Geriatric Neurology: Falls & Mobility

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Questions and Answers

Which factor is LEAST likely to contribute to acute falls in the geriatric population?

  • Chronic osteoarthritis (correct)
  • Toxic exposure
  • Metabolic imbalance
  • Infectious disease

A patient's mobility assessment reveals a deviation from normal walking. Which of the following is least likely to be a contributing factor?

  • Acute anxiety (correct)
  • Gait disturbance
  • Balance issues
  • Postural abnormalities

Which of the following best describes delirium?

  • A slowly progressive cognitive decline
  • A fluctuating state of disorganized thought (correct)
  • A consistent inability to perform activities of daily living
  • A fixed state of impaired memory

When evaluating a patient for delirium, which laboratory study is LEAST likely to be helpful in determining the underlying cause?

<p>Serum lipid panel (A)</p> Signup and view all the answers

Which feature is MOST indicative of dementia rather than delirium?

<p>Insidious onset (D)</p> Signup and view all the answers

Which of the following is the most common cause of dementia?

<p>Alzheimer's disease (A)</p> Signup and view all the answers

A patient presents with memory impairment, speech difficulties, and imbalance. Which of the following findings would most strongly suggest a diagnosis of vascular dementia?

<p>History of vascular risk factors (A)</p> Signup and view all the answers

Which of the following is the most common mechanism of stroke?

<p>Ischemia (D)</p> Signup and view all the answers

According to the World Health Organization (WHO), how long must neurological deficits last to be classified as a stroke rather than a transient ischemic attack (TIA)?

<p>24 hours or more (C)</p> Signup and view all the answers

Which of the following is a modifiable risk factor for stroke?

<p>Hypertension (A)</p> Signup and view all the answers

A patient presents with acute onset of right-sided weakness and speech difficulty. If no hemorrhage is seen on the initial head CT, what is the next step in management if the patient is NOT coagulopathic?

<p>Administer intravenous tissue plasminogen activator (tPA) (A)</p> Signup and view all the answers

Which of the following is considered the gold standard diagnostic test for subarachnoid hemorrhage (SAH)?

<p>Four-vessel angiogram (B)</p> Signup and view all the answers

Which of the following is a key risk factor for intracerebral hemorrhage (ICH)?

<p>Hypertension (D)</p> Signup and view all the answers

Which of the following is the most significant risk factor for subdural hematoma (SDH)?

<p>Age (D)</p> Signup and view all the answers

For a patient presenting with carotid stenosis, referral to a vascular surgeon is primarily for:

<p>Evaluation for potential intervention (C)</p> Signup and view all the answers

Which degree of carotid stenosis (or greater) in an asymptomatic patient is typically considered an indication for endarterectomy?

<p>60% (A)</p> Signup and view all the answers

What is the classic definition of a transient ischemic attack (TIA)?

<p>Sudden, focal neurological deficit lasting less than 24 hours (D)</p> Signup and view all the answers

Which of the following is a common characteristic of Parkinson's Disease?

<p>Involvement of brain's dopamine neuronal systems (A)</p> Signup and view all the answers

A patient with suspected Parkinson's disease is being assessed for motor symptoms. Which of the following is LEAST likely to be observed?

<p>Muscle spasticity (A)</p> Signup and view all the answers

A patient with motor symptoms consistent with Parkinson's disease also reports visual hallucinations and cognitive fluctuations. This presentation is most suggestive of:

<p>Lewy body dementia (D)</p> Signup and view all the answers

Which of the following will most likely exacerbate an essential tremor?

<p>Anxiety (D)</p> Signup and view all the answers

Which of the following is part of the "SNOOP" mnemonic used in headache evaluation?

<p>Neurologic symptoms (D)</p> Signup and view all the answers

A patient presents with chronic, severe headaches, and transient visual disturbances. Which condition is of greatest concern?

<p>Temporal arteritis (D)</p> Signup and view all the answers

Which of the following is the most typical presentation of trigeminal neuralgia?

