451 Final Exam multiple Choices Questions And Correct Answers

Major cognitive disorder - correct answers A. significant cognitive decline in 1+ domains based on: - concern of the individual, knowledgeable informant, or clinician ; and - impairment in performance, preferably via neuropsychological assessment B. Interference with independence in every day activities (e.g. bills, medication) Minor cognitive disorder - correct answers A. Modest cognitive decline in 1+ domains based on: - concern of the individual, knowledgeable informant, or clinician, and; - modest impairment and performance, preferably via neuropsychological assessment B. Deficits do not interfere with capacity for independence in everyday activities Common symptoms/presentations - correct answers General approach to assessment and treatment - correct answers -acetylcholinesterase inhibitors: inhibits an enzyme from breaking down acetylcholine(important for learning and memory) - anticholinergic drugs & lesions of the basal forebrain cholinergic system produce memory impairment -acetylcholine antagonists produce memory deficits -SSRI: antidepressants/ antipsychotics Alzheimer's (cortical) - correct answers - most common type of dementia, 50% of cases - progressive decline in memory and cognition -5 million americans have AD Pick's disease (cortical) - correct answers - type of frontal lobe dementia - loss of judgement and disinhibition -onset around 50-60 -more common in women -rare, 2% of dementia patients - personality changes (silliness, apathy, eating) lewy body (cortical) - correct answers - lewy bodies (protein deposits) found throughout cortex - symptoms include: motor dysfunction, visual hallucinations, delusions, severe cognitive fluctuations -more rapid decline parkinsons (subcortical) - correct answers - involuntary motor tremor with weakness - neuronal loss in basal ganglia - loss of nerve cells and dopamine - when symptoms appear, already 60% of neurons lost, dopamine levels decreased by 80% -restlessness/rigidity huntingtons/chorea (subcortical) - correct answers - inherited: 50% of offspring expected to inherit - cognitive, personality, motor impairments - involuntary spasmodic movements Progressive supranuclera pasly (subcortical) - correct answers - neuronal loss in striatum and substantia niagra with degeneration of basal ganglia, upper brainstem, & cerebellum - gait disorder/falling - tremor or motor symptoms: gaze, speech, swallowing, dexterity pseudo-dementia - correct answers depression, treatable dementia TBI: common causes/symptoms - correct answers - most common cause of brain damage - mortality varies from 5% to 10% -Falls (infants, children, elderly) and MVA are most common - most injuries are closed (intact skull, brain unexposed) - peak ages are 15-24 and elderly - males, low SES, unemployed, low education, alcohol & drug use, previous injuries GCS (glasgow coma scale) - correct answers - depth and duration of altered consciousness - based on eye opening, best motor response, best verbal response - commonly used with head injury - scoring: range of 3-15 (lower score=worse injury) - coma: typically scores of 3-8 - head injury rating: severe 9, moderate 9-12, mild 13-15 PTA correlates with injury severity and GCS - correct answers Injury - correct answers -Ischemia: absence of normal blood flow in affected area - Edema: tissue swelling - Hematoma: swelling filled with blood; acts as a growing mass and creates pressure, which pushes against brain tissue open injury - correct answers - focal lesion or damage (e.g. puncture, bullet) - rapid improvement within 1-2 years -highly productive of seizures closed injury - correct answers - primary injury occurs at time of impact - secondary injury consists of effects of physiological processes related to primary injury (e.g. hemorrhage, tissue, swelling, alterations in blood flow) - contrecoup lesion: brain sustains a contusion/bruise in an area opposite from the blow when brain strikes the skull - Diffuse axonal injury (DAI): damage to axons from acceleration/deceleration, accompanied by ruptured blood vessels. Utility of imaging - correct answers DSM criteria (major vs. mild due to TBI) - correct answers A. criteria met for major or mild neurocognitive disorder B. evidence of TBI with 1+: - LOC - post-traumatic amnesia - disorientation, confusion - neurological signs (e.g. imaging, seizures, etc.) C. Symptoms present immediately after TBI or recovery of consciousness and persist past acute injury period Recovery - correct answers Kennard effect: -ability of the young to recover from brain damage more thoroughly than adults -observed across several species Second Impact syndrome: - experiencing another TBI prior to full recovery from previous TBI -can lead to severe effects, including death - not well understood Limiting exertion: - brain has difficulty coping with normal demands, resulting in symptoms - avoid physical exercise, schoolwork, reading, driving, alcohol & caffeine. Common assessments: On-feild testing - correct answers - orientation: city stadium, opposing team, month, day - anterograde