1. Mia Yang, MD Please grab a clicker
3D Day Knowledge Quiz
Mia Yang, MD
Please grab a clicker

2. Q1. Ms. T is a 80yoF with COPD, DM, CAD, presenting to her primary care clinic with memory loss such as misplacing her keys and can’t remember people’s names. She lives alone and does her own cooking, shopping, and finances. Her primary care doctor speaks with her daughter who confirmed that Her MMSE in clinic is 24/30. Does she have dementia?
A. Yes, because her MMSE is 24 B. No, because she is still functioning well with her IADLs (cooking, shopping, finances) C. Not sure

3. Q1. Ms. T is a 80yoF with COPD, DM, CAD, presenting to her primary care clinic with memory loss such as misplacing her keys and can’t remember people’s names. She lives alone and does her own cooking, shopping, and finances. Her primary care doctor speaks with her daughter who confirmed that Her MMSE in clinic is 24/30. Does she have dementia?
A. Yes, because her MMSE is 24 B. No, because she is still functioning well with her IADLs (cooking, shopping, finances) C. Not sure

4. Dementia
Dementia is a disorder characterized by problems with cognition + functional impairment
Cognition components: learning/recall, reasoning, language, spatial ability/orientation, and executive function/handling complex tasks
Functional impairments:
Activities of Daily Living (ADLs): eating, dressing, toileting, etc
Instrumental Activities of Daily Living (IADLs): grocery shopping, cooking, finances, medications, driving, etc.

5. A. Parkinson’s dementia B. Alzheimer’s disease C. Lewy body dementia
Q2. Mr. W is a 67yoM with HTN who comes to clinic with his wife. His wife says that he has been more forgetful over the 6 months, initially making mistakes balancing the checkbook, but now forgetting how to drive to the bank. She is most worried that over the past week he started seeing and hearing children playing in the house, but she is adamant that there were no children. His MMSE in clinic is 22/30. You notice that he has a shuffling gait, which wife says is also new. What is the most likely diagnosis?
A. Parkinson’s dementia
B. Alzheimer’s disease
C. Lewy body dementia
D. Fronto-temporal dementia
E. Cruetzfeldt-Jakob disease

6. A. Parkinson’s dementia B. Alzheimer’s disease C. Lewy body dementia
Q2. Mr. W is a 67yoM with HTN who comes to clinic with his wife. His wife says that he has been more forgetful over the 6 months, initially making mistakes balancing the checkbook, but now forgetting how to drive to the bank. She is most worried that over the past week he started seeing and hearing children playing in the house, but she is adamant that there were no children. His MMSE in clinic is 22/30. You notice that he has a shuffling gait, which wife says is also new. What is the most likely diagnosis?
A. Parkinson’s dementia
B. Alzheimer’s disease
C. Lewy body dementia
D. Fronto-temporal dementia
E. Cruetzfeldt-Jakob disease

7. Dementia subtypes Lewy Body dementia: prevalence around 15%
cognitive impairment, hallucinations, & Parkinson-like symptoms such as shuffling gait, falls, rigidity & tremors
Cognitive & hallucinations may occur before or at the same time as Parkinson-like symptoms.
Parkinson’s dementia - must have motor symptoms before cognitive impairment by 1 year
Fronto-temporal dementia: usually younger patients, with executive and language dysfunction and often behavioral changes such as disinhibition & impulsivity.
Memory impairment less prominent.
5/2/2019

8. Q3. You test a patient in the hospital with mini-cognitive (Mini-Cog) screen. He drew the clock below when you asked him to put the hands at “ten past eleven.” He had 1/3 word recall. How do you interpret the result?
Positive for cognitive impairment
Negative for cognitive impairment
Inconclusive

9. Q3. You test a patient in the hospital with mini-cognitive (Mini-Cog) screen. He drew the clock below when you asked him to put the hands at “ten past eleven.” He had 1/3 word recall. How do you interpret the result?
Positive for cognitive impairment
Negative for cognitive impairment
Inconclusive

10. Mini-Cog- dementia screen
Ask patient to repeat three words: banana, sunrise, chair
Ask patient to draw face of a clock, then draw hands to read “ten past eleven”
Ask the patient to recall the three words

11. Q4. Which of the following is required in order to screen positive for delirium?
Memory impairment
Inattention
Presence of acute onset & fluctuating course
All of the above
Both B & C

12. Q4. Which of the following is required to screen positive for delirium?
Memory impairment
Inattention
Presence of acute onset & fluctuating course
All of the above
Both B & C

13. Delirium Screening
Screen is positive if the person has 1 & 2 plus either 3 or 4 of the following:
(1) Presence of acute onset and fluctuating course.
(2) Inattention
(3) Disorganized thinking (such as orientation questions, date of birth)
(4) Altered level of consciousness (ie somnolent or agitated)
5/2/2019

14. Q5. Ms. T is a 80yoF with COPD, DM, CAD, cognitive impairment, who fell and admitted to the hospital. She was found to have a L femur fracture. On POD 2, she was hard to arouse, cannot say the days of the week forward nor backwards, and did not know where she was. Which of the following could be the cause of her hypoactive delirium?
Constipation
Received lorazepam for anxiety prior to surgery
Uncontrolled pain
Hospital-acquired pneumonia
All of the above

15. Q5. Ms. T is a 80yoF with COPD, DM, CAD, cognitive impairment, who fell and admitted to the hospital. She was found to have a L femur fracture. On POD 2, she was hard to arouse, cannot say the days of the week forward nor backwards, and did not know where she was. Which of the following could be the cause of her hypoactive delirium?
Constipation
Received lorazepam for anxiety prior to surgery
Uncontrolled pain
Hospital-acquired pneumonia
All of the above

16. Q6. Older depressed patients are LESS likely to complain of this compared to younger patients?
Somatic complaints such as pain, fatigue
Sadness
Difficulty concentrating
Trouble performing daily tasks
None of the above, depression in older adults is the same presentation as in younger adults.

17. Q6. Older depressed patients are LESS likely to complain of this compared to younger patients?
Somatic complaints such as pain, fatigue
Sadness
Difficulty concentrating
Trouble performing daily tasks
None of the above, depression in older adults is the same presentation as in younger adults.