NBME 6

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FOLLOWYOURHEART

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Hey guys pls help out.

1.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 ******ation, 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 concentration is 25 mg/dL, and serum creatinine concentration is 1.7 mg/dL

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

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I- Major depressive disorder. She has trouble sleeping, decreased appetite/weight loss, poor functioning (unkempt, poor hygiene etc), psychomotor ******ation, and flat affect. Her memory loss and other symptoms are likely due to pseudodementia, which can occur in elderly people with depression. Although it doesn't explicitly mention anhedonia or a depressed mood, it does mention that she had symptoms in the past that were successfully treated. Her symptoms came on pretty acutely, in a matter of weeks, and she was fine before that and living independently.

It's not acute stress disorder, because there was no inciting event and she has no PTSD type sx. It's not Alzheimer's, as her sx are acute. It's not vascular dementia, because there is no mention of any focal issues or any medical history that would indicate that she may have had strokes. It's not NPH because there are no gait issues or incontinence. It's not Parkinson, because she has none of the typical findings. It's not Pick's, since she doesn't have any personality changes or anything. And it's not normal aging, because it's affecting her ability to live day-to-day. You can rule the other things out because they don't fit with the history.

Hope this helps!
 
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I- Major depressive disorder. She has trouble sleeping, decreased appetite/weight loss, poor functioning (unkempt, poor hygiene etc), psychomotor ******ation, and flat affect. Her memory loss and other symptoms are likely due to pseudodementia, which can occur in elderly people with depression. Although it doesn't explicitly mention anhedonia or a depressed mood, it does mention that she had symptoms in the past that were successfully treated. Her symptoms came on pretty acutely, in a matter of weeks, and she was fine before that and living independently.

It's not acute stress disorder, because there was no inciting event and she has no PTSD type sx. It's not Alzheimer's, as her sx are acute. It's not vascular dementia, because there is no mention of any focal issues or any medical history that would indicate that she may have had strokes. It's not NPH because there are no gait issues or incontinence. It's not Parkinson, because she has none of the typical findings. It's not Pick's, since she doesn't have any personality changes or anything. And it's not normal aging, because it's affecting her ability to live day-to-day. You can rule the other things out because they don't fit with the history.

Hope this helps!

UWORLD says that the way you differentiate pseudo dementia from Alzheimer's is - in pseudo dementia the patient is concerned about his/her memory loss. Here the patient is not concerned.
 
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UWORLD says that the way you differentiate pseudo dementia from Alzheimer's is - in pseudo dementia the patient is concerned about his/her memory loss. Here the patient is not concerned.
I got this question right bud. Alzheimer's doesn't present with a 6 week history and previous episodes being treated successfully with medications.
 
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I got this question right bud. Alzheimer's doesn't present with a 6 week history and previous episodes being treated successfully with medications.
I know no other option fits right for this case except Pseudo dementia but because it was specifically mentioned in UWORLD I was kind of hesitant to go for it.
Anyways, thanks a lot.
Good luck.
 
I got wrong this question because of the same reasoning, I didnt think that Pseudodementia causing so much disfunctioning
 
Yes,i agree , the most important clue is WEIGHT/Sleep/Appetite changes, also seen previously, indicating Depression . Remember pnumonic SIGECAPS.. These are not seen in Alzehmiers.
 
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