<p>Brief episodes of intense, sharp facial pain (D)</p> Signup and view all the answers

What is the treatment of choice for trigeminal neuralgia?

<p>Carbamazepine (A)</p> Signup and view all the answers

A patient presents with new-onset seizures, hemiparesis, and ataxia. These symptoms are most consistent with

<p>Neoplasm (D)</p> Signup and view all the answers

Which characteristic is LEAST likely to be associated with post-traumatic headaches?

<p>Acute confusion (C)</p> Signup and view all the answers

What is the classic triad of symptoms associated with normal pressure hydrocephalus (NPH)?

<p>Cognitive issues, gait disturbance, and urinary incontinence (A)</p> Signup and view all the answers

Which of the following is a typical symptom of insomnia related to sleep deprivation?

<p>Reduced vigilance (C)</p> Signup and view all the answers

Which of the following is most commonly associated with insomnia?

<p>GERD (C)</p> Signup and view all the answers

Which of the following is MOST indicative of obstructive sleep apnea?

<p>Morning headaches (D)</p> Signup and view all the answers

Which of the following factors differentiates central sleep apnea from obstructive sleep apnea?

<p>Neurological condition (A)</p> Signup and view all the answers

Among older adults, which assessment would directly evaluate social determinants of their health regarding neurological care?

<p>Questions about paying for care (B)</p> Signup and view all the answers

An 80-year-old patient with a history of falls is undergoing a Performance-Oriented Mobility Assessment (POMA). Which element of the assessment specifically evaluates immediate standing balance?

<p>Arising from a chair (C)</p> Signup and view all the answers

A 65-year-old patient is being evaluated for cognitive impairment. The patient's spouse reports that the patient's confusion started suddenly a couple of days ago, has periods of lucidity, and shows disorganized thinking. Which of the following conditions is the most likely cause of the patient's symptoms?

<p>Delirium (C)</p> Signup and view all the answers

A 70-year-old male patient with a history of hypertension and hyperlipidemia presents with sudden onset of right-sided weakness and difficulty speaking. A non-contrast CT scan of the head rules out hemorrhage. According to current guidelines, what is the MOST appropriate intervention?

<p>tPA (C)</p> Signup and view all the answers

An elderly patient presents with symptoms suggestive of a stroke. Which of the following symptoms would be MOST indicative of a potential vertebrobasilar artery stroke?

<p>Unilateral hearing loss and intensive vertigo (A)</p> Signup and view all the answers

Which of the following is the MOST appropriate initial diagnostic test for a patient presenting with suspected subarachnoid hemorrhage (SAH)?

<p>CT scan without contrast (D)</p> Signup and view all the answers

Which of the following is LEAST likely to be associated with intracerebral hemorrhage (ICH)?

<p>Afib (D)</p> Signup and view all the answers

Which assessment finding is most consistent with normal pressure hydrocephalus (NPH)?

<p>Gait disturbance (A)</p> Signup and view all the answers

The classic definition of transient ischemic attack (TIA) includes which characteristic?

<p>Vascular etiology (A)</p> Signup and view all the answers

Which of the following is the gold standard for treatment in Parkinson's Disease?

<p>Deep Brain Stimulator (B)</p> Signup and view all the answers

Which of the following would be the least likely effect of sleep deprivation symptoms?

<p>Excitement (D)</p> Signup and view all the answers

An 82-year-old patient is being evaluated after experiencing multiple falls at home. Which of the following acute conditions is LEAST likely to be considered as a contributing factor to their recent falls?

<p>New onset osteoarthritis (D)</p> Signup and view all the answers

During a home safety assessment for an elderly patient with a history of falls, which of the following modifications would be MOST effective in reducing fall risk related to environmental hazards?

<p>Removing throw rugs and clutter from walkways (C)</p> Signup and view all the answers

A 75-year-old patient presents with new onset confusion. Her daughter reports that the confusion started abruptly yesterday and fluctuates in severity throughout the day. The patient is also noted to be easily distractible and has disorganized thoughts. Which of the following is the MOST likely diagnosis?

