1. physiological activity associated with PTSD include all except:
A. Decreased parasympathetic tone.
B. Excessive sweating.
C. Increased blood pressure.
D. Increased circulating thyroxine.
E. Elevated baseline heart rate.
2. A 72 year-old lady with 4 months history of memory loss, urinary incontinence and falls. On examination she has mild memory loss and a broad based, slow gait. Muscle tone is normal and both plantar reflexes are down going. What is the likely diagnosis?
A) Alzheimer's disease
B ) Frontal lobe dementia
C ) Multi-infarct dementia
D ) Normal pressure hydrocephalus
E) Parkinson's disease
3. A 73-year-old man with advanced Parkinson's disease is being treated on the ward for a urinary tract infection. His regular medicationincludes co-careldopa, entacapone, cabergoline, and prn subcutaneousapomorphine injections. His wife tells you that for the last month hisbehaviour has changed and he has become agitated, disinhibited and hekeeps asking her for money. His dyskinesia has also become more
denies having hallucinations and, after probing questioning, you canfind no evidence of delusional thought. Mood assessment shows him tobe cheerful and there are no cognitive or biological features ofdepression. What is the likely physiological cause of the behaviouralchange?
A. Reduced breakdown of dopamine
B. Change in sensitivity to dopamine
C. Confusional state due to urosepsis
D. Direct dopamine agonism
E. Coexisting dementia
4. 15. A 24-year-old man is admitted to the psychiatric ward from home, where he lives alone. His neighbours have been increasingly concerned about rubbish piling up inside his flat and sometimes he isn't seen fordays. His family tell you that over the last year he has become veryodd and isolated. On examination, he is withdrawn and quiet and youfind it difficult to understand his answers as he frequently wandersoff the point, as if he is answering a different question. Althoughspontaneous movements are reduced, there are no neurological signs and
older brothers have both had episodes of major depression. Are thereany features that suggest a favourable outcome from this episode?
A. Young age
B. Insidious onset
C. No favourable features
D. Quiet speech
E. Family history of depression
5. An 83-year-old man is undergoing cognitive assessment in apsychogeriatric clinic. He was referred because of a change in hisbehaviour, and his wife has noticed a few aggressive outbursts overthe past months. His Mini-Mental test score is 18. Which patterns ofcognitive deficit would favour a dementia of subcortical origin?
A. Poor Visuospatial performance
B. Preserved verbal fluency
C. Severe memory disturbance
D. Constructional apraxia
E. Reduced verbal output
6. A 77 year old woman complains of memory loss. Which of the following makes a diagnosis of pseudodementia less likely:-
A. Rapid onset
B. Depressed mood
C. Patchy memory loss
D. Great effort in performing tests
E. Rapid progression
1 comment:
1. D 2. D 3. D 4. E 5.E 6. D
1. According to current conceptualisations, PTSD is associated with objective measures of physiological arousal. This includes elevated baseline heart rate, increased blood pressure and excessive sweating that have been reported in the context of trauma cue reactivity studies. Further, evidence from studies of baseline cardiovascular activity revealed a positive association between heart rate and PTSD. The chronicity of PTSD was a moderator of this association. The most chronic patients showed the largest heart rate elevation, suggesting that increased heart rate is a response to repeated stress. The finding of elevated baseline heart rate activity is consistent with the hypothesis of tonic sympathetic nervous system arousal in PTSD. Disturbance in ANS activity in PTSD is characterised by increased sympathetic and decreased parasympathetic tone. Preliminary evidence suggests that this autonomic imbalance can be normalised with SSRI treatment. There is no change in blood level of thyroxine in PTSD.
2. Normal pressure hydrocephalus is characterized by abnormal gait,
urinary incontinence, and dementia. It is an important clinical
diagnosis, because it is a potentially reversible cause of dementia.
It is important to distinguish it from Parkinson's disease. The onset
of gait disturbance and urinary symptoms is unusual so early in
dementia. Frontal lobe dementia is characterised by loss of
'executive' functions. Multi-infarct state has usually a stepwise
history.
3. Neuropsychiatric complications of Parkinson's disease (PD) are common
– experienced by some 70% of all patients. Hedonistic dysregulation is
being increasingly recognised; here patients typically take increasing
amounts of a dopamine agonist even though it worsens their dyskinesia
(usually apomorphine is abused in this way). This results in euphoria,
hypersexuality and gambling. There is an extensive body of research
literature on dopamine reward pathways (from the ventral tegmental
area to the nucleus accumbens) as the mediator of motivation and
possibly drug addiction. The commonest psychiatric complication,
however, is depression (50%, associated with a younger onset, female
gender), anxiety (40%), psychosis (40%, visual hallucinations and
persecutory delusions, often drug related) and dementia (20–40%
associated with an older onset PD, severe extrapyramidal features).
4. This man has schizophrenia with mainly 'negative' symptomatology, i.e.
asocial, reduced spontaneous movements, likely disorganised behaviour
given the state of his flat and his speech is disorganised reflecting
an underlying formal thought disorder. The 'positive' symptoms of
delusions and hallucinations are absent. The following are recognised
features that predict a poor outcome – young age, insidious onset,
poor premorbid social function, negative symptomatology, neurological
signs, no recognised precipitating factor, family history of
schizophrenia. A good outcome is associated with older age, acute
onset, recognisable precipitant, good premorbid social function, being
married, prominent mood disorder, family history of mood disorder,
positive symptomatology. The overall prevalence of schizophrenia is 1%
in all populations. Between 10 and 20% of patients will make a full
recovery from one episode.
5. The distinction between cortical and subcortical dementia is not
absolute but is clinically useful. Subcortical dementia is due to
disruption in the frontostriatal connections and so results in early
frontal lobe problems such as planning difficulties, poor verbal
fluency and task switching. Typically, the 'cortical' functions of
correct word use and complex motor tasks (praxis) are preserved. Basal
ganglia involvement results in 'psychomotor' slowing with reduced
verbal output, slowed rate of response and reduced alertness.
Visuospatial performance can be poor in both cortical and subcortical
dementia so it is less helpful for use in trying to differentiate
them. Severe memory disturbance is more often seen in cortical
dementia. Common causes of subcortical dementia include 1. Parkinsonism 2. Vascular dementia and 3. Multiple sclerosis; rarer causes include4. Normal-pressure hydrocephalus 5. Huntingdon's disease and 6. Wilson's disease.
6. In the elderly, differentiating dementia and pseudodementia may be difficult. Pseudodementia is an apparent disturbance in cognition which is actually due to depression. It is often useful to look for the biological features of depression, such as apathy, loss of appetite and libido, sleep disturbance and constipation. Although it should be borne in mind that dementia may be accompanied by disturbances in mood.
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