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Gurpal

Part II ISQ Club - Dementia

53 posts in this topic

Part II ISQs on two topics will be posted twice a week. You are encouraged to post a reply in the thread, stating whether you think an ISQ is true or false and why (eg. a short explanation, with reference to the textbook you used). Please only deal with one ISQ in each post and include the question as the first line of your post. All ISQs are taken from previous posts by Forum members.

In a few days this ISQ Club thread will be moved to the Question Bank board. If you submit an answer, your status will be changed to 'Question Bank member' and you will be able to see the Question Bank board. Please allow up to 48 hours for this change to happen.

Last Part II ISQ Club post on 25 March 2004. Nearly all the recalled past paper questions will have been posted. Hope the revision is going well!

1. Protozoal infections in pregnancy lead to cognitive impairment

2. Mumps in pregnancy leads to cognitive impairment

3. Cytomegalovirus infection in pregnancy leads to cognitive impairment

4. Recurrent urinary tract infections in pregnancy lead to cognitive impairment.

5. Leukoariosis is significant in a patient with dementia and gait disturbance

6. Shrunken frontal lobes indicates Pick's disease than Alzheimer’s

7, The EEG trace has exaggerated spikes in Huntington's disease

8. Port wine stain is seen in tuberous sclerosis

9. Hurler's syndrome can be treated by diet

10. SSRIs cause 10% of dementia cases to improve

11. In delirium, onset of rigidity and cogwheeling is due to nicotinic acid deficiency

12. Pantothenic acid deficiency cause dementia/delirium

13. Vitamin B12 deficiency commonly causes delirium

14. HIV causes Alzheimer’s dememtia

15. Fronto-temporal atrophy usually indicates Pick’s disease

16. In Alzheimer’s disease, the recency effect is preserved when reading a list

17. Diogene’s syndrome is treated by psychotherapy and in-patient treatment

18. In early onset dementia, progressive agnosia indicates Alzheimer’s disease than vascular dementia

19. Being demented nullifies testamentary capacity

20. Dementia is seen more often in women not prescribed HRT

21. Psychosis in temporal lobe epilepsy is mainly associated with a non-dominant focus

22. Herpes simplex infection causes progressive memory loss

23. HIV can lead to Azheimer’s disease

24. Decreased somatostatin levels are seen in Alzheimer’s disease

25. Fronto-temporal atrophy favours a diagnosis of Pick’s disease more than Alzheimer’s disease.

26. Memantine is useful in vascular dementia

27. Memantine is useful in Alzheimer’s dementia

28. Neuroleptics cause lethal side effects in Lewy Body disease

29. Leukoaraiosis is associated with gait disturbances in dementia

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3. Cytomegalovirus infection in pregnancy leads to cognitive impairment

true

ref:

oxford handbook of specialties

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. Protozoal infections in pregnancy lead to cognitive impairment

true

ref same as above

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The EEG trace has exaggerated spikes in Huntington's disease

false

ref:bbh

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3. Cytomegalovirus infection in pregnancy leads to cognitive impairment

TRUE

TERATOGENIC: May cause IUGR, microcephaly, periventricular calcifications,sensorineural deafness, blindness with chorioretinitis, mental retardation, hepatosplenomegaly, thrombocytopenic purpura, hemolytic anemia

Incidence of sequelae is 25% for primary infection, and 8% with recurrent infection [1]

Reference as above

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1. Protozoal infections in pregnancy

True

TERATOGENIC: 3/4 of infants are asymptomatic at birth. Infection may cause chorioretinitis, hydrocephaly,microcephaly, aqueductal stenosis, agenesis of corpus callosum, cerebral calcifications, nonimmune hydrops

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4. Recurrent urinary tract infections in pregnancy lead to cognitive impairment.

??/True

FOund lousy reference to a study showing this.

Some studies have shown a possible correlation between UTIs during pregnancy and low birth weight neonates, maternal hypertension, and first trimester abortions. Recently, a possible association has been found between UTIs and neonatal mental retardation and cerebral palsy. http://altmed.creighton.edu/cranberries/Why%20Important.htm

So far - better reference which gives all sorts of other risks which are known to be risks for cognitive impairment.

http://www.aafp.org/afp/20000201/713.html

The maternal and neonatal complications of a UTI during pregnancy can be devastating. Thirty percent of patients with untreated asymptomatic bacteriuria develop symptomatic cystitis and up to 50 percent develop pyelonephritis.6 Asymptomatic bacteriuria is also associated with intrauterine growth retardation and low-birth-weight infants.9 Schieve and associates39 conducted a study involving 25,746 pregnant women and found that the presence of UTI was associated with premature labor (labor onset before 37 weeks of gestation), hypertensive disorders of pregnancy (such as pregnancy-induced hypertension and preeclampsia), anemia (hematocrit level less than 30 percent) and amnionitis (Table 337). While this does not prove a cause and effect relationship, randomized trials have demonstrated that antibiotic treatment decreases the incidence of preterm birth and low-birth-weight infants.13 A risk of urosepsis and chronic pyelonephritis was also found.40 In addition, acute pyelonephritis has been associated with anemia.41

Neonatal outcomes that are associated with UTI include sepsis and pneumonia (specifically, group B streptococcus infection).31,42 UTI increases the risk of low-birth-weight infants (weight less than 2,500 g [5 lb, 8 oz]), prematurity (less than 37 weeks of gestation at delivery) and preterm, low-birth-weight infants (weight less than 2,500 g and less than 37 weeks of gestation at delivery)39 (Table 337).

