CMN 577 Unit 2
In performing the PE on a patient with a neurological complaint, what is important to
take note of? -ANS-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? -ANS-B12 deficiency,
infection, polypharmacy, alcohol/drug abuse
What may be psychosocial factors in altered mental status? -ANS-Depression, Anxiety,
Grief, ? Elder Abuse
STM loss is associated with? -ANS-B12 deficiency and Hypothyroidism
What diagnostic tests should be performed in AMS? -ANS-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...? -ANS-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?
-ANS-Delirious
Some acute mental status changes noted in delirium include? -ANS-Confusion,
hallucinations, restlessness, and incoherent speech
Onset of dementia is gradual and progressive, and usually occurs after age ?? -ANS-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? -ANS-Pick's Disease
What is the first noticeable difference between Pick Disease and Alzheimer's? -ANS-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? -ANS-Lewy Body
Dementia
Lewy body dementia and Parkinson's disease can result in? -ANS-Rigid muscles,
slowed movements, and tremors
In Lewy body dementia, protein deposits develop in nerve cells in regions of the brain
involved in? -ANS-Thinking, memory, and movement
What diagnostic tests are appropriate for Alzheimer's diagnosis? -ANS-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? -ANS-Axona
What are the treatment options for Alzheimer's Disease? -ANS-Cholinesterase
Inhibitors (memantine (Namenda)) and antidepressants, diet and exercise
What tests are helpful in evaluating/diagnosing Dementia? -ANS-MMSE (not used
anymore), MoCa, SLUMS, and Mini-Cog
The Mini-Cog should be used for initial testing. If (+), then move on to? -ANS-MoCa or
SLUMS
What is NPH? -ANS-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? -ANS-Gait changes, Altered thought processes,
and urinary incontinence
What is the treatment of NPH? -ANS-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? -ANS-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. -ANS-4.5
What medications are indicated for post-stroke treatment? -ANS-Anti-coagulant therapy
(may include ASA, Plavix, Aggrenox, Coumadin)
If atrial fibrillation is the underlying cause of the CVA, what anticoagulants may be
considered? -ANS-Pradaxa, Xarelto, Eliquis
What is the typical age of onset for Parkinson's disease? -ANS-45-65
What are the symptoms of Parkinson's? -ANS-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? -ANS-Huntington's Chorea and Wilson's disease
What is Huntington's Chorea? -ANS-Inherited disease with progressive dementia,
bizarre movements, and posture
What is Wilson's disease? -ANS-Accumulation of copper in various vital organs
What are some medications that may create Parkinson's-type symptoms?
-ANS-Metoclopramide, Reserpine, and Anti-psychotics
Parkinson's related dementia must be diagnosed ??? After the diagnosis of Parkinson's
is made -ANS-2 years
How can I distinguish between essential familial tremors and PD tremors?
-ANS-Essential familial tremors are ABSENT at rest and PRESENT with intention- they
often affect the head, have normal movement speed, and are fairly animated—— Also,
usually BILATERAL
In PD, when functional disability w/ cognitive impairment are noted, what should be
used first line? -ANS-Sinemet
In PD management, what medication may be appropriate with mild functional debility
and a predominant tremor? -ANS-Amantadine
In performing the PE on a patient with a neurological complaint, what is important to
take note of? -ANS-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? -ANS-B12 deficiency,
infection, polypharmacy, alcohol/drug abuse
What may be psychosocial factors in altered mental status? -ANS-Depression, Anxiety,
Grief, ? Elder Abuse
STM loss is associated with? -ANS-B12 deficiency and Hypothyroidism
What diagnostic tests should be performed in AMS? -ANS-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...? -ANS-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?
-ANS-Delirious
Some acute mental status changes noted in delirium include? -ANS-Confusion,
hallucinations, restlessness, and incoherent speech
Onset of dementia is gradual and progressive, and usually occurs after age ?? -ANS-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? -ANS-Pick's Disease
What is the first noticeable difference between Pick Disease and Alzheimer's? -ANS-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? -ANS-Lewy Body
Dementia
Lewy body dementia and Parkinson's disease can result in? -ANS-Rigid muscles,
slowed movements, and tremors
In Lewy body dementia, protein deposits develop in nerve cells in regions of the brain
involved in? -ANS-Thinking, memory, and movement
What diagnostic tests are appropriate for Alzheimer's diagnosis? -ANS-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? -ANS-Axona
What are the treatment options for Alzheimer's Disease? -ANS-Cholinesterase
Inhibitors (memantine (Namenda)) and antidepressants, diet and exercise
What tests are helpful in evaluating/diagnosing Dementia? -ANS-MMSE (not used
anymore), MoCa, SLUMS, and Mini-Cog
The Mini-Cog should be used for initial testing. If (+), then move on to? -ANS-MoCa or
SLUMS
What is NPH? -ANS-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? -ANS-Gait changes, Altered thought processes,
and urinary incontinence
What is the treatment of NPH? -ANS-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? -ANS-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. -ANS-4.5
What medications are indicated for post-stroke treatment? -ANS-Anti-coagulant therapy
(may include ASA, Plavix, Aggrenox, Coumadin)
If atrial fibrillation is the underlying cause of the CVA, what anticoagulants may be
considered? -ANS-Pradaxa, Xarelto, Eliquis
What is the typical age of onset for Parkinson's disease? -ANS-45-65
What are the symptoms of Parkinson's? -ANS-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? -ANS-Huntington's Chorea and Wilson's disease
What is Huntington's Chorea? -ANS-Inherited disease with progressive dementia,
bizarre movements, and posture
What is Wilson's disease? -ANS-Accumulation of copper in various vital organs
What are some medications that may create Parkinson's-type symptoms?
-ANS-Metoclopramide, Reserpine, and Anti-psychotics
Parkinson's related dementia must be diagnosed ??? After the diagnosis of Parkinson's
is made -ANS-2 years
How can I distinguish between essential familial tremors and PD tremors?
-ANS-Essential familial tremors are ABSENT at rest and PRESENT with intention- they
often affect the head, have normal movement speed, and are fairly animated—— Also,
usually BILATERAL
In PD, when functional disability w/ cognitive impairment are noted, what should be
used first line? -ANS-Sinemet
In PD management, what medication may be appropriate with mild functional debility
and a predominant tremor? -ANS-Amantadine
