Ujk
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A 72-year-old man is brought to the physician
by his son because
of a 4-day history of increasing confusion and memory
problems. The
son says that his father's ability to function
independently has been
generally declining over the past few years, and he
has become much more
impaired over the past week. The patient has had at
least three to four
previous episodes of a sudden decline of cognitive
functioning over the
past 3 years without full recovery. He has a history
of hypertension.
His blood pressure is 160/95 mm Hg without orthostatic
changes.
Neurologic examination shows no focal findings.
Mini-Mental State Examination
score is 21/30. Which of the following is the most
likely underlying
pathophysiologic process?
A) Central nervous system demyelination
B) Central nervous system infection
C) Diffuse axonal injury
D) Diffuse cortical atrophy
E) Left temporal lobe infarction
F) Multiple, small, central nervous system
infarctions
G) Subdural hematoma
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| Ujk
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Posts: 446
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A 6-year-old girl is brought to the physician because of a 4-week history of headache, fatigue, and decreased appetite. During this period, she has had nausea and vomiting. At the age of 4 years, she was diagnosed with poststreptococcal glomerulonephritis. She is at the 15th percentile for height and the 10th percentile for weight. Examination shows no abnormalities. Her serum urea nitrogen (BUN) level is 50 mg/dL. Which of the following is most likely to limit progression of this patient's renal failure?
A) Increased potassium and sodium bicarbonate intake
B) Decreased sodium and daily calorie intake
C) Low-protein diet
D) Strict fluid restriction
E) Dialysis
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| mildus
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1. It looks to me like vascular dementia, multiinfarcts dementia, F?
History of hypertension and current hypertension, progression in steps (it says that there were several episodes of worsening during previous past years), old age - suggest vascular nature of the disease. However, no focal neurological findings (although not necessarily) don't fit in that dg (I would rather expect at least some signs of cerebrovascular insults, although it is not necessary since it depends on the location of lacunar infarcts; in Binswanger's I would also expect gait disturbance and urinary incontinence)
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| ummair
Forum Newbie
Topics: 2
Posts: 12
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1.D
2.C
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| DrAlex_76
Forum Junior
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what is diffuse cortical atrophy. Thought it's Alzheimer 's path ?!
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| MAB
Forum Senior
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1. E(Multiinfarct Dementia-long history of HTN and stepwise progression of the memory loss)
2.C
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| doc-o8
Forum Elite
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why si teh answer to second q c?can anyone explain plz
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| rdhawan
Forum Newbie
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Posts: 1
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I think because it causes protineuria but look up post streptococcal glomerulonephritis and i think they have are part of nephritic syndrome.
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| mikky
Forum Elite
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Posts: 349
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F
D
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| arlete
Intern in 2009!!!!!
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F
C
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| brutus25
Forum Junior
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F - For sure
C - Most probably
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| hero
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Posts: 506
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Currently, several sets of diagnostic criteria for VaD exist. This list summarizes the main common criteria.
- Vascular risk factors such as hypertension, coronary disease, and diabetes mellitus
- Specific evidence of cerebrovascular disease, eg, strokes and transient ischemic attacks: The cerebrovascular insult should precede (by no more than 3 mo) or coincide with the onset or worsening of cognitive abnormalities.
- Neuroimaging evidence of strokes
- Lateralizing neurologic signs
- Psychiatric disturbances (eg, emotional lability, depression, apathy)
http://www.emedicine.com/neuro/topic227.htm
i.e. it is not multiinfarct dementia in #1
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| Ivonne
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Posts: 1,561
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F------------> PMH of hypertension and multiple episodes of sudden decline of cognitive functioning without full recovery. Souds like step wise dementia...
C -----------> Low protein diet
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| xthine
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F----
C----
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| hero
Forum Guru
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Posts: 506
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"Neurologic examination shows no focal findings" - not consistent with multiinfarct dementia, could smb explain WHY choice F is considered correct ?
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| mikky
Forum Elite
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Posts: 349
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previous episodes of a sudden decline of cognitive
functioning over the
past 3 years without full recovery
this history favours multi infarct dementia
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| hero
Forum Guru
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Posts: 506
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mikky wrote:
previous episodes of a sudden decline of cognitive
functioning over the
past 3 years without full recovery
this history favours multi infarct dementia
agree that history favours, but there is no evidence
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| arlete
Intern in 2009!!!!!
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Ujk:
Answers, please?...
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| drms
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F
C
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| mikky
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@ hero...the patient has most of the criterion which u have posted except for no focal neurological defeceits and also neuroimaging findings r not given...so y not multi infarct dementia??
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