<p>Delirium (C)</p> Signup and view all the answers

When differentiating between delirium and dementia, which of the following historical features is MOST suggestive of delirium?

<p>Abrupt onset of symptoms within hours to days (B)</p> Signup and view all the answers

Which of the following laboratory findings is MOST likely to be associated with delirium in an elderly patient presenting with acute confusion?

<p>Hyponatremia (D)</p> Signup and view all the answers

A 78-year-old patient is diagnosed with Alzheimer's disease. Which of the following medication classes is MOST commonly used to manage the cognitive symptoms associated with this condition?

<p>Cholinesterase inhibitors (A)</p> Signup and view all the answers

Vascular dementia is most directly associated with which pathophysiological process?

<p>Cerebrovascular disease leading to brain injury (A)</p> Signup and view all the answers

An 80-year-old patient with a history of hypertension, hyperlipidemia, and atrial fibrillation presents with sudden onset of left-sided weakness and expressive aphasia. This clinical presentation is MOST consistent with which type of cerebrovascular event?

<p>Ischemic stroke (A)</p> Signup and view all the answers

According to the World Health Organization's (WHO) definition of stroke, the minimum duration of neurological deficits to differentiate a stroke from a transient ischemic attack (TIA) is:

<p>24 hours (C)</p> Signup and view all the answers

Which of the following is the MOST critical initial step in the management of a patient presenting with acute stroke symptoms?

<p>Performance of a non-contrast head CT scan (B)</p> Signup and view all the answers

If a non-contrast CT scan of the head is negative for hemorrhage in a patient with acute stroke symptoms, and the patient is not coagulopathic, the MOST appropriate next step in management, within the first few hours of symptom onset, is:

<p>Administration of intravenous tissue plasminogen activator (tPA) (B)</p> Signup and view all the answers

A lumbar puncture (LP) is considered the gold standard diagnostic test for which type of intracranial hemorrhage when CT findings are inconclusive?

<p>Subarachnoid hemorrhage (SAH) (A)</p> Signup and view all the answers

Uncontrolled hypertension is the MOST significant risk factor for which type of intracranial hemorrhage?

<p>Intracerebral hemorrhage (ICH) (C)</p> Signup and view all the answers

Which of the following patient populations is at HIGHEST risk for subdural hematoma (SDH)?

<p>Elderly patients on anticoagulant therapy (A)</p> Signup and view all the answers

Referral to a vascular surgeon is MOST indicated for a patient diagnosed with carotid stenosis to primarily:

<p>Assess for surgical intervention to prevent future stroke (A)</p> Signup and view all the answers

For an asymptomatic patient with carotid stenosis detected on ultrasound, surgical intervention (endarterectomy) is generally considered when the stenosis is what degree or greater?

<p>60% (B)</p> Signup and view all the answers

The classic definition of a transient ischemic attack (TIA) includes neurological deficits that resolve within:

<p>24 hours (A)</p> Signup and view all the answers

Which of the following motor symptoms is a hallmark characteristic of Parkinson's Disease?

<p>Resting tremor (A)</p> Signup and view all the answers

Which of the following findings is LEAST likely to be associated with Parkinson's disease motor symptoms?

<p>Hyperreflexia (A)</p> Signup and view all the answers

A patient with motor features of Parkinsonism also presents with prominent visual hallucinations and fluctuating cognition. This clinical presentation is MOST suggestive of:

<p>Lewy Body Dementia (D)</p> Signup and view all the answers

Which of the following factors is known to exacerbate essential tremor?

<p>Anxiety and stress (B)</p> Signup and view all the answers

In the 'SNOOP' mnemonic used to evaluate headache patients for secondary causes, the 'S' stands for:

<p>Systemic symptoms (C)</p> Signup and view all the answers

A 70-year-old patient presents with chronic, severe headaches, new onset transient visual disturbances, and scalp tenderness. Which of the following conditions is of GREATEST concern and requires urgent evaluation?

