MDcooper
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In patients suspected of having Alzheimer's disease, a search for reversible causes of dementia might include all of the following EXCEPT
A. blood sugar
B. serum calcium
C. thyroid function tests
D. serum B12
E. urinary and plasma amino acids
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| aml
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a is probable as DM can manifest in any manner
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| achilles
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good questions mdcooper. the one on bronchiectasis was good.
well for this question, is it e-urinary and plasma amino acids ??? i came to this answer by way of excluding others as possible answers though i am not sure.
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| Jinx
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D? is b12 neuropathy completely reversible?
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| drk1980
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good point jinx!
now i change my answer from 'either A or B' to 'D' :-S
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| AAAAA
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Routine blood tests are usually performed to rule out treatable causes. These tests include vitamin B12, folic acid, thyroid-stimulating hormone (TSH), C-reactive protein, full blood count, electrolytes, calcium, renal function and liver enzymes. Abnormalities may suggest vitamin deficiency, infection or other problems that commonly cause confusion or disorientation in the elderly. Chronic use of substances such as alcohol can also predispose the patient to cognitive changes suggestive of dementia.
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| AAAAA
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The answer is E
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| AAAAA
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What Is It?
Amyloidosis is a disease in which an abnormal protein called amyloid accumulates in body tissues and organs. The protein deposits can be in a single organ or dispersed throughout the body. The disease causes serious problems in the affected areas, which may include the heart, brain, kidneys and digestive tract. As a result, people with amyloidosis in different body parts may experience different physical problems:
Brain — Dementia
Heart — Heart failure, arrhythmias, enlarged heart
Kidneys — Kidney failure
Nervous system — Numbness, tingling or weakness from nerve disease
Digestive system — Intestinal bleeding, intestinal obstruction, poor nutrient absorption
Blood — Low blood counts, easy bruising
No one knows what causes amyloidosis. To make matters more complex, amyloidosis is not a single disease, and there are many different types of amyloid proteins that can be involved. For example, Alzheimer's disease and Creutzfeldt-Jakob disease (a rare cause of dementia linked to viruses living in livestock) are two distinct conditions characterized by amyloid deposits in the brain, but the proteins involved are different.
One of the methods physicians use to categorize the type of amyloidosis is to classify it as either primary or secondary. When there is no other underlying disease, and the main problem stems from amyloidosis, the disorder is considered primary. When another disease, usually a chronic inflammatory condition such as tuberculosis or rheumatic disease, leads to amyloidosis, the disorder is considered secondary.
Symptoms
The symptoms caused by amyloidosis depend on the extent of the damage done by the protein deposits, and which body organs are affected. Symptoms can include:
Fatigue
Difficulty breathing
Chronic diarrhea, constipation or excessive gas
Vomiting
Blood in the stool, which may look red or black like coffee grounds
Weight loss
Muscle weakness
Joint pain
An enlarged tongue
Difficulty chewing or swallowing
Rash
Memory problems
Nerve pain or numbness
Diagnosis
Amyloid proteins can build up for a long time before causing any symptoms, so the disease usually is not diagnosed until it is well established. Because the symptoms associated with amyloidosis are common to several different diseases, your doctor probably will run many different tests to check for other diseases first.
He or she will begin with a general examination to look for signs of disease that might be caused by amyloidosis. The examination might include:
Examining joints for signs of arthritis or tendonitis
A test checking for blood in the stool or an endoscopic procedure (in which a flexible, lighted tube with a tiny camera on the end is inserted into the rectum to the colon, or into the stomach through the mouth) to detect gastrointestinal bleeding
Testing the heart for evidence of heart failure or enlargement
Testing muscles for signs of weakness
Examining hands, feet, arms and legs for signs of fluid swelling or poor sensation
Checking mental status to assess possible dementia
Urine will be collected to test for excess protein, which is often a first sign of systemic amyloidosis that has infiltrated the whole body. Blood will be drawn and tested to look for evidence of abnormal blood counts, kidney or liver disease, or abnormal protein.
The only definitive test for amyloidosis is a biopsy, in which a small sample of affected tissue is removed surgically and examined. Biopsies from the rectum or abdominal fat often reveal systemic amyloidosis, in which the whole body is affected. If the amyloid has accumulated in a single organ, such as the brain, the biopsy needs to come directly from that organ. For this reason, many types of amyloidosis are difficult to diagnose. For example, in Alzheimer's disease, a biopsy of brain tissue rarely is done. The biopsy could injure the brain and while the results might provide a diagnosis, it would be unlikely to change treatment. If amyloidosis is diagnosed, additional blood and urine tests will be done to look for diseases that could cause the protein accumulation.
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| AAAAA
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urine and plasma proteins and biospy of fat pad can confirm the diagnosis of amyloidosis which is an irreversible cause of dementia not just among elderly !
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| AAAAA
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Primary amyloidosis is a disorder in which insoluble protein fibers are deposited in tissues and organs, impairing their function.
Causes, incidence, and risk factors Return to top
The cause of primary amyloidosis is unknown, but the condition is related to abnormal production of immunoglobulins by a type of immune cell called plasma cells.
The symptoms depend on the organs affected by the deposits, which can include the tongue, intestines, skeletal and smooth muscles, nerves, skin, ligaments, heart, liver, spleen, and kidneys.
