Dementia
80 yo w/ Alzheimer’s brought in for increasingly combative behavior. Daughter would like to keep the patient at home if possible.
What interventions would be most helpful in this situation? (3x)
Assess for caregiver burnout
MRI brain shows ventriculomegaly of 65 yo w/ progressive cognitive decline. LP w/ normal opening pressure. Likely to be found on exam? (2x)
Gait apraxia
35M awakens frequently in the middle of night with severe HAs, which sometimes occur nightly and lasts approx 1-2 hrs, so severe that pt is afraid to go to sleep, located around L eye and associated w/ lacrimation, ptosis, & miosis. Likely dx? (16x)
Cluster Headache
35 yo reports episodes of flashing lights traveling slowly from L to R in the L visual field, symptoms persisting for about 30 min, followed by difficulty expressing self and concentrating. Afer about 30 min, these neuro symptoms seem to subside, and pt develops a pounding HA associated w/ nausea. Both the physical exam and MRI are normal. Likely dx? (3x)
Migraine with aura
Role of the hippocampus and parahippocampal gyrus (4x)
Declarative memory (facts)
91 yo hospice pt w/ cachexia, end stage dementia, and renal impairment has stopped eating and drinking. What comfort measure would be most appropriate? (3x)
Frequent small sips of water
Hippocampal tissue, tau stained, pt with progressive dementia. Dx? (2x)
Alzheimer's disease
Abortive tx of common migraines is best achieved w/ which med? (8x)
Rizatriptan
25 yo has HA and vomiting. Pain is dull and in occipital region, worse when lying down. Severe papilledema b/l. LP shows opening pressure of 80 w/ normal CSF chemistry, and 120 RBCs in last tube. D-dimer, FDP in blood are elevated. CT normal. Dx? (3x)
Sagittal sinus thrombosis
On the way to the airport for vacation, 58F begins to behave strangely. Husband notices when he talks to her she answers appropriately w/ fluent speech but seems to have no ability to retain any new info. Repeatedly asks where they are going, even afer he has told her many times. The episode lasts for about 6 hours. Next day she is back to normal but has no recollection of the prior day events. This episode most consistent w/ a dx of? (3x)
Transient global amnesia
Specific factor distinguishing delirium from dementia of the Alzheimer type? (2x)
Fluctuating arousal
Which neurocognitive disorder has more severe EPS side effects from antipsychotics? (2x)
Lewy Body Disease
Young pt with new onset severe HAs associated w/ periods of visual obscuration. Neuro exam normal except for papilledema. MRI: normal and shows no mass effect. Next test? (8x)
Lumbar puncture to assess pressure
28F w/ episodes of severe HAs w/ N/V. HAs can be incapacitating, ofen preceded by flashes of light in the R visual field. During HA, pt sometimes has difficulty expressing herself. Which med would be appropriate to prevent these episodes? (2x)
Topiramate
Characteristic of ETOH-induced blackouts: (2x)
ANTEROGRADE AMNESIA FOR A TIME WHILE HEAVILY INTOXICATED BUT AWAKE
Neurocognitive function most likely to show decline in people > 65 years old? (2x)
Information processing speed
25 yo w/ VH – similar to the wavy distortions produced by heat rising from asphalt – affecting the whole of both visual fields, w/ vertigo, dysarthria, tingling in both hands and feet and around both sides of mouth followed by occipital HA. Most likely dx? (2x)
Basilar migraine
A characteristic of post LP headache: (4x)
headache worse with sitting upright
26 yo obese pt presents to ER with severe HA. Pt is otherwise healthy and not on meds. Head CT and brain MRI are unrevealing. The only finding on exam is shown in the fundoscopic images below (blurred optic disk). Dx? (2x)
Idiopathic Intracranial Hypertension
What characterizes type of memory loss in patients w/ dissociative amnesia? (2x)
EPISODIC
Over several months a 46 yo w/ no past psych hx becomes emotionally labile/irritable. Pt undergoes personality changes, laughs inappropriately when neighbor kids taunt stray cats. Within 2 yrs pt is convinced all food have germs. Memory is preserved. Pt is no longer able to work/live independently. Neuropsych testing shows impaired language and attention. Dx? (2x)
Frontotemporal dementia
30 yo w/ intermittent HAs, each attack lasting approx 1 hour. Attacks w/ sharp, stabbing pain around eye, tearing, and nasal congestion. Most effective abortive Tx? (2x)
Oxygen
Effective tx for acute migraine: (2x)
Sumatriptan
Pt w/ hx of HSV and seizure d/o undergoing EEG monitoring that recorded no epileptic activity during, afer, and before a confused state where pt suddenly awoke frightened. Next day pt w/ baseline demeanor has no memory about that episode. Dx? (2x)
Amnestic disorder
Example of declarative memory: (2x)
Attention and recall of facts