<p>Temporal arteritis (B)</p> Signup and view all the answers

The pain associated with trigeminal neuralgia is BEST described as:

<p>Brief, paroxysmal, electric shock-like pain (D)</p> Signup and view all the answers

First-line pharmacological treatment for trigeminal neuralgia typically involves:

<p>Carbamazepine (D)</p> Signup and view all the answers

New-onset seizures, progressive hemiparesis, and ataxia in an elderly patient are MOST concerning for:

<p>Brain neoplasm (D)</p> Signup and view all the answers

Which of the following characteristics is LEAST typical of post-traumatic headaches?

<p>Severity is always directly proportional to the degree of injury (B)</p> Signup and view all the answers

The classic triad of symptoms associated with normal pressure hydrocephalus (NPH) includes:

<p>Cognitive impairment, gait disturbance, urinary incontinence (B)</p> Signup and view all the answers

Which of the following symptoms is MOST indicative of insomnia related to sleep deprivation?

<p>Reduced vigilance and lack of focus (D)</p> Signup and view all the answers

Which of the following conditions is MOST commonly associated with chronic insomnia in older adults?

<p>Chronic pain (C)</p> Signup and view all the answers

Loud snoring, witnessed apneas, and excessive daytime sleepiness are MOST suggestive of:

<p>Obstructive sleep apnea (C)</p> Signup and view all the answers

The primary differentiating factor between central sleep apnea and obstructive sleep apnea is:

<p>Respiratory effort during apneic episodes (D)</p> Signup and view all the answers

When assessing social determinants of health in an older adult with neurological concerns, which question would be MOST pertinent to their access to care?

<p>“How are you going to manage to pay for your medications?” (A)</p> Signup and view all the answers

During a Performance-Oriented Mobility Assessment (POMA), which component specifically evaluates a patient's ability to maintain balance immediately after standing?

<p>Immediate standing balance (B)</p> Signup and view all the answers

A 68-year-old patient presents with new onset cognitive impairment. Her family reports that her confusion started gradually over the past year and has been progressively worsening. Which of the following conditions is the MOST likely cause of her symptoms?

<p>Dementia (A)</p> Signup and view all the answers

A 72-year-old male patient with a history of smoking and hypertension presents with sudden onset of right-sided weakness and difficulty speaking. A non-contrast CT scan of the head rules out hemorrhage. According to current guidelines, what is the MOST appropriate acute intervention?

<p>Administer intravenous tissue plasminogen activator (tPA) if within the eligible time window (D)</p> Signup and view all the answers

An elderly patient presents with acute onset of vertigo, diplopia, and bilateral weakness. These symptoms are MOST suggestive of a stroke affecting which vascular territory?

<p>Vertebrobasilar artery (A)</p> Signup and view all the answers

What is considered the MOST sensitive initial diagnostic test for a patient presenting with suspected subarachnoid hemorrhage (SAH)?

<p>Non-contrast CT scan of the head (C)</p> Signup and view all the answers

According to the classic definition, a transient ischemic attack (TIA) is characterized by:

<p>Neurological deficits resolving within 24 hours (C)</p> Signup and view all the answers

While medications like levodopa are used to manage symptoms, the gold standard surgical treatment for advanced Parkinson's Disease aimed at improving motor function is:

<p>Deep brain stimulation (DBS) (B)</p> Signup and view all the answers

Which of the following is LEAST likely to be a direct effect of sleep deprivation symptoms?

<p>Increased alertness and focus (B)</p> Signup and view all the answers

A 78-year-old man presents with progressive memory impairment and difficulty with spatial orientation. Which screening tool would be most appropriate to initially evaluate cognitive impairment?

<p>Mini-Cog (C)</p> Signup and view all the answers

A 68-year-old woman with recent frequent falls is being evaluated. Which physical exam technique specifically assesses mobility and balance?

<p>Romberg Test (C)</p> Signup and view all the answers

An 85-year-old woman presents with chronic headaches, scalp tenderness, and transient vision disturbances. What diagnostic test is considered gold standard to confirm the suspected diagnosis?

