

Delirium in the last year, family history of dementia, substance abuse, age, co-morbidities (hypertension, hyperlipidemia, MI)

30
Q

What are the causes of cognitive dysfunction?

A

Psuedodementia (reversible), CVD, Nutritional Deficiency (B12 especially), DM 2, COPD, OSA (really common cause if left untreated), Thyroid dysfunction, Depression, Medication, or Delirium

31
Q

What are the big 3 that cause cognitive dysfunction?

A

Depression, Medication, or Delirium

32
Q

How is dementia evaluated?

A
  1. Full neurological examination
  2. Cognitive testing (Mini-Cog, MMSE, SLUMS, MoCA)
  3. Neuroimaging
33
Q

What is the treatment for dementia?

A

It is a terminal disease, but there are some treatments that are available to slow the disease. (Ach esterase inhibitors, NMDA antagonist, focus on quality of life)

34
Q

Who does depression have a high prevalence in?

A

In older adults especially and it is under diagnosed

35
Q

What are the risk factors for depression?

A

Loss of social support, death of family and friends, changing social roles, physical limitations

36
Q

What is the evaluation for depression?

A

Geriatric Depression Scale, PSQ-9, or Cornell Scale for Depression in Dementia

37
Q

How does the Geriatric Depression Scale work?

A

Looks at how the patent has felt in the last week and asks hard questions that must be asked exactly how they are written and must be answered in a yes or no manner. A score of 4+ indicates depression

38
Q

What is the gold standard for depression treatment at all ages?

A

Medication and Cognitive Behavioral Therapy

39
Q

What is the diagnostic work up for the etiology of delirium?

A

Initially CBCD & CMP to look for infection

40
Q

What is the diagnostic work up for the etiology for dementia?

A

Cognitive testing, B-12 levels, thyroid function tests, and geriatric depression scale

41
Q

What is the diagnostic work up for the etiology for depression?

A

Geriatric Depression scale OR Cornell scale for depression and dementia.

42
Q

What is the sequence of events that occurs at a chemical synapse for synaptic transmission?

A
  1. A signal action potential reaches the presynaptic terminal/end bulb.
  2. Voltage gated Ca++ channels open and the presynaptic membrane depolarizes.
  3. Ca++ flows inward, triggering the synaptic vesicles to fuse to the presynaptic membrane and the neurotransmitter is released.
  4. The neurotransmitter cross the synaptic cleft & binds to ligand-gated receptors
    (The more neurotransmitter that is released the greater the change in potential of the postsynaptic cell)
  5. Ion channels are opened
    (one-way information transfer)
43
Q

Describe the mechanisms that generate resting membrane potential in a neuron.

A
  1. Steady-state condition with no net flow of ions across the membrane. (No net change in total distribution of ions)
  2. Concentration gradient is maintained, ion channels are closed. (Voltage-gated Na+ and K+ channels closed.)
  3. Electrical gradient is maintained by the Na/K ATPase pumps
  4. Typically resting membrane potential is -70 mV.
  5. Sodium and chloride are outside of the cell.(Making the outside of the cell positive)
  6. Potassium and negatively charged anions are inside of the cell, making the inside of the cell negative.
44
Q

Describe the mechanisms that generate an action potential in a neuron

A
  1. Threshold is reached at -55 mV by voltage-gated Na+ channels opening and Na+ entering the axon, beginning to depolarize the axon.
  2. Depolarization happens because of the flow from ions through gated channels. The membrane potential becomes less negative and may even become positive and generates transmittable electrical signal, which is considered excitatory. (More voltage-gated Na+ channels open. Na+ rushing in depolarized the membrane. Na+ channels close about 1 msec after opening.)
  3. Repolarization happens because of ions flowing through the gated channels. The membrane potential becomes more negative again. (Many voltage-gated K+ channels open, K+ exits, taking the positive charges out of the axon.)
  4. Hyperpolarization happens when the membrane potential becomes even more negative, typically to -75mV. This decreases the ability to transmit an electrical signal and is considered inhibitory. (Voltage-gated K+ channels remain open. K+ continues to leave the axon restoring the polarized membrane potential.)
  5. Action potentials occur on the axon
    (If the axon is myelinated, the potential will jump from one node of Ranvier to another and transmit the signal even quicker.)
45
Q

Describe the difference between gray matter and white matter.

A

White matter is axons and they look white because of the myelin around the axons. In the brain it is seen buried deep within the brain and in the spinal cord it is seen on the peripheral and it appears darker than gray matter.

Gray matter is cell bodies and it appears gray because the cell bodies don’t have myelin. In the brain it is found on the periphery and in the spinal cord it is found deep within the spinal cord and it appears brighter than white matter.

46
Q

List different cell types in the nervous system, and their morphological characteristics

A
  1. Bipolar Neurons: Mostly primitive, Two processes connected to the cell body (Dendrite and the axon)
    • Very few cells have this type of neuron: Cranial Nerve I – olfactory nerve, Cranial Nerve II – optic nerve, Cranial nerve VIII – vestibular portion of the nerve
  2. Pseudounipolar Neuron: Begins as bipolar, but the body becomes extended away from the neuron, single process connected to a cell body (Two kinds of axons)
    - Types of cells with this: Sensory neurons
  3. Multipolar Neuron: More than two processes connected to a cell body (Most common)
    - Types of cells with these neurons: Motor Neurons & Most other types of neurons within the CNS

MCM (1 decks)

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