Mental Health II

Question 2

What is the definition of delirium?

Answer 2

Fluctuating disturbance of attention, awareness and cognition. Often reversible and caused by underlying cause

Question 3

Name risk factors for delirium.

Answer 3

Advanced age, infection, cognitive impairment, hx of delirium, polypharmacy, withdrawal, surgery, uncontrolled pain

Question 4

What is hypoactive delirium?

Answer 4

Mental state of reduced activity, drowsiness, difficulty focusing.

Question 5

When is hypoactive delirium most common?

Answer 5

In the elderly, can be missed

Question 6

What is AUDIT and AUDIT-c?

Answer 6

Alcohol use disorder identification test, with AUDIT-C being a shorter version

Question 7

What AUDIT score indicates alcohol use disorder?

Answer 7

AUDIT score of 16 or greater, AUDIT-C score of 8 or greater

Question 8

Name some screening tools for alcohol use disorder.

Answer 8

AUDIT & AUDIT-C, CAGE

Question 9

What is Mallory-Weiss syndrome?

Answer 9

Common cause of upper GI bleeding in those with active/recurrent alcohol use

Question 10

What are delirium tremens?

Answer 10

Confusion, perceptual disturbances and hallucinations, tremor, altered sleep-wake cycle, changes to pyschomotor activity, fever, tachycardia. Usually occurs a few days into withdrawal from alcohol

Question 11

What is Wernicke- Korsakoff syndrome?

Answer 11

Neurodegenerative disorder affecting memory, movement, vision, and coordination caused by Vitamin B1 (thiamine) deficiency. Can be seen in alcohol use disorder, eating disorders, malnourishment

Question 12

What is defined as elder abuse?

Answer 12

Abuse to those 65 years or older

Question 13

Name risk factors for dementia.

Answer 13

Advanced age, depression, family hx, A-fib*?

Question 14

What are the different types of dementia?

Answer 14

Vascular dementia, Alzheimer’s, Lewy body, frontotemporal

Question 15

What must be ruled out when diagnosing dementia?

Answer 15

Delirium

Question 16

What is vascular dementia?

Answer 16

Cognitive decline d/t reduced blood flow in the brain, usually following TIA/stroke

Question 17

What is Lewy Body dementia?

Answer 17

Accumulation of Lewy bodies in neurons that results in neurodegenerative cognitive fluctuations, visual hallucinations and Parkinsonism

Question 18

What is frontotemporal dementia?

Answer 18

Atrophy of the frontal and temporal lobes with abnormal accumulation of proteins (tau, TDP-43) that results in progressive degeneration

Question 19

What is Alzheimers?

Answer 19

Accumulation of beta-amyloid plaques and Tau tangles that lead to synaptic dysfunction and neuronal death

Question 20

What is the most common form of dementia?

Answer 20

Alzheimer’s

Question 21

Is dementia more common in men or women?

Answer 21

Men

Question 22

What are risk factors for Alzheimer’s?

Answer 22

Advanced age, fam hx, APOE-e4 gene, CVD, traumatic brain injury

Question 23

What are the risk factors for Lewy body dementia?

Answer 23

Advanced age, Parkinson’s, REM sleep behaviour disorder, fam hx

Question 24

What are the risk factors for frontotemporal dementia?

Answer 24

Family hx, genetic mutations, hx of head trauma

Question 25

What are appropriate screening tools for dementia?

Answer 25

Cognitive tests such as MoCA and MMSE, may need other screening (Geriatric depression scale, PHQ9, etc.)

Question 26

Which dementia can have a more acute onset?

Answer 26

Vascular dementia of large blood vessels- sudden in onset

Question 27

What is a key clinical feature of Lewy body dementia?

Answer 27

Visual hallucinations. Also see EPS symptoms, sleep disturbance

Question 28

What are some key clinical features of Alzheimers?

Answer 28

Progressive & gradual onset of memory loss, disorientation, difficulty with tasks. Can see depressive symptoms, apathy, agitation

Question 29

What is insomnia in the elderly closely correlated with?

Answer 29

Depression

Question 30

What is Korsakoff dementia?

Answer 30

Neurodegenerative disorder caused by severe and prolonged thiamine deficiency

Question 31

What is the COWS scale used for?

Answer 31

Clinical opioid withdrawal scale

Question 32

What is the criteria for insomnia?

Answer 32

Complaints about quality or quantity of sleep at least THREE times a week for at least ONE month

Question 33

What is CIWA for?

Answer 33

Clinical Institute Withdrawal Alcohol Assessment

Question 34

What is a major risk factor for alcohol use disorder in the elderly?

Answer 34

Depression

Question 35

What differentiates Lewy body dementia from dementia secondary to Parkinsons?

Answer 35

Lewy body= onset of cognitive and motor symptoms within one year, dementia secondary to parkinsons= cognitive symptoms >1 year after onset of motor

Question 36

What symptoms occur early in frontotemporal dementia?

Answer 36

Inappropriate social behaviours (disinhibition, apathy)

Question 37

What is a normal score on the MoCA?

Answer 37

26 or higher

Question 38

What is a normal score on the MMSE?

Answer 38

Score of higher than 23

Question 39

What are the different types of delirium?

Answer 39

Hypoactive (common in elderly), hyperactive (common with substance use/withdrawal), mixed type (common in general population)

Question 40

What labs should be drawn when working up delirium?

Answer 40

Electrolytes, urea/creatinine, ALP/AST, glucose, thyroid, ABG, urinalysis

Question 41

What should be reported to MTO?

Answer 41

Disorder causing cognitive impairment, can cause sudden incapacitation, causing severe motor/sensory impairment affecting strength or control, uncontrolled substance use disorder

Question 42

What labs should be drawn when working up dementia?

Answer 42

CBC, TSH, B12, lytes, toxicology, LFTs, albumin, VDRL

Question 43

What is the criteria for alcohol use disorder?

Answer 43

2 or more of the following over the last 12 months: strong urge to drink drinking more than intended, increasing amounts needed to achieve same effects, unsuccessful attempts to stop, inability to fulfil daily tasks, etc.