dementia/CP

Question 1

Dementia definition and progression

Answer 1

Loss of the ability to problem solve significant enough to affect the patient’s activities of daily living
Chronic slowly progressive loss of function

Question 2

Alzheimer’s Disease is the most common cause making up about 75% of all dementias
Brain injury
Lewy body dementia
Vascular dementia

Answer 2

Non reversible causes of dementia

Question 3

Alzheimer’s Disease is what % of all dementias

Answer 3

75%

Question 4

Hypothyroidism
Vitamin B12 deficiency
Lyme disease
Neurosyphilis
Hydrocephalus

Answer 4

Reversible causes of dementia

Question 5

dementia is 2 out of what spheres

Answer 5

language, memory, visuospatial skills, emotional behavior, personality, cognition

Question 6

most significant risk factor for alzheimers

3 other factors

Answer 6

old age

other: FH, education level, female

Question 7

alzheimers prevelance

Answer 7

doubles every 5 years in the older population.

reaching 30%-50% at age 85 yrs

Question 8

what chromosomes for alzheimers

Answer 8

1, 14, 19, 21

Question 9

alzheimers tx

Answer 9

Psychological Therapies
Medication
Acetylcholinesterase inhibitors – Donepezil(improve memory function and delay d/s progression)
Antipsychotic drugs
Antidepressants

Question 10

improve memory function and delay d/s progression

Answer 10

Acetylcholinesterase inhibitors – Donepezil

Question 11

multi-infarct dementia

• gender
• assoc with what

Answer 11

men

HTN with or w/out hx of TIA or stroke

Question 12

vascular dementia symptoms

Answer 12

forgetfulness in the absence of depression and inattentiveness

Question 13

speech difficulty, trouble performing routine tasks, sensory interpretation difficulty, confusion, amnesia, executive dysfunction

Answer 13

cortical symptoms of vascular dementia

Question 14

gait problems, urinary difficulties, motor deficits, personality changes

Answer 14

subcortical symptoms of vascular dementia

Question 15

syndrome secondary to degeneration of the frontal lobe and may include the temporal lobe

Answer 15

frontotemporal dementia

Question 16

frontal lobe symptoms

Answer 16

behavioral- euphoria, apathy, dishibition; and

compulsive disorders

Question 17

frontal release signs

Answer 17

palmomental, palmar grasp, rooting reflexes

Question 18

MRI of frontotemporal dementia

Answer 18

atrophy to lobe in late cases

Question 19

what other test for frontotemporal dementia

Answer 19

PET: show hypometabolism- to differentiate alzheimer from biparietal hypometabolism

Question 20

seen with psychiatric illness who appear to be demented; seen with what illness

Answer 20

pseudodementia; seen with major depressive episode

Question 21

complain of memory problems but attention span and concentration appear intact while appearing upset or distressed

Answer 21

pseudodementia

Question 22

in true dementia… you see what

Answer 22

pt will often give wrong answers, have poor attention and concentration, and appear indifferent or unconcerned

Question 23

pseudodementia tx

Answer 23

antidepressant with SSRI first line; no acetylcholinesterase inhibitors

Question 24

Change in mental status
Seizures
Loss of bowel or bladder function
Poor Balance
Falling
Difficulty walking
Fainting
Lightheadedness
Weakness in the face, arms and legs

Answer 24

altered level of consciousness

Question 25

``` Levels of consciousness Conscious Confused Delirious Somnolent Obtunded Stuporous Comatose ```

Answer 25

Levels of consciousness Conscious – Normal Confused – Disoriented / Impaired Delirious – Disoriented, restless, hallucinations, and delusions may occur Somnolent – Sleepy Obtunded – Decreased alertness and slowed response Stuporous –Respond only to severe pain Comatose – Non-arousable, Non-responsive to stimuli

Question 26

Levels of consciousness – Normal – Disoriented / Impaired – Disoriented, restless, hallucinations, and delusions may occur – Sleepy – Decreased alertness and slowed response –Respond only to severe pain – Non-arousable, Non-responsive to stimuli

Answer 26

Levels of consciousness Conscious – Normal Confused – Disoriented / Impaired Delirious – Disoriented, restless, hallucinations, and delusions may occur Somnolent – Sleepy Obtunded – Decreased alertness and slowed response Stuporous –Respond only to severe pain Comatose – Non-arousable, Non-responsive to stimuli

Question 27

altered level of consciousness tx

Answer 27

Maintain patent airway and monitor circulatory status Medications Dextrose – for hypoglycemia Naloxone Thiamine Lumbar puncture – if meningitis is suspected

Question 28

Cerebral Palsy - progressive? - Evident when?

Answer 28

Cerebral Palsy Things you should know Lifelong physical disability due to damage of the developing brain. This is not progressive. Evident in the first 12 to 18 months

Question 29

- Risk Factors 4 CP

Answer 29

About 50% of CP patients are born premature Low birth weight Infection of the mother in early pregnancy Prolonged loss of oxygen during the pregnancy or birthing process

Question 30

Musculoskeletal CP - muscle tone and control - unable to hold what up - 75% have what - walk when - talk when - reflexs

Answer 30

Low muscle tone Unable to hold head up 75% of patients present with spasticity and contractures. This is often found on one side of the body. Poor muscle control Unable to walk at 12 to 18 month Language delay – Inability to speak simple sentences by 24 months hyporeflexia

Question 31

``` Physical Exam: Slow motor movement Tight or floppy muscle tone Contractures & spasticity Missed developmental milestones CT or MRI – may show what? ```

Answer 31

CP

Question 32

CP in pregnancy

Answer 32

Preventative measures Carry baby to term Magnesium Sulphate – Is used to help prevent preterm labor

Question 33

Medical treatment CP

Answer 33

Benzodiazepines -help with muscle spasms Diazepam Botulinum toxin type A injection – administered IM for muscles with spasticity Antiepileptic medication – to minimize seizures

Question 34

surgery for CP

Answer 34

Fasciotomy Muscle lengthening Joint replacement

Question 35

What is the #1 risk factor for a child having CP?

Answer 35

Prematurity