TABLE 3

Comparison of Adverse Outcomes in Pregnant Patients Who Developed UTI During Pregnancy and Those Who Did Not

--------------------------------------------------------------------------------

Outcome

--------------------------------------------------------------------------------

Odds ratio

--------------------------------------------------------------------------------

95% confidence interval

--------------------------------------------------------------------------------

Perinatal

Low birth weight (weight less than 2,500 g [5 lb, 8 oz]) 1.4 1.2 to 1.6

Prematurity (less than 37 weeks of gestation at delivery) 1.3 1.1 to 1.4

Preterm low birth weight (weight less than 2,500 g and less than 37 weeks of gestation at delivery) 1.5 1.2 to 1.7

Maternal

Premature labor (less than 37 weeks of gestation at delivery) 1.6 1.4 to 1.8

Hypertension/preeclampsia 1.4 1.2 to 1.7

Anemia (hematocrit level less than 30%) 1.6 1.3 to 2.0

Amnionitis (chorioamnionitis, amnionitis) 1.4 1.1 to 1.9

--------------------------------------------------------------------------------

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4. leukoariosis is a significant.....dementia and gait

false

Subcortical white-matter lesions (leukoariosis) are related to age whereas lesions around the ventricular system appear to be associated with cognitive decline and are found in AD (Matsubayashi et al., 1992; McDonald et al., 1991). The prevalence of leukoariosis varies from 20% to over 60% and specific relationships have been found between the severity of the white-matter change and the degree of cognitive impairment, particularly deficits of attention and comprehension (Kertesz et al., 1990

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6. shrunken froontal lobes indicative of picks rather than ad.

true

BBH - p 180, 3rd edition

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8. Port wine stain is seen in tuberous sclerosis

false

seen in sturge weber syndrome

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9. Hurler's syndrome can be treated by diet

false

mucopolysaccharidoses along with hunter and sanphillipos syndromes. no treatment. bone marrow transplant is still being considered.

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11. In delirium, onset of rigidity and cogwheeling is due to nicotinic acid deficiency

false no evidence

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19. Being demented nullifies testamentary capacity

false many patients do write thier will after the onset of dementia.

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25. Fronto-temporal atrophy favours a diagnosis of Pick’s disease more than Alzheimer’s disease

true

BBH- p 179

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26. Memantine is useful in vascular dementia

27. Memantine is useful in Alzheimer’s dementia

both true

systemic review of cochrane database

Reference: Areosa-Sastre, A. and Sheriff F. The Cochrane Database of Svstematic Reviews: Memantine for dementia, Cochrane Library (3), May 28, 2003.

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28. Neuroleptics cause lethal side effects in Lewy Body disease

true

increased incidence of NMS

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24. Decreased somatostatin levels are seen in Alzheimer’s disease

true including decreased gaba and ck

p 176- BBH

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12. Pantothenic acid deficiency cause dementia/delirium

13. Vitamin B12 deficiency commonly causes delirium

both false;

Pantothenic acid is widespread in foods, making deficiency very rare except for those with a highly processed diet since much of the vitamin B-5 activity is lost during the refinement process. Additionally, pantothenic acid is produced by beneficial bacterial in the digestive system. A reduction or destruction of intestinal flora, most commonly by antibiotic use, can contribute to vitamin B-5 deficiency.

There are claims that pantothenic acid can prevent graying and even restore hair to its natural color, but this is based on animal research that showed increased graying of the fur, decreased growth, progressing to hemorrhage and destruction of the adrenal glands.

In humans, pantothenic acid deficiency results in diminished adrenal gland function. A variety of metabolic problems will also manifest themselves. Fatigue is common along with depression, and problems associated with the digestive system. There will also be loss of nerve function and problems with blood sugar metabolism, with hypoglycemia being the most common.

Pantothenic acid deficiency can reduce immune system responses, increasing the risk of infection. Other symptoms of B-5 deficiency include skin problems, insomnia, lack of coordination, muscle cramps and worsening of allergy symptoms.

th false

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4. Recurrent urinary tract infections in pregnancy lead to cognitive impairment.

FALSE

“Maternal UTI has few direct fetal sequelae because fetal septicemia is rare; however, uterine hypoperfusion due to maternal dehydration, maternal anemia, and direct bacterial endotoxin damage to the placental vasculature may cause fetal cerebral hypoperfusion”

PJ Woodman. Urinary Tract Infections in Pregnancy

http://www.emedicine.com/med/topic3089.htm#target12

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5. Leukoariosis is significant in a patient with dementia and gait disturbance

TRUE

Suggests vascular dementia

(Pg 410, Rev Notes in Psych, Puri & Hall)

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14. HIV causes Alzheimer’s dememtia

FALSE

Herpes simplex not HIV

(Pg 332, Synopsis of Psych, Kaplan & Sadock, 8th Ed)

(Pg 409, Revision Notes in Psych, Puri & Hall)

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15. Fronto-temporal atrophy usually indicates Pick’s disease

TRUE

(Pg 331, Synopsis of Psych, Kaplan & Sadock, 8th Ed)

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16. In Alzheimer’s disease, the recency effect is preserved when reading a list

TRUE

“…Primacy effect is impaired for immediate and delayed recall in dementia of the Alzheimer type. By contrast, immediate recall recency effect and possibly also long-term recency effect are preserved.”

Martin Burkart, Reinhard Heun, Otto Benkert Serial Position Effects in Dementia of the Alzheimer Type

Dementia and Geriatric Cognitive Disorders 1998;9:130-136

http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowAbstract&ProduktNr=224226&Ausgabe=225514&ArtikelNr=17036

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