Cognitive Disorders

Question 1

symptomatic treatment of delirium and what NOT to use and why?

Answer 1

low dose haloperidol

don’t use benzos cuz they will cause or prolong delirium (unless it’s due to alcohol or benzo w/d)

Question 2

tremor, EPS, frontal dizziness, and sluggish pupillary reflexes. dx?

Answer 2

tertiary syphilis

Question 3

definition of delirium

Answer 3

waxing and waning change in a pt’s level of consciousness
lasts days to weeks
aka encephalopathy

Question 4

clinical manifestations of delirium (2 common + 5)

Answer 4

visual disturbances and short attention span are common
disorientation
language disturbances
changes in speech
perceptual disturbances: hallucinations
sleep disturbances: sundowning (daytime drowsiness, nighttime insomnia)

Question 5

most common finding in delirium

Answer 5

impairment of recent memory

waxing and waning of sx

Question 6

neurotransmitter decreased in dementia

Answer 6

ACh

Question 7

common comorbidity with AD

Answer 7

Down syndrome (senile plaques and neurofibrillary tangles)

Question 8

postmortem findings of AD

Answer 8

diffuse atrophy with enlarged ventricles and flattened sulci

Question 9

do neuritic plaques or neurofibrillary tangles correlate with severity of dementia?

Answer 9

neuritic plaques

Question 10

treatment for AD

Answer 10

mild to moderate: cholinesterase inhibitors (donepezil, tacrine, rivastigmine, galantamine)
moderate to severe: NMDA antagonists (memantine)

Question 11

findings on CT of vascular dementia

Answer 11

multiple small lacunar infarcts

Question 12

stroke to what part of brain can lead to sx of schizophrenia, BP d/o and depression

Answer 12

frontal lobe

Question 13

stepwise loss of function is common with what disease

Answer 13

vascular dementia (b/c infarcts add up)

Question 14

lewy bodies come from aggregates of what and where?

Answer 14

alpha synuclein, basal ganglia

Question 15

core features of Lewy body dementia (4)

Answer 15

waxing and waning sx
Parkinsonism
VH
sensitivity to neuroleptics

Question 16

which dementia progresses to death in 4-6 years?

Answer 16

frontotemporal (pick disease)

Question 17

cause of huntington’s disease

Answer 17

CAG repeats on chromosome 4p. if longer, earlier age of onset

Question 18

MRI of HD

Answer 18

caudate atrophy

Question 19

what meds do you NOT want to use in Parkinson

Answer 19

antipsychotics: exacerbate dementia

Question 20

3 signs of Creutzfield Jakob dz

Answer 20

rapidly progressive dementia 6-12 months after onset of sx
myoclonus
personality changes
–> stupor, coma, death

Question 21

how to dx CJD

Answer 21

rapidly progressive dementia and generalized sharp waves on EEG

Question 22

3 findings of normal pressure hydrocephalus

Answer 22

3 W’s

wobbly: gait disturbance
wet: urinary incontinence
wacky: dementia

Question 23

treatment of NPH

Answer 23

relieve increased pressure with shunt