Neuro Cases 2

Question 1

Classification of tremors

Answer 1

• resting
• action
• enhanced physiologic
• essential
• parkinsonism
• cerebellar
• psychogenic

Question 2

Resting Tremor

Answer 2

• occurs in body pt at rest

- enhanced by stress or movement of another body part

Question 3

Action Tremor

Answer 3

• Postural: maintain position against gravity (arm elevation)
• Isometric: m. contraction against station object (make fist)
• Kinetic: associated with voluntary movement and includes intention tremor

Question 4

Enhanced Physiologic Tremor

Answer 4

• low amp, high freq at rest or during activity

- enhanced by anxiety and stress, meds,

Question 5

Essential Tremor

Answer 5

• usually kinetic
• common in hands and wrists
• usually bilateral and progresses with age
• symmetrical tremor
• alcohol can help symptoms
• handwriting is very loopy and can be illegible

Question 6

Parkinsonism Tremor/Parkinsons

Answer 6

• resting pill rolling tremor
• asymmetrical tremor
• flat affect
• reduced arm swing
• micrographia
• decreased smell
• shuffling gait

Question 7

Cerebellar Tremor

Answer 7

• low freq slow intension tremor

- usually caused by MS with cerebellar plaques, stroke, brainstem tumors

Question 8

Psychogenic Tremor

Answer 8

-abrupt onset, spontaneous remission, changing tremor characteristics

Question 9

Dementia Prevalence

Answer 9

-females more common with older age b/c females live longer

Question 10

Etiologies of Dementia

Answer 10

• Alzheimers
• Delirium
• Frontotemporal dementia
• HIV
• Intracranial tumor
• Lewy Body dementia
• Vascular dementia

Question 11

6 Domains Affected by Dementia

Answer 11

1. Complex Attn
2. EF
3. Language
4. Learning and Memory
5. Perceptual-Motor
6. Social Cog

Question 12

Complex Attention Domain Examples

Answer 12

normal tasks take longer, hard to remember a phone number to dial, work requires more checking, hard to complete tasks when multi stimuli present

Question 13

Executive Function Domain Examples

Answer 13

-difficulty doing multistep tasks, hard to prepare meals, not wanting to participate in activities, social outings less enjoyable

Question 14

Language Domain Examples

Answer 14

-difficulty finding correct words, using pronouns instead of names, mispronouncing words, problems understanding communication

Question 15

Learning and Memory Domain Examples

Answer 15

-forgetting to buy items, repetition in conversation, forgetting to pay bills, relying on lists

Question 16

Perceptual-motor Domain Examples

Answer 16

-difficulty using tech, tools, or appliances, getting lost

Question 17

Social Cognition Domain

Answer 17

-apathy, increase inappropriate behaviors, loss of empathy

Question 18

DSM-5 Criteria for Major Neurocog Disorder and Minor Neurocog disorder

Answer 18

Major Neurcog Disorder: significant cog decline in at least one domain interfering with activities of daily living
Minor Neurocog Disorder: modest cog decline that DOESNT interfere with activities of daily living

Question 19

Reversible Causes of Dementia

Answer 19

• hypothyroidism
• vitamin deficiencies
• intracranial tumors
• depression
• hypoperfusion from heart failure

Question 20

Testing for Cog Impairment Steps

Answer 20

1. Brief Screening-Mini-Cog, Ascertain Dementia Questionnaire, General Practioner Assessment of Cog
2. Screen for Degree: MMSE, MOCA, SLUMS
3. Screen for depression and other reversible causes: GDE to rule out pseudodementia