Neurocognitive Disorders

Description

Test I: 4, 69, 112, 147 Test II: 92, 130, 144 Test III: 9, 49, 55, 106 Test IV: 126, 147 Test V: 142 Test VI: none Vignette 16 Vignette 17
Eleanor garvey
Quiz by Eleanor garvey, updated more than 1 year ago
Eleanor garvey
Created by Eleanor garvey over 4 years ago
27
1

Resource summary

Question 1

Question
Test 1 Question 4. A patient with lesions in the orbitofrontal region of the brain will present as:
Answer
  • Profane, irritable, and irresponsible
  • Manic
  • Depressed
  • Apathetic
  • Psychotic

Question 2

Question
Test 1 Question 69. Homozygosity for which one of the following is believed to predispose patients to Alzheimer-type dementia?
Answer
  • Tau
  • Apolipoprotein E4
  • Amyloid precursor protein
  • Trisomy 21
  • Presenilin

Question 3

Question
Test 1 Question 112. Which one of the following is associated with the amyloid precursor protein?
Answer
  • Wilson’s disease
  • Schizophrenia
  • Alzheimer’s disease
  • Bipolar disorder
  • Huntington’s disease

Question 4

Question
Test 1 Question 147. The sign that best differentiates between delirium and dementia is:
Answer
  • Sleep disturbance
  • Hallucinations
  • Disorientation to place
  • Violent behavior
  • Alteration of consciousness

Question 5

Question
Test 2 Question 92. Which one of the following is not more typical of a cortical dementia than of a subcortical dementia such as dementia of the Alzheimer type?
Answer
  • Apathy and depression
  • Aphasia
  • Dyspraxia
  • Absence of motor abnormalities
  • Insidious progression of cognitive decline

Question 6

Question
Test 2 Question 130. An 82-year-old patient in a skilled nursing facility displays confusion, restlessness, agitation, and disorganized speech only during the evening hours. Which one of the following is not an appropriate treatment approach?
Answer
  • Increased lighting in the room
  • Low-dose haloperidol at bedtime
  • Having a calendar on the wall
  • Flurazepam at bedtime for sleep
  • Companionship and family support during the day

Question 7

Question
Test 2 Question 144. Which one of the following characteristics pertaining to vascular dementia is false?
Answer
  • There is a stepwise decline in functioning
  • Hypertension is a known risk factor
  • There is abrupt onset of symptoms
  • There is a good response to cholinergic therapies
  • Smoking is a known risk factor

Question 8

Question
Test 3 Question 9. You are called to evaluate a 60-year-old man with a history of depression. His family reports that he has not been himself for the past 5 days. On examination he makes poor eye contact, is inattentive, mutters incoherently, keeps rearranging pieces of paper on his bed tray with no apparent logic, and drifts off to sleep while you are talking to him. What is his most likely diagnosis?
Answer
  • Depression
  • Dementia
  • Systemic lupus erythematosus
  • Delirium
  • Obsessive–compulsive disorder

Question 9

Question
Test 3 Question 49. Which one of the following psychiatric symptoms is not found with AIDS?
Answer
  • Progressive dementia
  • Personality changes
  • Heat intolerance
  • Depression
  • Loss of libido

Question 10

Question
Test 3 Question 55. Which one of the following dopaminergic tracts or areas is responsible for the parkinsonian side effects of antipsychotic medications?
Answer
  • Mesolimbic–mesocortical tract
  • Tuberoinfundibular tract
  • Nigrostriatal tract
  • Caudate neurons
  • Ventral striatum

Question 11

Question
Test 3 Question 106. An elderly hospitalized patient with vascular risk factors has a stroke. The patient’s behavior following the stroke is noted to be unusually calm and markedly hypersexual. This presentation probably resulted from a stroke to the:
Answer
  • Hippocampi
  • Nucleus accumbens
  • Hypothalamus
  • Occipital lobes
  • Amygdaloid bodies

Question 12

Question
Test 4 Question 126. On which chromosome is the gene for amyloid precursor protein found?
Answer
  • Chromosome 19
  • Chromosome 20
  • Chromosome 21
  • Chromosome 4
  • Chromosome 13

Question 13

Question
Test 4 Question 147. Which one of the following is most consistent with delirium?
Answer
  • Slow onset
  • Impaired remote memory
  • Fragmented sleep
  • Impaired immediate memory
  • Normal alertness

Question 14

Question
Test 5 Question 142. The prevalence of Alzheimer’s disease in those patients over age 85 years is:
Answer
  • Less than 5%
  • 5% to 10%
  • 11% to 20%
  • 21% to 40%
  • 41% to 50%