amnesia (immediate memory): repeat word list -Retrograde amnesia: memory of the hit and events leading up to the hit, score prior to the hit, what happened prior quarter/period? - concentration: digit span backwards - memory: delayed recall of word list Common assessments: Headminder - correct answers - 25 minute technician assisted computerized bedside cognitive screening tool - symptom survey (depression and health screening) - brief computerized neurocognitive tests: keyboard proficiency (number pressing), motor speed (number pressing), processing speed (symbol search with number entry), memory/speed (visual recognition of series of images) & learning/memory ImPACT - correct answers -concussion symptom checklist -brief computerized neurocognitive tests: verbal memory (word list), visual memory (designs), visual motor speed, reaction time, & impulse control Artery vs. Vein - correct answers Arteries: ascending, carry oxygenated blood from heart to parts of body Veins: descending, cary deoxygenated blood toward heart Meninges - correct answers Pia: Inner membrane surrounding the brain and spinal cord Arachnoid: middle membrane, subarachnoid space - under arachnoid, contains CSF Dura: outer layer Stroke Terminology - correct answers - cerebral hemorrhage: blood vessel bursts (epidural, subdural, subarachnoid, intracerebral) - Ischemic stroke: clogged vessel; reduced blood flow (thrombotic: locally formed clot, embolic: blood clot travels, lodging in vessel) - Transient ischemic attack (temporary, clot may dissolve or dislodge) TIA Multi-infarct dementia - correct answers - death of brain tissue (infarct) after series of small strokes, often at different sites and may be small enough to avoid notice - a type of vascular dementia - differs from alzheimer's: onset tends to be acute with fluctuating symptom severity; progresses in stepwise fashion - history of hypertension and stroke - evident focal neurological signs - better memory test performance - reduced verbal output Multiple sclerosis (MS) symptoms - correct answers Prominent symptoms: - weakness or loss of control of limb - transient blindness in one eye - eye muscle imbalance causing double vision - dysarthria - loss of sphincter control - sensory changes such as numbness, fatigue Average age of onset - 30 - 10% have onset after 50 - more common in women Survival is 85% of normal expectations MS etiology - correct answers Neuronal death is not the initiating process - possible autoimmune disease - blood destroys myelin Patchy destruction of myelin sheath - disrupts transmission of nerve impulses - ineffective re-myelination with plaques build up around damaged sites - MRI can visualize plaques in many cases Progressive neurological symptoms - erratic flare-up of symptoms with stable periods. each acute attack may involve different areas and produce different symptoms that mostly resolve with some residual problems MS: Disease process - correct answers - Most begin with relapsing-remitting course - some change to rapid secondary progression - early symptoms tend to be visual changes - flare-ups occur less than once a year and leave some permanent neuronal damage and residual symptoms, which accumulate over time - 10-15% have "chronic-progressive" MS, later age of onset MS: Management - correct answers Vulnerabilities - fatigue, usually difficult to do activities for more than a few hours - heat and stress may exacerbate symptoms Treatment - intereron beta-ib may slow disease progression -anti-inflamatory drugs (corticosteroids, ACTH) may reduce severity/duration of acute steroids Korsakoff's psychosis - correct answers - insufficient diet may lead to thiamine deficiency and then impaired neuronal function, cell death and hemorrhagic lesions in thalamic nuclei, mammillary bodies, limbic system. Depressed neurotransmitter levels - gross memory impairment - sudden onset, often appears as residual condition of confusional state with gain and occulomotor abnormalities - symptoms: confusion, disordered eye and limb movements, similar cognitive impairments to alcoholism with significant memory impairment, anterograde and retrograde deficits Mechanism for early vs. long-term recovery - correct answers - early recovery within hours is often related to edema(swelling) - long-term recovery can take years: cortical reorganization, alternative behavioral strategies Goals of rehabilitation - correct answers Restoration: - using direct training -improvement may occur on the training task but often fails to generalize to other similar tasks -difficult to use direct training to ameliorate the effects of TBI, Stroke, dementia etc. (physical rehab does not equal cognitive rehab) Compensation: - re-learning skills using different/unimpaired processes -external aids (calendars/reminders) Normalization: - decline with age Acceptance: - coming to terms with your situation - evaluating without judgement (giving up) Examples of computer-based rehabilitation - correct answers Examples of memory and attention compensation strategies - correct answers Lists - break down in small parts Reminders - calendars