Neuro Geriatrics

Question 1

MC type of dementia

Answer 1

AD

Question 2

pathophys of AD

Answer 2

amyloid beta protein
neurofibrillary tangles (tau)
acetylcholine deficiency

Question 3

sx AD

Answer 3

short term memory loss (first sx)
cognitive deficits

Question 4

dx AD

Answer 4

clinical

MRI - cortex atrophy

Question 5

tx AD

Answer 5

acetylcholinesterase inhibitors - Donepezil, Rivastigmne, Galantamine

NMDA antagonist - memantine

Question 6

most important RF for vascular dementia

Answer 6

HTN

Question 7

sx vascular dementia

Answer 7

sudden decline in function with stepwise progression of sx

Question 8

dx vascular dementia

Answer 8

clinical

MRI may show infarcts; CT may show lacunar infarcts

Question 9

another name for frontotemporal dementia

Answer 9

pick’s disease

Question 10

what is frontotemporal dementia

Answer 10

brain degeneration in the frontotemporal lobes due to pick’s bodies (round or oval aggregates of tau protein)

Question 11

sx frontotemporal dementia

Answer 11

marked change in personality and language

disinhibition or socially inappropriate behaviors

Question 12

difference btwn diffuse Lewy body dz and Parkinson dz

Answer 12

Lewy bodies are localized in PD

Question 13

sx diffuse Lewy body dz

Answer 13

recurrent visual histology
cognitive fluctuations
Parkinsonism
dementia - late finding

Question 14

epidural hematoma is MC due to

Answer 14

rupture of the middle meningeal artery - associated with temporal bone fx

Question 15

sx epidural hematoma

Answer 15

brief loss of consciousness –> lucid interval –> neuro deterioration

uncle herniation - CN3 palsy – fixed, dilated, blown pupil

Cushing reflex - HTN, bradycardia, repiratory irregularity

Question 16

dx epidural hematoma

Answer 16

CT - convex lens shaped hyper density that does not cross suture lines

Question 17

MCC subdural hematoma

Answer 17

rupture of cortical bridging veins

usually elderly and/or alcholic

Question 18

dx subdural hematoma

Answer 18

CT - concave crescent shaped bleed that can cross suture lines

Question 19

MCC subarachnoid hemorrhage

Answer 19

ruptured saccular (berry) aneurysm at the ACA (circle of willis)

Question 20

most important RF subarachnoid hemorrhage

Answer 20

cigarette smoking
HTN

also polycystic kidney dz

Question 21

if someone has a head injury what should you always look for

Answer 21

retinal hemorrhage (funduscopy)

Question 22

LP for subarachnoid hemorrhage

Answer 22

xanthochromia - yellow to pink CSF due t breakdown of RBCs
elevated RBC count that does not diminish from CSF tube 1 to tube 4

Question 23

type of inheritance of essential tremor

Answer 23

autosomal dominant

Question 24

sx essential tremor

Answer 24

intentional tremor MC in UE and head
tremor worse with action
postural tremor (hold affected body part against gravity)

tremor improved with alcohol

Question 25

tx essential tremor

Answer 25

meds not needed if mild

can do propranolol and/or primidone

Question 26

pathophys of PD

Answer 26

decreased dopamine and acetylcholine

eosinophilic cytoplasmic inclusions (Lewy bodies)

Question 27

sx PD

Answer 27

triad - resting tremor, bradykinesia, muscle rigidity

cogwheel rigidity

may have depression
may have loss of smell

Question 28

myerson’s sign PD

Answer 28

tapping the bridge of the nose repetitively causes sustained blink

Question 29

tx PD

Answer 29

levo-carbo
dopamine agonists - bromocriptine, ropinerole, pramipexole