<p>Temporal artery biopsy (B)</p> Signup and view all the answers

An elderly patient complains of brief, intense facial pain triggered by chewing and brushing teeth. Physical exam is normal. What is the treatment of choice for this disorder?

<p>Carbamazepine (B)</p> Signup and view all the answers

According to current geriatric recommendations, which of the following screening practices is routinely indicated for early detection of cerebrovascular disease?

<p>Assessment of modifiable stroke risk factors during routine health maintenance visits (D)</p> Signup and view all the answers

Which evaluation is critical when assessing an older adult with an acute fall and suspected neurologic deficit?

<p>Neurologic exam and imaging (C)</p> Signup and view all the answers

An 80-year-old patient with progressive cognitive decline undergoes evaluation. What is the most common cause of dementia in older adults?

<p>Alzheimer's disease (C)</p> Signup and view all the answers

A 70-year-old woman presents with rapid onset confusion, altered consciousness, and disorganized thinking for the past 24 hours. What is the most likely diagnosis?

<p>Delirium (C)</p> Signup and view all the answers

Which screening method is recommended for evaluating risk of falls and mobility impairment in elderly adults?

<p>Timed Up and Go test (TUG) (D)</p> Signup and view all the answers

A 77-year-old woman has symptoms suggestive of Normal Pressure Hydrocephalus (NPH). Which of the following is part of the classic triad seen with NPH?

<p>Dementia, gait disturbance, urinary incontinence (A)</p> Signup and view all the answers

An 83-year-old woman reports frequent falls and impaired balance. Which test specifically evaluates immediate standing balance, turning, and sitting balance to assess fall risk?

<p>Performance-Oriented Mobility Assessment (POMA) (C)</p> Signup and view all the answers

An 80-year-old patient is being evaluated for dementia. Which laboratory test should routinely be included in this patient's evaluation?

<p>Serum vitamin B12 (D)</p> Signup and view all the answers

A patient presents with progressively worsening tremors in both hands, especially noticeable when holding a coffee cup or signing a check. Symptoms improve significantly after consuming a small amount of alcohol. Which diagnosis is most likely?

<p>Essential tremor (D)</p> Signup and view all the answers

A 72-year-old man presents with slowly progressive resting tremor, decreased arm swing while walking, and reduced facial expressions. Which of the following conditions is the most likely diagnosis?

<p>Parkinson's disease (B)</p> Signup and view all the answers

An elderly patient presents after a mild head injury complaining of headaches, confusion, and weakness that developed over two weeks after the incident. Which condition is most likely?

<p>Subdural hematoma (C)</p> Signup and view all the answers

A 67-year-old male develops sudden-onset facial asymmetry, dysarthria, and unilateral weakness lasting more than 24 hours. No hemorrhage is seen on CT. What is the most appropriate immediate treatment?

<p>Start IV tissue plasminogen activator (tPA) within 3 hours (B)</p> Signup and view all the answers

Which factor most strongly predisposes elderly patients to intracerebral hemorrhage?

<p>Hypertension (B)</p> Signup and view all the answers

A 76-year-old patient presents with gradual cognitive impairment, difficulty walking, and recent episodes of urinary incontinence. Imaging shows enlarged cerebral ventricles. What is the most likely diagnosis?

<p>Normal pressure hydrocephalus (NPH) (D)</p> Signup and view all the answers

A 69-year-old patient presents with unilateral, sharp, electric shock-like facial pain triggered by chewing. Physical exam and imaging are normal. What is the first-line treatment?

<p>Carbamazepine (Tegretol) (B)</p> Signup and view all the answers

A 70-year-old patient experiences unilateral headache, jaw claudication, and transient visual loss. What diagnostic test confirms the suspected diagnosis?

<p>Temporal artery biopsy (D)</p> Signup and view all the answers

An elderly patient with a 30-pack-year smoking history and atrial fibrillation asks about stroke prevention. Which modifiable risk factor, if managed, would most significantly reduce stroke risk?

<p>Smoking cessation (D)</p> Signup and view all the answers

An elderly woman complains of impaired sleep, nocturnal awakenings, and daytime fatigue. She reports drinking alcohol nightly before bed. Which intervention is most likely to improve her sleep?

