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      New question bank for paper B   05/11/18

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Gurpal

Part 2 ISQ Club - Organic

37 posts in this topic

Below are some ISQs from the autumn 2004 exam. The complete paper can be downloaded by clicking here.

1. The plenum temporale is situated on the anterior part of inferior temporal lobe

2. HIV enters the brain via infected macrophages

3. Seizures are seen in tuberous sclerosis

4. Atypical facial pain (odontalgia) is characteristically associated with temporo-mandibular joint problems

5. In impotence due to organic pathology, masturbatory erections are diminished

6. Alexia without agraphia occurs in anterior cerebral artery lesions

7. In alexia with agraphia, naming errors occur

8. Broca's aphasia results in short phrase sentences

9. The complications of Tay-Sachs disease can be prevented by diet restriction

10. CJD is most common in Libyan Jews who emigrate to Israel

11. Delusional disorder usually precedes dementia

12. Normal pressure hydrocephalus causing dementia is potentially reversible

13. Personality changes before memory changes suggests Pick’s disease rather than Alzheimer’s disease

14. Having a seizure is more suggestive of Pick’s disease than Alzheimer’s disease

15. Urinary incontinence in an elderly man suggests vascular dementia rather than Alzheimer’s disease

16. Visuospatial functions can differentiate depressive pseudo-dementia from true dementia

17. There is an increased incidence of Alzheimer’s disease in cerebral palsy

18. Leukosariosis is associated with gait disturbance in dementia

19. The age of onset of Huntington’s disease depends on the number of repeated nucleotides

20. In Huntington’s dementia, the retrograde amnesia is consistent throughout the decades of life.

21. In presymptomatic Huntington disease, there is a decrease in the metabolism of glucose in the striatum

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2.HIV enters the brain via infected macrophages.

FALSE

?CD4 T lymphocyte.

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3. seizures are seen in Tuberous Scerosis.

TRUE

all who are mentally retarded & 2/3 who are not.

Kaplan & Saddocks pg 1166

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5. in impotence due to organic pathology, mastubatory erections are diminished.

TRUE

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6. alexia withouh agraphia occurs in ant. cerebral artery lesions.

FALSE

pure word blindness. lesion of corpus callosum & dom occ.lobe

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8. Broca's aphasia results in short phrase sentence.

FALSE

expressive aphasia with few disjointed words & failure to construct sentences.

Kumar & Clarke

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16. Visiospatial function can differentiate depressive pseudo-dementia from true dementia.

TRUE

esp parietal lobe damage

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2.HIV enters the brain via infected macrophages

True -main port of entry by attaching to macrophages

3. Seizures are seen in tuberous sclerosis

True

4. Atypical facial pain (odontalgia) is characteristically associated with temporo-mandibular joint problems

False atypical usually no cause found

10.CJD is most common in Libyan Jews who emigrate to Israel-True

In a country-wide study of Creutzfeldt-Jakob disease (CJD) in Israel, we diagnosed 114 cases, among them 49 Libyan-born, with onset of their disease during the years 1963-1987. After age adjustment, the mean annual incidence rate per million population was 43 among Libyan-born and 0.9 in the rest of the population

14. Having a seizure is more suggestive of Pick’s disease than Alzheimer’s disease

False

18. Leukosariosis is associated with gait disturbance in dementia

True

Leukoariosis- In our Veteran population, leukoaraiosis is an independent predictor of gait disturbance after accounting for stroke and cerebral atrophy. Although leukoaraiosis is a form of cerebrovascular disease, it appears to be most closely associated to gait disturbance in the absence of symptomatic stroke or leg deficit.

19. The age of onset of Huntington’s disease depends on the number of repeated nucleotides

True

manchester notes

20. In Huntington’s dementia, the retrograde amnesia is consistent throughout the decades of life

True

Retrograde amnesia (RA) was studied in patients with Huntington's disease (HD) or Alzheimer's disease (AD) using an updated version of the remote memory battery originally developed by Albert, Butters and Levin. Regardless of whether remote memory was measured by unaided recall or cued recall, HD patients exhibited deficits that were equally severe across decades

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QUES 4) Atypical facial pain is characteristically associated with tempomandibular joint problems.

ANS :---FALSE Atpical facial pain and Tempmandibular pain are two different conditions.

Atypical facial pain : mostly 30 to 50 y females, dull constant ache in one or both cheeks,no triggers,worsened by fatigue/stress,spared during sleep and radiates to ear,forehead and jaw.Treated with TCA/MAOIs.

Temporomandibular Pain: myofacial pain dysfunction,young adults,aching in front of the ear,WORSE ON JAW OPENING with clicks and clunks.Definite relation with jaw opening/chewing.Treatment:Correct dental bite,local inj. of steroid or lignocaine and Amitryptiline.

hasit

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1. The plenum temporale is situated on the anterior part of inferior temporal lobe

FALSE

Posterior part of Superior temporal gyrus

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2. HIV enters the brain via infected macrophages

True

The Blood-Brain Barrier in HIV-associated Dementia

C.F. Pereira1, H.S.L.M. Nottet1

1Eijkman-Winkler Institute, Section of Neuroimmunology, UMC Utrecht, hp. G04.614, Heidelberglaan 100, NL-3584 CX, Utrecht, The Netherlands.

E-mail: h.s.l.m.nottet@lab.azu.nl

Keywords: Macrophages; blood-brain barrier; brain microvascular endothelial cells; HIV-1; HIV-associated dementia.

