Family Medicine EOR: Neurology (Smarty PANCE) Exam Questions and Answers 100% Verified and Updated 2024

Family Medicine EOR: Neurology (Smarty PANCE) Exam Questions and Answers 100% Verified and Updated 2024 An 84-y/o F brought by her son c/o forgetfulness (e.g., forgets phone numbers, loses her way back home) along with difficulty performing some of her daily activities (e.g., bathing, dressing, managing money, using the phone). The problem has gradually progressed over the past few years. What's the dx? Alzheimer's disease ● Progressive cognitive decline; most common older than age 65 years An 81-y/o M presents with progressive confusion over the past several years together with forgetfulness and clumsiness. He has a history of hypertension, diabetes mellitus, and two strokes with residual left hemiparesis. Mental status has clearly worsened after each stroke. What's the dx? Vascular (“multi-infarct”) dementia ● Associated with arteriolosclerotic small vessel disease ● Multi-infarct, usually correlated with a cerebrovascular event and/or cerebrovascular disease ● Stepwise deterioration with periods of clinical plateaus A 55-y/o M presents with a rapidly progressive change in mental status, inability to concentrate, and memory impairment for the past two months. His symptoms are associated with myoclonus and ataxia. What's the dx? Creutzfeldt-Jakob disease What are neurocognitive disorders? Neurocognitive disorders are described as those with a significant (major) or moderate (mild) impairment of cognition or memory that represents a marked deterioration from a previous level of function In addition to memory, what are several other areas of cognitive decline that should be evaluated in the workup of suspected neurocognitive disorder? Judgment, praxis, language, abstract thinking, constructional abilities, and visual recognition When altered perception or level of consciousness is present *along with memory impairment*, what diagnosis should be considered? *Delirium*, which is primarily a disorder of attention and ability to concentrate. The delirious patient may also be demented (dementia is a risk factor for the development of delirium), but the initial diagnosis of dementia cannot be made while a patient is delirious. What is the natural history of most neurocognitive disorders? For the most part, neurocognitive disorders are progressive, but this is not exclusive. Neurocognitive disorders secondary to trauma is not necessarily progressive. A 70-y/o insulin-dependent diabetic presents with episodes of confusion, dizziness, palpitation, diaphoresis, and weakness. What's the dx?. Hypoglycemia A 55 yo F presents with gradual altered mental status and headache. Two weeks ago she slipped, hit her head on the ground, and lost consciousness for two minutes. What's the dx? Subdural hematoma What percentage of neurocognitive disorder are reversible? Rarely (<5%) are neurocognitive disorders reversible. What are the 6 causes of reversible neurocognitive disorders? 1. Secondary to an infection of the CNS (neurosyphilis) 2. Metabolic and nutritional neurocognitive disorders (vitamin B12 deficiency) 3. Inflammatory neurocognitive disorders (vasculitis involving cerebral blood vessels) 4. Neurocognitive disorders caused by a structural defect impinging on the brain (a subdural hematoma or tumor) 5. NPH 6. Endocrine-related neurocognitive disorders (hypothyroidism) What is the initial workup of the demented patient? The workup can be directed by the history and physical examination, but the following initial tests should be considered: vitamin B12 level, thyroid function tests, RPR, HIV test, ESR, CBC, chemistries, liver enzy