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Neuro 9 Degen D/O 2

Degenerative Disorders Part 2

A 66yo woman with forgetfulness and decreased B/L parietal lobe activity on PET scan has what form of dementia? Alzheimer's Disease
What 2 classes of medications are used in the tx of Alzheimer's Disease? 1. AChE-i like donepezil and rivastigmine 2. NMDA-receptor blocker like memantadine
How does one differentiate between vascular dementia and Alzheimer disease? MRI brain will show evidence of multiple infarcts in case of vascular dementia.
What are 2 sx that should clue you in to the diagnosis of MS? 1. Unilateral optic neuritis with pain in one eye that is worse w/movement and central vision loss 2. Internuclear ophthalmoplegia
What is the most sensitive test for MS? MRI brain: look for assymetrical white matter lesions of different ages
What medication decreases the frequency of relapses in pts with MS? IFN-beta
What important neuronal tract is the first to be compressed and compromised in the case of a syringomyelia? Spinothalamic tract (carries pain and temp)
What are the differing presentations of Alzheimer disease, Pick disease, and Lewy body dementia? *Alz: regular dementia *Pick: dementia + personality changes + progressive aphasia *Lewy body: dementia + Parkinsonian sx + visual hallucinations (may also have syncope and frequent falls)
What 2 SE should a physician be aware of when using atypical antipsychotics? Weight gain and DM (rare, but can progress to DKA!)
What are the s/s of a TCA overdose? How is it managed? Anticholinergic, cardiotox, and CNS tox. Tx is sodium bicarb (esp if QRS >100ms) and benzos (seizures)
A pt is brought to ER with HA, vomiting, neck pain, and fever. There is progressive m weakness, but sensation is intact. CSF analysis shows normal glucose and protein, but the CSF lymphocyte ct ishigh. What is the dx? Polio
How is dementia diagnosed in general? With the MMSE (<24/30=dementia)
What are the unique features of dementia cuased by Pick disease? dementia + behavioral/personality changes + progressive aphasia
What are the unique features of Lewy body dementia? Dementia + Parkinsonian sx (bradykinesia, shuffling gait, cogwheel rigidity) + visual hallucinations + repeat syncopal episodes (falls)
What are the components of a dementia workup? MMSE, CBC (megaloblastic anemia), UA (UTI), Chem 8 (hypercalcemia), RPR, HIV, TSH (hypo), Vit B12, CT or MRI head (MRI superior)
What anticholinergic drug can be used to treat the early tremors of Parkinson's disease? Trihexylphenidyl
Pt presents with rapidly progressive dementia, myoclonus, and shart triphasic synchronous discharges on EEG. What is the diagnosis and the prognosis? Creutzfeld-Jacob dz, spongiform encephalopathy caused by prions. Die in 1yr or less from dx.
What is the most specific symptom for dementia? Impairment in functioning.
What CT findings might you see in an Alzheimer pt? Are these findings specific for the disease? Cortical atrophy that is more prominent in temporal and parietal lobes. Not a specific finding. AD is a dx of exclusion.
What is the 2nd MCC of dementia? Vascular (differentiate from AD with MRI looking for multiple infarcts)
What is the tx for AD? Cholinesterase inhibitors: donepezil, rivastigmine, galantamine. NMDA receptor blocker: memantine
Pt presents with pain in her R eye that is exacerbated by movement. She also complains of weakness in her lower extremities and problems with "dizziness." On PE, when she tries to her L, her R eye barely moves and her L eye has L-beating nystagmus. Dx? MS. Her PE finding is internuclear opthalmoplegia caused by lesion of the R medial longitudinal fasciculous
What are the CSF findings in MS? Increased protein, mildly elev Wt ct, oligoclonal banding, and increased IgG
What are the MRI findings in MS? Multiple asymmetric white matter lesions
What is the tx for MS? Corticosteriods: methylprednisone
What drugs can be used to reduce the frequency and length of MS exacerbations? IFN-beta and glatiramer acetate
Created by: sarah3148



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