<p>Discontinuing nightly alcohol intake (D)</p> Signup and view all the answers

Flashcards

Mobility disorder?

Deviation from normal ambulation involving balance or posture issues.

Confusion?

Lack of clear thinking, often caused by UTI in elderly patients.

Delirium?

Disorganized thinking developing over hours/weeks, often acute and fluctuating. Examples include Disorientation, ETOH withdrawal and Hepatic Failure

Dementia?

Insidious, progressive memory loss, impoverished thought, can take months to years to develop.

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Dementia evaluation?

History, cognitive/memory questions, spatial orientation assessment, neurovascular risk factors.

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Dementia and Delirium lab studies?

CBC, Chemistry panel, UA, Liver/Thyroid function, B12, Syphilis labs

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CVA?

Characterized by sudden, focal neurological deficits, which last > 24 hrs related to compromised blood flow to focal neurological area.

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Stroke modifiable risk factors?

Smoking, ETOH abuse, obesity, substance abuse.

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Non-modifiable stroke risk factors?

HTN, DM, Age, Gender, Race/ethnicity, Heredity.

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Disease processes related to stroke?

Coronary artery disease, hypertension, hyperlipidemia, afib, carotid stenosis, obesity, hypercoagulable state

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CVA clinical presentation?

Visual loss, diplopia, vertigo, unilateral hearing loss, ataxia, weakness, paralysis.

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Acute stroke tx?

Rule out bleed with a head CT. If no hemorrhage, administer IV tPA within 3 hours of sx onset.

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Intracerebral hemorrhage?

Hemorrhage within brain tissue.

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Subarachnoid Hemorrhage?

Bleeding between the arachnoid and pia mater, often resulting in thunderclap HA and nuchal regidity

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SAH Diagnosis?

CT may miss initial bleed. Confirmed with LP revealing elevated opening pressure. 4-vessel angiography is gold standard.

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Intracerebral hemorrhage risk factors?

Age, history of HTN key risk factor, tumor, drug use, warfarin/Coumadin.

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Subdural hematoma?

Bleeding between dura and arachnoid, forming a blood clot on the brain's surface.

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Transient Ischemic Attack (TIA)?

Commonly presents as Brief, focal neurological deficit with symptoms typically resolve within 24 hours.

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Parkinson's disease?

Slowly progressive neurologic disorder involving the degradation of dopamine in neuronal systems.

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Parkinson's classic motor findings?

Tremor, Rigidity, Bradykinesia, Masked facial expression, & Antero-flexed posture.

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Lewy Body Dementia?

Form of PD with hallucinations and eosinophilic intracytoplasmic neurons

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What is an Essential Tremor?

Most common cause of tremors, often affecting hands (postural tremor) possibly with head involvement.

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"SNOOP" criteria for headache?

Systemic or Neurologic symptoms, Onset sudden, Older patient, Progression

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Secondary headache causes?

Post-traumatic, cerebrovascular disease, neoplasm, temporal arteritis, trigeminal neuralgia.

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Temporal arteritis?

Chronic severe headaches involving temporal/occipital regions, transient visual disturbances.

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Trigeminal neuralgia?

Typically occurs in 60s, impacts CN V distribution, Brief and paroxysmal facial pain

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Trigeminal Neuralgia findings?

Brief facial pain triggered by mild stimulation (makeup, teeth brushing is mild stimulation.).

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Trigeminal Neuralgia tx?

PE is normal and MRI is unnecessary. tx is Carbamazepine

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Neoplasm characteristics?

Median age of diagnosis: 57 yo. Lifetimes chance is 1 in 200. Often present with worsened morning headaches.

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Normal Pressure Hydrocephalus (NPH)?

A defect in CSF resorption due to dysfunctioning arachnoid granulations causing increased intracranial pressure and subsequent triad: gait disturbance, cognitive issues & urinary incontenance

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Elderly sleep disorders?

Insomnia & Sleep Apnea

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Define Insomnia?