This can result in the following conditions:
Cardiomyopathy (poor heart function)
Kidney failure
Carpal tunnel syndrome (painful swelling of nerves in the wrist)
Malabsorption (inadequate absorption of nutrients from the intestinal tract)
Gastrointestinal reflux (GERD)
Other conditions
The deposits infiltrate the affected organs, causing them to lose resilience and become stiff, which decreases their ability to function. Secondary amyloidosis can be caused by infection, inflammatory diseases, and sometimes cancer.
Risk factors have not been identified. Primary amyloidosis is rare. It is related to the malignant plasma cell disorder multiple myeloma.
Symptoms Return to top
fatigue
numbness of hands and feet
weak hand grip
weight loss
shortness of breath
swelling of the extremities
swallowing difficulties
irregular heart rhythm
skin changes
enlarged tongue
Additional symptoms that may be associated with this disease:
weakness
urine output, decreased
other tongue problems
stools, clay colored
diarrhea
joint pain
hoarseness or changing voice
Signs and tests Return to top
Your doctor may discover that you have an enlarged liver or spleen. There may be signs of heart failure.
If specific organ damage is suspected, testing to confirm amyloidosis of that organ may be performed. For example:
biopsy of a tissue or organ will be positive for amyloid. A skin biopsy that includes subcutaneous fat, a rectal mucosa biopsy, or a bone marrow biopsy can help confirm the diagnosis.
heart evaluation may reveal arrhythmias, abnormal heart sounds, or signs of heart failure.
ECG shows abnormalities.
echocardiogram shows poor wall motion because of a stiff heart muscle (cardiomyopathy).
kidney function evaluation may reveal renal failure or nephrotic syndrome (excessive protein in the urine).
Urinalysis shows protein, casts, or fat bodies.
Serum creatinine is increased.
BUN is increased.
abdominal ultrasound may reveal enlarged liver or spleen.
evaluation for carpal tunnel syndrome may reveal involvement of the nerve:
nerve conduction velocity shows a conduction block.
hand grips are weak because of weakness of the thumb.
This disease may also alter the results of the following tests:
tongue biopsy
nerve biopsy
myocardial biopsy
gum biopsy
carpal tunnel biopsy
Bence-Jones protein (quantitative)
immunoelectrophoresis - serum
quantitative immunoglobulins
urine protein
Treatment Return to top
Some patients with primary amyloidosis respond to chemotherapy directed at the abnormal plasma cells. Autologous stem cell transplanation may be used, as in multiple myeloma.
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| AAAAA
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Amyloid is a class of human proteins with normal function in their soluble forms. Amyloidosis is a diverse group processes characterized by extracelluar tissue deposits of amyloid fibrils including Alzheimer's Disease, amyloid-associated Diabetes, Hemorrhagic Stroke due to Cerebral Amyloid Angiopathy (CAA), Systemic Amyloidosis, and a number of other common and rare disorders.
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| AAAAA
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Deposit of proteins called amyloid can cause irreversible dementia.
Tests may involve urine and plasma protein but the definite diagnostic test is fat pad biopsy--- take a small amount of tissue in the abdomin !!
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| AAAAA
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AD is named after Dr. Alois Alzheimer, a German doctor. In 1906, Dr. Alzheimer noticed changes in the brain tissue of a woman who had died of an unusual mental illness. He found abnormal clumps (now called amyloid plaques) and tangled bundles of fibers (now called neurofibrillary tangles). Today, these plaques and tangles in the brain are considered signs of AD.
Scientists also have found other brain changes in people with AD. Nerve cells die in areas of the brain that are vital to memory and other mental abilities, and connections between nerve cells are disrupted. There also are lower levels of some of the chemicals in the brain that carry messages back and forth between nerve cells. AD may impair thinking and memory by disrupting these messages.
What Causes AD?
Scientists do not yet fully understand what causes AD. There probably is not one single cause, but several factors that affect each person differently. Age is the most important known risk factor for AD. The number of people with the disease doubles every 5 years beyond age 65.
Family history is another risk factor. Scientists believe that genetics may play a role in many AD cases. For example, early-onset familial AD, a rare form of AD that usually occurs between the ages of 30 and 60, is inherited. The more common form of AD is known as late-onset. It occurs later in life, and no obvious inheritance pattern is seen in most families. However, several risk factor genes may interact with each other and with non-genetic factors to cause the disease. The only risk factor gene identified so far for late-onset AD is a gene that makes one form of a protein called apolipoprotein E (ApoE). Everyone has ApoE, which helps carry cholesterol in the blood. Only about 15 percent of people have the form that increases the risk of AD. It is likely that other genes also may increase the risk of AD or protect against AD, but they remain to be discovered.
Scientists still need to learn a lot more about what causes AD. In addition to genetics and ApoE, they are studying education, diet, and environment to learn what role they might play in the development of this disease. Scientists are finding increasing evidence that some of the risk factors for heart disease and stroke, such as high blood pressure, high cholesterol, and low levels of the vitamin folate, may also increase the risk of AD. Evidence for physical, mental, and social activities as protective factors against AD is also increasing.
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| MDcooper
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Yes E is right.We run electrolytes,liver function tests,EEG,and chest Xray to rule out the reversible causes.Thanx AAAAA
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