Neurology 2

Question 1

65y M w 6m h/o confusion episodes, disorientation, VHs of children playing in his room. Hallucinated images are fully formed, colorful, vivid & pt has little insight into their nature. No AH. Wife says he is normal between episodes. Exam: nl language, memory, mod diff with trails test, mild diff with serial subtractions, mild symmetric rigidity, bradykinesia. Brain MRI unremarkable. CSF, routine labs, UDS nl. Dx? (7x)

Answer 1

Lewy body dementia

Question 2

When combined with functional neuroimaging, which biomarkers most likely to ID geriatric pts with mild cognitive impairment most at risk for developing Alzheimer’s Dz (7x)

Answer 2

E-4 apolipoprotein E allele

Question 3

80y w VH, worsening gait, episodic confusion, disturbed sleep, fighting in sleep, bilateral rigidity, masked facies. Levodopa/carbidopa improved movement temporarily. Dx? (4x)

Answer 3

Dementia w lewy bodies

Question 4

Which brain pathologyis assoc w 69y F w progressive behavioral changes, rudeness, interrupting conversations, watching exs TV (turned off), large meals despite no hunger, stooped posture w/ slow shuffling gait? amyloid deposition, dopamine depletion, intraneural tau deposits, ubiquinated inclusions, alpha synuclein accumulation? (4x)

Answer 4

Intraneural tau deposits

Question 5

80y Alzheimer’s brought in for incr combative behavior. Daughter would like to keep the pt at home if possible. What interventions would be most helpful? (3x)

Answer 5

Assessing for caregiver burnout

Question 6

91y hospice pt w/ cachexia, end stage dementia, renal impairment has stopped eating & drinking. What comfort measure most appropriate (3x)

Answer 6

frequent small sips of water

Question 7

Which of the following is most specific factor for distinguishing delirium from dementia of the Alzheimer type? (2x)

Answer 7

fluctuating arousal

Question 8

Neurocog fx most likely to show decline in ppl 65y+ (2x)

Answer 8

information processing speed

Question 9

Over several months, 46y w no past psych hx becomes emotionally labile/irritable. Pt undergoes personality changes, observed to laugh inappropriately when kids taunt stray cats. Within 2y, pt convinced all food has germs. Memory preserved. Pt no longer able to work/live independently. Neuropsych testing shows impaired language/attention. Dx? (2x)

Answer 9

frontotemporal dementia

Question 10

Brain MRI shows ventriculomegaly of 65yo w progressive cognitive decline. Normal opening LP pressure. Likely found on exam? (2x)

Answer 10

gait apraxia

Question 11

Most accurate genetic test for Alzheimer’s

Answer 11

the testing has limited predictive value for Alzheimer’s Dz in sx-free individuals

Question 12

What sx is MC associated w aggressive behavior in Alzheimer’s patients

Answer 12

concurrent psychosis