The transmigration through the blood-brain barrier is facilitated by both endothelial and monocyte/macrophage-derived nitric oxide, as well as by the increased production of gelatinase B activity by HIV-infected monocytes/macrophages. Chemokines produced within the brain regulate the traffic of infiltrating monocytes through the brain parenchyma. In addition, endothelial cells also produce monocyte-attracting chemokines during their interactions with HIV-infected monocytes/macrophages, thus promoting additional influx of mononuclear phagocytes into the brain. Furthermore, excessive infiltration of monocytes is accompanied by endothelial damage resulting in the loss of tight junctions. In summary, brain microvascular endothelial cells might contribute to the neuropathogenesis of HIV-1 infection.

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2. HIV enters the brain via infected macrophages

True

The Blood-Brain Barrier in HIV-associated Dementia

C.F. Pereira1, H.S.L.M. Nottet1

1Eijkman-Winkler Institute, Section of Neuroimmunology, UMC Utrecht, hp. G04.614, Heidelberglaan 100, NL-3584 CX, Utrecht, The Netherlands.

E-mail: h.s.l.m.nottet@lab.azu.nl

Keywords: Macrophages; blood-brain barrier; brain microvascular endothelial cells; HIV-1; HIV-associated dementia.

The transmigration through the blood-brain barrier is facilitated by both endothelial and monocyte/macrophage-derived nitric oxide, as well as by the increased production of gelatinase B activity by HIV-infected monocytes/macrophages. Chemokines produced within the brain regulate the traffic of infiltrating monocytes through the brain parenchyma. In addition, endothelial cells also produce monocyte-attracting chemokines during their interactions with HIV-infected monocytes/macrophages, thus promoting additional influx of mononuclear phagocytes into the brain. Furthermore, excessive infiltration of monocytes is accompanied by endothelial damage resulting in the loss of tight junctions. In summary, brain microvascular endothelial cells might contribute to the neuropathogenesis of HIV-1 infection.

Also refer to Superego course 2005 liaison Psychiatry

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18. Leukosariosis is associated with gait disturbance in dementia

True

leukoariosis is a form of vascular dementia associated with reduced white matter density

Manchester course

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QUESTION 8)

IN PRESYMPTOMATIC HUNTINGTON'S DX, THERE IS A DECREASE IN THE METABOLISM OF GLUCOSE IN THE STRIATUM TRUE

malhi pg 122

PET shows early (prior to structural changes) caudate hypometabolism

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question 15)

Urinary incontinence in an elderly man suggests vascular rather than Alzheimer's dx TRUE

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normal pressure hydrocephalus causing dementia is potentially reversible. .... true. is one of the reversible causes of dementia

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Question 11

Delusional disorder usually precedes dementia

True (from internet)

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Question 11

Delusional disorder usually precedes dementia

True (from internet)

could u please give the reference.

In books they mention a relation of delusional disorder with paranoid personality disorder and schizophrenia but not dementia

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Delusional disorder usually precedes dementia ?

False

I feel the question can be conceptualized in terms of Lewy body dementia, which above all dementias presents more commonly with delusional pathology in initial stages and is certainly less prevalent in the hierarchies of various types of dementias.

The typical clinical picture includes the insidious onset of confusion with psychosis (hallucinations, delusions, and paranoia). The patient's level of alertness and degree of confusion may seem to fluctuate from hour to hour or be episodic. Hallucinations (when present) are often visual, well formed, detailed, and typically involve people. They are often most evident during periods of marked confusion. Parkinsonian features (rigidity, resting tremor, slow movements, and changes in gait and postural balance) usually develop in concert with the cognitive and psychotic features. Memory impairments may not be present in the early stages but are usually evident with progression.

Kelley's Textbook of Internal Medicine

4th Edition © 2000 Lippincott Williams & Wilkins

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. The plenum temporale is situated on the anterior part of inferior temporal lobe

i think false its the superior part

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Delusional disorder usually precedes dementia ?

False

I feel the question can be conceptualized in terms of  Lewy body dementia, which above all dementias presents more commonly with delusional pathology in initial stages and is certainly less prevalent in the hierarchies of various types of dementias.

The typical clinical picture includes the insidious onset of confusion with psychosis (hallucinations, delusions, and paranoia). The patient's level of alertness and degree of confusion may seem to fluctuate from hour to hour or be episodic. Hallucinations (when present) are often visual, well formed, detailed, and typically involve people. They are often most evident during periods of marked confusion. Parkinsonian features (rigidity, resting tremor, slow movements, and changes in gait and postural balance) usually develop in concert with the cognitive and psychotic features. Memory impairments may not be present in the early stages but are usually evident with progression.

Kelley's Textbook of Internal Medicine

4th Edition © 2000 Lippincott Williams & Wilkins  

I don't think that the delusions that accompany should be considered as delusional disorder because delusional disorder is a clearly defined entity in the ICD10.

The way I see this question is to consider a group of people with dementia and review their past history for delusional disorder. Would this figure be high enough to say that delusional disorder USUALLY precedes dementia? Well, I don't have any study to back this but it sounds fairly reasonable to say it is false!

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17. There is an increased incidence of Alzheimer’s disease in cerebral palsy

I guess it is false.

I have not come across this - cerebral palsy as a predisposing factor to Alz dis. as is Down's. However any insult to the brain may lead to an increase amyloid plaques and NF tangles( eg autoimmune, infection and head injury - Ref Core Psychiatry pg 481)

NB The reference is only for the bracketted stuff, does anyone have a reference for cerebral palsy?

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dear donald

i agree with your suggestion regarding delusional disorder`s criteria (3 months,personal delusions rather than subcultural,no evidence of brain disease etc).

its a difficult one but false seems reasonable.

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