Difficulty falling or staying asleep of 1 month or longer

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Causes of insomnia?

Chronic disease, dyspnea, GERD, nocturia, caffeine or ETOH use

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Obstructive sleep apnea sx?

Obesity, Witnessed Apneas, Loud Snoring, enlarged T&A, large neck circumference.

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What is a Mini-Cog?

Brief screening tool for cognitive issues, including memory impairment & spatial orientation.

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What does the Romberg test assess?

Physical exam to assess balance and proprioception.

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Acute Fall Evaluation

Neurological exam and imaging (CT or MRI) to check for intracranial abnormalities.

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POMA assesses what?

Assess sitting, standing, turning balance with Romberg; gauges fall risk.

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Check Vitamin B12 in?

Lab to check during dementia evaluation.

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What worsens Essential tremors?

Postural tremor that improves with ETOH.

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What 3 features define parkinsonism?

Resting tremor, rigidity, bradykinesia

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Common Subdural hematoma sx?

Delayed symptoms (days/weeks), confusion, headache, weakness.

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Acute ischemic stroke symptoms?

Facial asymmetry, dysarthria, and weakness.

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Modifiable stroke risk factors?

Smoking, HTN, DM, Afib.

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Study Notes

Geriatric Cognitive Impairment Evaluation

  • The Mini-Cog is commonly used for the initial screening of cognitive impairment and dementia in elderly patients.
  • Dementia evaluation should include CBC, metabolic panel, thyroid function tests, vitamin B12, and syphilis serology.
  • Ask the patient and family about cognitive, memory, and behavioral issues.
  • Assess the patient's spatial orientation
  • Evaluate for neurovascular risk factors.

Balance and Fall Risk Assessment

  • The Romberg test assesses balance/proprioception, important in evaluating fall risk in elderly patients.
  • The Timed Up and Go (TUG) test assesses mobility and fall risk; >20 seconds indicates significant fall risk in elderly.
  • POMA evaluates sitting balance, standing, turning balance, and Romberg testing.
    • POMA is used specifically to assess fall risk and mobility impairment in older adults.

Temporal Arteritis (Giant Cell Arteritis)

  • This is common in the elderly that may cause blindness if untreated.
  • This is definitively diagnosed via temporal artery biopsy.
  • Presents with unilateral headache, jaw claudication, and transient visual loss.

Trigeminal Neuralgia

  • Presents as brief, intense facial pain along the CN V distribution.
  • First-line therapy is carbamazepine.

Cerebrovascular Disease Screening

  • Routine carotid screening is not recommended unless symptomatic or high-risk.
  • Carotid ultrasound is indicated in patients with suspected significant carotid artery disease.

Acute Falls With Neurologic Deficit

  • These falls require immediate neurological evaluation and appropriate imaging.
  • Exclude intracranial pathology (stroke, subdural hematoma).

Alzheimer's Disease

  • This is the most common dementia.
  • It is characterized by slow, progressive cognitive decline over years.

Delirium

  • Presents with acute onset confusion and fluctuating course.
  • Often secondary to infection, metabolic changes, or medications.

Normal Pressure Hydrocephalus (NPH)

  • The classic triad includes dementia, gait disturbance, and urinary incontinence.
  • Often treatable with ventricular shunting.

Stroke and Treatment

  • Acute ischemic stroke—IV tPA is indicated within 3 hours of onset if no hemorrhage or contraindications are present.
  • Hypertension is the most significant risk factor for intracerebral hemorrhage in the elderly.
  • Modifiable stroke risk factors include smoking cessation, hypertension control, diabetes management, and managing atrial fibrillation.

Essential Tremor

  • This is a postural tremor that worsens with stress and caffeine.
  • It improves with alcohol and beta-blockers.

Subdural Hematoma

  • Common in the elderly.
  • Presents with delayed symptoms (days to weeks), confusion, headache, and weakness.

Sleep and Alcohol

  • Alcohol exacerbates insomnia and disrupts sleep architecture in the elderly.
  • Cessation improves sleep quality.

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