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Case Background
Work-up
Pathophysiology
Pharmacology
Grab Bag: Speed Round!
100
Name three abnormal findings in the patient's physical examination...
soft/monotonous voice altered recall loss of vibration/joint position sense in toes ankle reflexes absent can't tandem gait
100
What pituitary hormone test would you run in a patient presenting with these symptoms?
TSH
100
Alzheimer's Disease causes oxidative stress as a result of mitochondrial dysfunction. Lack of OxPhos in melanocytes can result in which condition?
Vitiligo
100
What is the primary class of drugs used as pharmacotherapy for Alzheimer's Disease?
AChE inhibitor (e.g. Donepezil, galantamine, rivastigmine)
100
How do you spell Dr. Varghai's first name?
Houman
200
What medication is the patient taking for HTN?
Lisinopril
200
A deficiency in which vitamin (also deficient in megaloblastic anemia) could cause these symptoms?
B12
200
Patients with this genetic syndrome (caused either by a nondisjunction event or a Robertsonian translocation) almost universally display symptoms of Alzheimer's Disease by age 40...
Trisomy 21 - Down's Syndrome
200
What is the secondary class of drugs used as pharmacotherapy for Alzheimer's Disease?
NMDA receptor antagonist (e.g. Memantine); helps to prevent excitotoxicity
200
What does the "DJ" is DJ Lowrie, PhD stand for?
Donald James
300
This 81 year old female patient is overweight, has HTN, DM, and hypothyroidism. What is her CHADS2 score?
Three (3) (tres) (drei) (trois)
300
What would you expect to see on head CT scan in a patient with Alzheimer's Disease?
mild diffuse cerebral atrophy
300
The active compound in what illicit substance is a more effective acetylcholinesterase inhibitor than actual Alzheimer's Disease drugs?
Cannabis (Tetrahydrocannabinol)
300
Primary side effects of NMDA receptor antagonists include:
dizziness, confusion, hallucinations
300
Dr. Aaron Marshall spends his free time researching which bodily fluid?
Breast Milk
400
Why was a thorough sexual history not conducted?
Because she is 81...
400
What is the leading differential for this case?
Dementia, slowly progressive (90%): Alzheimer's type (85%), B12 deficiency (<5%), vascular dementia (<5%), normal pressure hydrocephalus, hypothyroidism, etc. (0 %) Pseudodementia (10%): grief reaction (5%), loss of social support (5%)
400
Name the two abnormalities found in the brains of patients with Alzheimer's Disease.
Beta-amyloid Plaques and Tau-protein Tangles
400
Primary side effects of AChE inhibitors include:
nausea, dizziness, insomnia
400
What is Dr. Wan Lim's country of origin?
Malaysia
500
What phrase does the patient keep repeating whenever she is asked a question?
"I just don't know, I just don't know"
500
What type of disease, in which the transmissible agent is a misfolded protein, causes symptoms similar to Alzheimer's Disease?
Prion Diseases (Bovine Spongiform Encephalopathy, Kuru, Creutzfeld-Jakob Disease)
500
Older women are more at risk for Alzheimer's Disease than men. What is the hypothesized reason for this?
Post-menopausal women produce less estrogen, which has cytoprotective properties against amyloid toxicity.
500
Name 1 of the 3 classes of drugs associated with drug-induced dementia.
Benzodiazepines, Antihypertensives, or Anticholinergics
500
How old is Dr. Bruce Giffin (+/- 2 years)?
66 Years Young