MS3 Psychiatry – cognitive disorders – Flashcards

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Delirium
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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
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Delirium + focal neurologic sign
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DDx: CVA or mass lesion test: brain CT or MRI
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Delirium + elevated blood pressure & papilledema
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dx: hypertensive encephalopathy test: brain CT or MRI
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Delirium + dilated pupils & tachycardia
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dx: stimulant intoxication test: urine toxicology
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Delirium + fever, nuchal rigidity, & photophobia
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dx: meningitis test: brain CT >> LP
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Delirium + tachycardia, tremor, & thyromegaly
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dx: thyrotoxicosis test: T4, TSH
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Dementia
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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)
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Aphasia
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language disturbance
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Apraxia
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impaired ability to carry out motor activities despite normal motor function
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Agnosia
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inability to recognize or identify objects despite normal sensory functions
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Executive functioning
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planning organizing sequencing abstraction
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Dementia + focal neurologic signs
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multi-infarct dementia test: brain CT & MRI
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Dementia + cogwheel rigidity & resting tremor
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Lewy body dementia
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Dementia + ataxia + urinary incontinence
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normal pressure hydrocephalus test: brain CT & MRI
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Dementia + obesity, coarse hair, constipation, & cold intolerance
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hypothyroidism test: TSH, T4
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Dementia + diminished proprioception & vibration sense & megaloblastic anemia
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B12 deficiency test: B12 level
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Dementia + tremor, abnormal LFTs, & Kayser-Fleischer rings
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Wilson disease test: serum ceruloplasmin
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Dementia + diminished proprioception & vibration sense & Argyll-Robertson pupils
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tertiary syphilis test: CSF VDRL or CSF FTA-ABS
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