d****y
发帖数: 2180 | 1 选B， J， I的都有，到底哪个是正确的？ A++ 有没有建议？
For each patient with cognitive impairment, select the most likely
diagnosis.
A ) Acute stress disorder
B ) Dementia, Alzheimer's type
C ) Dissociative amnesia
D ) General paresis
E ) Head trauma
F ) Hepatolenticular degeneration (Wilson's disease)
G ) HIV encephalitis
H ) Huntington's disease
I ) Major depressive disorder
J ) Multi-infarct (vascular) dementia
K ) Niacin deficiency
L ) Normal-pressure hydrocephalus
M ) Parkinson's disease
N ) Pick's disease
O ) Schizophrenia, catatonic type
P ) Normal aging
9. An 82-year-old woman is brought to the physician by her granddaughter
because of a 6-week history of increasing forgetfulness. She is a
retired
schoolteacher and lives independently. Her granddaughter is concerned
because on several occasions she has left the stove on when she went to
bed.
During conversations with her granddaughter, she has difficulty
remembering
past events and seems unconcerned about her memory lapses. The patient
describes trouble sleeping through the night and has had a decreased
appetite resulting in a 4.5-kg (10-lb) weight loss over the past month.
She
has a history of similar symptoms 2 and 5 years ago that were
successfully
treated with medication. She appears unkempt and has poor personal
hygiene.
Her temperature is 37 C (98.6 F), blood pressure is 110/70 mm Hg, and
pulse
is 80/min and regular. Mental status examination shows psychomotor
retardation, a flat affect, impaired ability to recall past events, and
trouble repeating three numbers in sequence. She is unable to recall the
names of recent presidents. Her serum urea nitrogen (BUN) level is 25
mg/dL,
and serum creatinine level is 1.7 mg/dL. |
A*******s
发帖数: 9638 | 2 Depression.
In fact, clinically, major depression related amnesia is over-estimated.
Only 3% dementia is due to depression from a study. |
d****y
发帖数: 2180 | 3 The diagnostic criteria for major depression is:
depressed mood + five of SIG E CAPS symptoms.
I couldn't clearly identify depressed mood in this case, for SIG E CAPS
symptoms, I could find four of them.
Can you explain it more specifically? Thanks!
【在 A*******s 的大作中提到】
: Depression.
: In fact, clinically, major depression related amnesia is over-estimated.
: Only 3% dementia is due to depression from a study.
|
d****y
发帖数: 2180 | 4 How about Multi-infarct (vascular) dementia?
【在 A*******s 的大作中提到】
: Depression.
: In fact, clinically, major depression related amnesia is over-estimated.
: Only 3% dementia is due to depression from a study.
|
A*******s
发帖数: 9638 | 5 What is psychomotor retardation? What is a flat affect? :)
A history of a treatable condition speaks enough for this case. Other
choices like vascular dementia are irreversible.
【在 d****y 的大作中提到】
: The diagnostic criteria for major depression is:
: depressed mood + five of SIG E CAPS symptoms.
: I couldn't clearly identify depressed mood in this case, for SIG E CAPS
: symptoms, I could find four of them.
: Can you explain it more specifically? Thanks!
|
d****y
发帖数: 2180 | 6 The patient seems unconcerned about her memory lapses and she didn't seek
help by herself. She was brought to the Dr. by her daughter.
What is psychomotor retardation? That's P
What is a flat affect? I?
Yes, there're some symptoms could fit in depression, but I didn't find
sufficient to fit the criteria.
vascular dementia: step-wise deterioration. Treatment can stabilize the
condition.
【在 A*******s 的大作中提到】
: What is psychomotor retardation? What is a flat affect? :)
: A history of a treatable condition speaks enough for this case. Other
: choices like vascular dementia are irreversible.
|
A*******s
发帖数: 9638 | 7 如果vascular dementia是答案， 这道题就是坑嗲。
Alzheimer's 和vascular dementia的最大区别就是clinical course。 所以光光凭一
个office visit就能区分是不可能的。 前者是slow progression， 后者往往是stable
until next ischemic event。 最容易的区分就是CT， 有没有stroke一看就知道了，
没有stroke，vascular dementia就是浮云。
depression可以是cause或者complication of dementia， 是可以治疗的， 这个题目
说2年和5年前用药后成功的治好了， 什么病可以这样？ 后来又可以复发？ Vascular
dementia是stroke引起的， 阿司匹林可以治愈dementia？
【在 d****y 的大作中提到】
: How about Multi-infarct (vascular) dementia?
|
A*******s
发帖数: 9638 | 8 不错， stepwise with every new event.
Treatment will not reverse the dementia. As a matter of fact, there is no
treatment for vascular dementia.
Antiplatelet agents are preventive only for stroke.
【在 d****y 的大作中提到】
: The patient seems unconcerned about her memory lapses and she didn't seek
: help by herself. She was brought to the Dr. by her daughter.
: What is psychomotor retardation? That's P
: What is a flat affect? I?
: Yes, there're some symptoms could fit in depression, but I didn't find
: sufficient to fit the criteria.
: vascular dementia: step-wise deterioration. Treatment can stabilize the
: condition.
|
A*******s
发帖数: 9638 | 9 when a patient is unkempt, inattentive and has a flat affect, I would think
about a depressed mood.
We should ask Benpu for his thoughts.
【在 d****y 的大作中提到】
: The patient seems unconcerned about her memory lapses and she didn't seek
: help by herself. She was brought to the Dr. by her daughter.
: What is psychomotor retardation? That's P
: What is a flat affect? I?
: Yes, there're some symptoms could fit in depression, but I didn't find
: sufficient to fit the criteria.
: vascular dementia: step-wise deterioration. Treatment can stabilize the
: condition.
|
d****y
发帖数: 2180 | 10 其实我也觉得depression很像。但是我水平不够，凑不齐标准，另外你看麦地几乎所有
人都说是J，所以比较困惑。
而且depression的病人是不是一般会主动求医，自己会比较concern？
think
【在 A*******s 的大作中提到】
: when a patient is unkempt, inattentive and has a flat affect, I would think
: about a depressed mood.
: We should ask Benpu for his thoughts.
|
|
|
A*******s
发帖数: 9638 | 11 SICAP， E 可以理解为因为fatigue而不修边幅吗？
When dementia becomes a part of depression, the patient would behave like
dementia without self-awareness.
【在 d****y 的大作中提到】
: 其实我也觉得depression很像。但是我水平不够，凑不齐标准，另外你看麦地几乎所有
: 人都说是J，所以比较困惑。
: 而且depression的病人是不是一般会主动求医，自己会比较concern？
:
: think
|
A*******s
发帖数: 9638 | 12 应该说， 很多题有它们的问题， 因为是题库里的， 有点问题并没有什么大不了。 不
过对CMG说， 99是至关重要的， 所以每题必争， 如果有争议， 记住答案就是了。 |
h*******l
发帖数: 1542 | 13 I major depressive disorder She has a history of similar symptoms 2 and 5
years ago that were successfully treated with medication. |
h**s
发帖数: 1757 | |
d****y
发帖数: 2180 | 15 今天看Kaplan 题库看到一道题关于老年人depression的，也是由女儿带去就诊的，主诉是
personality change and forgetfulness for 3 months.
重新看回这道题，觉得可能还是Depression.
S: sleep
I: loss of interest
E: lack of energy
C: Low concentration
A: loss of appetite
P: psychomoror retardation
姜还是老的辣啊
estimated.
【在 A*******s 的大作中提到】
: Depression.
: In fact, clinically, major depression related amnesia is over-estimated.
: Only 3% dementia is due to depression from a study.
|
