MS3 Psychiatry – cognitive disorders – Flashcards

waxing & waning change in level of consciousness occurs in 10-30% of medical pts most common in: elderly, ICU, post-op, cancer DDx: metabolic, infection, neurologic/neoplastic, toxic, trauma *sx:* *disoriented*, change in speech, sleep disturbance, perceptual disturbance, PMA/PMR, emotional disturbance, perseveration, *decreased attention, impaired recent memory* tx: -identify underlying cause -maintain hydration & nutrition -pt safety: 1-on-1 obs, re-orient pt, correct sleep cycle -low-dose haloperidol (PO/IM/IV) -avoid BDZs unless due to EtOH/BDZ withdrawal

DDx: CVA or mass lesion test: brain CT or MRI

dx: hypertensive encephalopathy test: brain CT or MRI

dx: stimulant intoxication test: urine toxicology

dx: meningitis test: brain CT >> LP

dx: thyrotoxicosis test: T4, TSH

memory impairment + impairment of other cognitive functions *no* alteration of consciousness *prevalence*: 1.5% at 60, 40% at 90 (doubles every 5 years) most common etiologies: -Alzheimer's: 50-70% -vascular: 15-25% dx: check med list! chemistry, CBC, TSH, B12/folate, brain CT & MRI (Lyme, syphilis, HIV if necessary)

language disturbance

impaired ability to carry out motor activities despite normal motor function

inability to recognize or identify objects despite normal sensory functions

planning organizing sequencing abstraction

multi-infarct dementia test: brain CT & MRI

Lewy body dementia

normal pressure hydrocephalus test: brain CT & MRI

hypothyroidism test: TSH, T4

B12 deficiency test: B12 level

Wilson disease test: serum ceruloplasmin

tertiary syphilis test: CSF VDRL or CSF FTA-ABS