CMN 577 Unit 2 exam with complete
solutions
In performing the PE on a patient with a neurological complaint, what is important
to take note of? - ANSWER- General appearance and affect, Establish mental
status, Oberve motor function/gain, Consider cranial nerves, reflexes,
fundoscopic and sensory exam
10-20% of treatable causes of altered mental status include? - ANSWER- B12
deficiency, infection, polypharmacy, alcohol/drug abuse
What may be psychosocial factors in altered mental status? - ANSWER-
Depression, Anxiety, Grief, ? Elder Abuse
STM loss is associated with? - ANSWER- B12 deficiency and Hypothyroidism
What diagnostic tests should be performed in AMS? - ANSWER- UA, CBC, BMP,
B12, RPR, ESR, and TSH——- Further tests dependent upon
complaints/symptoms
What test is the gold standard for a dementia work-up and is often useful for
ruling out stroke, masses, etc...? - ANSWER- Head CT Scan
Rhonda is a 68 y.o woman who has started having problems remembering things
in the last few days (like where she put her keys). She comes to your clinic and
you test a UA and see she has a raging UTI and fever. Is Rhonda demented or
delirious? - ANSWER- Delirious
Some acute mental status changes noted in delirium include? - ANSWER-
Confusion, hallucinations, restlessness, and incoherent speech
Onset of dementia is gradual and progressive, and usually occurs after age ?? -
ANSWER- 60
,Gil is a 62 y.o Male coming into the clinic today (with his daughter) with
progressive loss of speech and memory problems, as well as angry outbursts.
Upon investigation, Gil is found to have a build-up of Tau proteins in his neurons
that have accumulated into silver-staining, spherical aggregations. What is Gil's
diagnosis? - ANSWER- Pick's Disease
What is the first noticeable difference between Pick Disease and Alzheimer's? -
ANSWER- the personality change that hallmarks the onset of Pick's disease
versus the short term memory loss of Alzheimer's
Hillary has a recent diagnosis of dementia and comes into the clinic today with
her daughter. Hillary has been talking to her deceased sister around the house
and is increasingly drowsy. What type of dementia do you suspect? - ANSWER-
Lewy Body Dementia
Lewy body dementia and Parkinson's disease can result in? - ANSWER- Rigid
muscles, slowed movements, and tremors
In Lewy body dementia, protein deposits develop in nerve cells in regions of the
brain involved in? - ANSWER- Thinking, memory, and movement
What diagnostic tests are appropriate for Alzheimer's diagnosis? - ANSWER-
CBC, CMP, TSH, B12, RPR, CT Head
What is the name of the prescription medical food that is intended for the clinical
dietary management of the metabolic processes associated with mild to moderate
Alzheimer's disease? - ANSWER- Axona
What are the treatment options for Alzheimer's Disease? - ANSWER-
Cholinesterase Inhibitors (memantine (Namenda)) and antidepressants, diet and
exercise
What tests are helpful in evaluating/diagnosing Dementia? - ANSWER- MMSE (not
used anymore), MoCa, SLUMS, and Mini-Cog
The Mini-Cog should be used for initial testing. If (+), then move on to? -
ANSWER- MoCa or SLUMS
What is NPH? - ANSWER- Normal Pressure Hydrocephalus- It is an enlargement
of the ventricles WITHOUT increased ICP- presents in >/= 60 y.o
, What is the triad of symptoms in NPH? - ANSWER- Gait changes, Altered thought
processes, and urinary incontinence
What is the treatment of NPH? - ANSWER- Treatment of symptoms-
anticholinesterase inhibitors may be helpful w/ memory loss
Shunt placement- can be considered but must weigh pros and cons
What are some risk factors for stroke? - ANSWER- HTN, DM, CAD, Migraine
Headaches, Hyperlipidemia, Tobacco Abuse, ETOH/drug abuse, personal/family
hx of stroke
Ischemic stroke treatment must be initiated within ??? Hours of onset. -
ANSWER- 4.5
What medications are indicated for post-stroke treatment? - ANSWER- Anti-
coagulant therapy (may include ASA, Plavix, Aggrenox, Coumadin)
If atrial fibrillation is the underlying cause of the CVA, what anticoagulants may
be considered? - ANSWER- Pradaxa, Xarelto, Eliquis
What is the typical age of onset for Parkinson's disease? - ANSWER- 45-65
What are the symptoms of Parkinson's? - ANSWER- Tremor, rigidity,
bradykinesia, and postural instability- considered "hallmark" features
First symptom is usually "pill-rolling" tremor unilaterally, that is absent during
sleep, with maximum SXS at rest
If a patient has SXS of Parkinson's, but are younger than 50, what two diseases
must be ruled out? - ANSWER- Huntington's Chorea and Wilson's disease
What is Huntington's Chorea? - ANSWER- Inherited disease with progressive
dementia, bizarre movements, and posture
What is Wilson's disease? - ANSWER- Accumulation of copper in various vital
organs
What are some medications that may create Parkinson's-type symptoms? -
ANSWER- Metoclopramide, Reserpine, and Anti-psychotics
Parkinson's related dementia must be diagnosed ??? After the diagnosis of
Parkinson's is made - ANSWER- 2 years