Question 15

Question
Vignette 16 Question 1. Given his history, the most likely diagnosis is: (Pick two of six)
Answer
  • Major depressive disorder
  • Generalized anxiety disorder
  • Vascular dementia
  • Diffuse Lewy body disease
  • Alzheimer’s dementia
  • Pick’s disease

Question 16

Question
Vignette 16 Question 2. What would be your next maneuver with respect to this patient in the outpatient setting? (Pick three of seven)
Answer
  • Start sertraline 25mg daily
  • Start trazodone 50 mg at bedtime
  • Start donepezil 5mg daily
  • Obtain an electroencephalogram
  • Start risperidone 0.25mg at bedtime
  • Obtain an outpatient brain MRI
  • Obtain neuropsychological consultation

Question 17

Question
Vignette 16 Question 3. His daughter is concerned that she cannot manage her father properly in the home. What suggestions can you make to help her with this situation? (Pick three of six)
Answer
  • Refer him to an ACT team for ongoing management
  • Obtain a visiting-nurse consultation
  • Refer her to caregiver support programming and groups
  • Convince her to get family members to provide coverage in the home to monitor the patient more closely
  • Consult a physiatrist to have the patient placed in a subacute rehabilitation facility
  • Seek skilled nursing facility or assisted-living facility placement for the patient

Question 18

Question
Vignette 16 Question 4. If the patient has a dementia of the Alzheimer type, what would be his expected prognosis if he were to remain untreated?
Answer
  • 1 to 3 years
  • 4 to 6 years
  • 7 to 10 years
  • 11 to 15 years
  • 15 to 20 years

Question 19

Question
Vignette 16 Question 5. The treatment of choice for a case of dementia believed to have features of both Alzheimer and vascular type would be: (Pick three of seven)
Answer
  • An antiplatelet aggregant agent
  • An atypical antipsychotic agent
  • A sedative–hypnotic anxiolytic agent
  • A cholinesterase-inhibiting agent
  • Vitamin B complex supplementation
  • An antidepressant agent
  • An antihypertensive agent

Question 20

Question
Vignette 16 Question 6. Which of the following is not typically a complication of this man’s illness?
Answer
  • Agitation and sundowning
  • Personality changes
  • Aggression
  • Hallucinations and delusions
  • Depression
  • Mania

Question 21

Question
Vignette 16 Question 7. Which of the following drugs should be avoided in this patient? (Pick two of seven)
Answer
  • Rivastigmine
  • Aspirin
  • Memantine
  • Benztropine
  • Diphenhydramine
  • Fluoxetine
  • Galantamine

Question 22

Question
Vignette 17 Question 1. Which of the following symptoms are not generally characteristic of Wanda’s present syndrome? (Pick two of six)
Answer
  • Mood stability
  • Irritability
  • Sleep–wake cycle disturbance
  • Language disturbance
  • Gradual onset over weeks to months
  • Memory impairment

Question 23

Question
Vignette 17 Question 2. Which of the following risk factors predispose this patient to the current condition you now find her in? (Pick three of six)
Answer
  • Smoking history
  • Female gender
  • Her age
  • Her current medications
  • Her MS
  • Hypertension

Question 24

Question
Vignette 17 Question 3. The central nervous system (CNS) area(s) believed to be most closely implicated in this patient’s present condition is (are) the:
Answer
  • Cerebellum
  • Frontal and parietal lobes
  • Midbrain and nigrostriatal pathway
  • Reticular formation and dorsal tegmental pathway
  • Hippocampus and amygdala

Question 25

Question
Vignette 17 Question 4. Which of the following neurotransmitters is probably the least likely to be implicated in the pathophysiology of delirium?
Answer
  • Norepinephrine
  • Dopamine
  • Serotonin
  • Acetylcholine
  • Glutamate

Question 26

Question
Vignette 17 Question 5. Which of the following electroencephalography findings would you expect to find in this patient?
Answer
  • Temporal lobe spikes
  • Hypsarrhythmia
  • Generalized background slowing
  • Triphasic waves
  • Periodic lateralizing epileptiform discharges (PLEDs)

Question 27

Question
Vignette 17 Question 6. Which of the following agents would not be appropriate treatment for Wanda’s current condition? (Pick two of six)
Answer
  • Haloperidol
  • Risperidone
  • Diphenhydramine
  • Quetiapine
  • Benztropine
  • Olanzapine

Question 28

Question
Vignette 17 Question 7. Which of the following are true about the course and prognosis of delirium? (Pick three of six)
Answer
  • Prodromal symptoms can occur months prior to onset of florid symptoms
  • Symptoms usually persist as long as causally relevant factors are present
  • Delirium usually progresses to dementia according to longitudinal studies
  • Delirium does not adversely affect mortality in patients who develop it
  • Prognosis of delirium worsens with increased patient age and longer duration of the episode
  • Periods of delirium are sometimes followed by depression or PTSD
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