Buy Care Of The Neurosurgical Patient Discussion

Buy Care Of The Neurosurgical Patient Discussion
Buy Care Of The Neurosurgical Patient Discussion
1. An 84-year-old man has been brought into
hospital because of self-neglect. He lives
alone in a ground floor flat and has daily
carer who have found him to be increasingly
suspicious, accusing them of stealing and
moving his property and becoming physically
aggressive. In the past month he had been
refusing to let them in. He also seemed to
be experiencing auditory hallucinations and
had lost weight. Examination was normal
except for BMI 19 and MMSE 18/30. Bloods,
CXR, urine, cultures normal. CT is shown.
Which one of the following is most likely?
a. Alcoholic hallucinosis
b. Alzheimer’s disease
c. Delirium
d. Paranoid schizophrenia
e. Pick’s disease
2. A 70-year-old gentleman attends outpatient
clinic with his wife. She reports that her husband’s behavior has changed and that he has
become increasingly forgetful over the past
year. He has gained 10 kg of weight over
the past 6 months. His wife reports that he
has an uncontrollable appetite occasionally
eating to the point of vomiting. She also
states that he has a lack of interest when
the grandchildren visit. Over the last 4 weeks
she has noticed that her husband has become
more unsteady on his feet having had a number of falls. On examining him in clinic he has
impaired word comprehension, reduced
safety awareness on mobilizing and a positive
palmomental reflex. There is no tremor,
rigidity or shuffling gait. MMSE is 22/30.
CT head is shown. Which one of the following is most likely?
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a. Depression
b. Hypomania
c. Pick’s disease
d. Lewy body dementia
e. CJD
3. A 64-year-old man presents with a 6 month
history of abnormal behaviors which have
been noticed by his wife. He has described
seeing vivid visual hallucinations of clowns
in his living room which sometimes talk to
him and appear very real. He believes that
he is the head of a circus and is about to go
on a world tour although this is not true.
At times he is lucid and is fully independent
but at other times he is disorientated in time
and place and is unable to perform simple
tasks such as preparing food and going to
the shops. His wife thinks that his mood is
also lower since the onset of symptoms. He
presented in A E today because of having a
second fall in 2 weeks. There is no history
of infective symptoms. He went to see his
GP two days ago who thought that he may
have a UTI and prescribed trimethoprim.
He has a history of stroke 10 years ago and
hypertension and takes warfarin, amlodipine,
and enalapril. Physical examination is unremarkable except for slightly increased tone
on the left side compared to the right. Which
one of the following is most likely?
a. Alzheimer’s disease
b. Semantic dementia
c. Hypothyroidism
d. Lewy body dementia
e. Schizophrenia
4. A 55-year-old man presents with cognitive
decline over a 6-month period. He continues
to progress and develops myoclonus and a left
hemiparesis. On examination, he is alert and
orientated to time and place but appears easily
startled every time you start a sentence. There
is bilateral finger-nose and heel-shin dysmetria, mild postural tremor and mild speech
slurring. Blood tests are normal including thyroid and liver function. Lumbar puncture:
WCC<1, RBC 16, Protein 0.5 g/l, Glucose
3.4 mmol/l, gram stain negative, and no
organisms cultured. An EEG demonstrated
brief periodic spikes. A MRI head (FLAIR
sequence) is shown. Which one of the following is most likely?
a. Alzheimer’s disease
b. Creutzfeldt-Jakob disease
c. Carbon monoxide poisoning
d. Huntington’s disease
e. Pick’s disease
5. A 81-year-old male experiences progressive
cognitive decline over the past 10 years.
His wife reports that every 6 months or so
she will notice another significant decrease
in his functioning. It is now at the point where
he is aggressive and has little short-term memory. Past medical history includes hypertension and percutaneous coronary intervention
after a myocardial infarction. Examination
findings include poor attention and memory,
mild left hemiparesis (face, arm, and leg), and
brisk reflexes throughout with extensor plantar reflex bilaterally and a shuffling
gait. Which one of the following is most
appropriate?
a. Referral for subthalamic nucleus deep
brain stimulation
b. Treat cardiovascular risk factors
c. Carotid endarterectomy
d. Commence carbidopa/levodopa
e. Commence memantine
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