Year 1 Prof: Sar Sothearith 2nd semester DES

1/ Which is the most technique for measuring and mapping brain activity that is non invasive and safe?

2/Which is main the following test for noninvasive diagnostic that uses X-ray and one machine creating image of the body?

3/ Which is best test for noninvasive diagnostic to measure biochemical change in the brain?

4/ Which is best measure test for the function of the specific biochemical entities in the brain?

5/ Which is the best statement of vascular dementia on MRI scans?

6/ Which Statement is the best for AD and rarely is associated with diffuse loss of brain volume?

7/ It is estimated that normal brain aging loses approximately of its volume each year:

8/ In mild cognitive impairment (MCI), the brain loses approximately of its volume each year in normal aging:

9/ In dementia due to alzheimer’s desease, it is estimated that the brain volume loses approximately :

10. A 72-year-old woman is admitted to the emergency unit with second- and third-degree burns covering 35% of her body. At the fourth day of her hospital stay, she pulls out her IV, screaming that people are trying to hurt her and had to be difficult to arouse and disoriented. Which of the following is the most likely diagnosis?

11. Mrs. S is 75-year-old who had undergone a hip replacement 2 days before. On examination, the patient states the date as 1956, and she thinks she is at her son’s house. These impairments best illustrate which aspect of the mental status examination?

12. A 23-year-old woman comes to the emergency room with hearing voices for 7 months. She has the idea that the radio is giving her special messages. The rapist asked “People in glass houses should not throw stones,” the patient replies, “Because the windows would break.”Which of the following mental status findings does this patient display?

13. A 69-year-old man is brought to see his physician by his wife. In the previous year he has experienced a slow, stepwise decline in his cognitive functioning and he gets lost around the house and can’t remember simple directions. The patient insists that he feels fine, though he is depressed about his loss of memory. He is eating and sleeping well.Which of the following is the most likely diagnosis?

14. An 18-year-old man is brought to the emergency room by police after he is found wandering in the street, screaming loudly at passersby. In the emergency room he is placed in an examination room, and paces the floor and pounds his fist against the door repeatedly. Which of the following actions should be taken by the psychiatrist first?

15. A 65-year-old man, hospitalized for an acute pneumonia. 3 days previously, begins screaming for his nurse, stating that “there are people in the room out to get me.” He gets out of bed and pulling out his IV line. He alternates between agitation and somnolence. He is not oriented to time or place. His pulse: 126 .mn; respiration, 32 breaths /mn; BP: 80/58mmHg; temperature, 39.2 oC. Which of the following diagnoses best fits this patient’s clinical picture?

16. A 45-year-old woman, who has been on chronic steroid treatment for her asthma, has thin arms and legs but has a large amount of fat deposited on her abdomen, chest, and shoulders. Physical examination shows elevated blood pressure and laboratory tests show decreased glucose tolerance.Which of the following psychiatric conditions is the most likely diagnosis?

17. A 40-year-old woman’s cognitive functions have progressively deteriorated for several years. She is depressed, easily irritated, and prone to aggressive outbursts, she also presents with irregular, purposeless, and asymmetrical movements of her face, limbs, and trunk, which worsen when she is upset and disappear in sleep. Her MRI shows atrophy of the caudal nucleus and the putamen.Which of the following is the most likely diagnosis of this patient?

18. A 37-year-old mildly retarded man with trisomy 21 syndrome has been increasingly forgetful. In previous several years, he makes frequent mistakes when counting change at the grocery store. He often cannot recall the names of common objects. He was fairly good in the past.Which of the following is the most likely diagnosis of this patient?

20. A 72-year-old, has been having difficulties with tasks he used to find easy and enjoyable, because he cannot remember the correct words and his handwriting has deteriorated and difficulty remembering the events of previous days and subsequently, he develops slurred speech. He had a long history of hypertension. Which of the following is the most likely diagnosis?

21. A 23-year-old man comes with the complaint the memory has worsened over the past 2 months and that he has difficulty concentrating. He has lost interest in his friends and his work. He has difficulty with abstract thoughts and problem solving. He has also felt depressed. MRI scan shows parenchymal abnormalities. Which of the following is the most likely diagnosis?

22. A 37-year-old alcoholic is brought to the emergency room after he was found unconscious in the street. He is hospitalized for dehydration and pneumonia. While being treated, he becomes acutely confused and agitated. He cannot move his eyes upward or to the right, and he is ataxic.Which of the following is the most likely diagnosis?

23. A 32-year-old man is admitted to the hospital after he is hit by a car and breaks his femur. At day 3, he had repeatedly hearing the voice of his mother telling him to protect himself from danger. He also notes that he sees movement out of the corners of his eyes.BP: 160/92 mmHg; respirations 12 breaths/mn, pulse: 110 beats/mn; and temperature:38oC.Which of the following is the most likely diagnosis for this patient?

24. A 26-year-old woman is brought to the emergency room by begins screaming that her children are calling to her and becomes hysterical. 2 weeks previously, the couple’s two children were killed in a car accident, and since that time she has been agitated, disorganized, and incoherent. She believes of poisoning by others, did not sleep for the past 2 days. One week treatment, all her symptoms remit spontaneously.Which of the following is the most likely diagnosis for this patient?

25. A 35-year-old man, brought to the emergency room. His pulse is 100 beats/ mn, BP: 170/95 mm Hg, and he is diaphoretic. He is tremulous and has difficulty relating a history. He does admit to insomnia the past two nights and sees spiders walking on the walls. He has been a drinker since age 19, but has not had a drink in 3 days.Which of the following is the most likely diagnosis?

26. A 40-year-old man comes to the emergency room with symptoms of tachycardia, diaphoresis, mydriasis, and hyperthermia. He also shows muscle twitching and clonus. His medications include a protease inhibitor (for AIDS) and fluoxetine 20 mg daily which was started 1 week ago.What is the main problem of this patient?

27. A 76-year-old man is diagnosed with dementia of the Alzheimer type. Which of the following chemicals has been most commonly associated with this disease?

32. Which of the following sites is thought to be significant for formation and storage of immediate and recent memories?

33. A 74-year-old woman has progressively declined for 10 years. Lately, she cannot remember how to cook her favorite recipes, and she becomes disoriented and confused at night. She identifies an increasing number of objects and cannot recall the correct name. Which of the following is the most likely diagnosis?

34. A 76-year-old woman was admitted to the hospital after she was found lying on the floor of her bedroom by her daughter. She was incoherently speak, hypervigilant and had disorganized thoughts. She was currently used digoxin and a benzodiazepine. What is the most likely diagnosis?

35- Which is the following answer for contraindication of the computed tomographic (CT)?

36- Which is the following answer for contraindication of the magnetic resonance imaging (MRI) ?

37- Which is the following that cause of dementia can be reversible?

38- Which is the following answer of the core symptom of dementia?

39- Which is the following answer of the cause of dementia that has gradual onset of symptoms?

40- Which is the following answer of the common medication use to treat in dementia?

41. Which is the following answer the level conscience of the delirium’s patients?

42. It is produces particular problems with memory and thinking impairment . Learning new information becomes harder – can't remember recent events, appointments or phone messages. Which is the best following answer ?

43. When the arteries supplying blood to the brain become blocked, There may be memory loss, poor concentration, word finding difficulties, mood swings and depression. Some people have hallucinations (where they see or hear something that is not there). Which is the best following answer?

44. The level of confusion can vary during the course of the day, but visual hallucinations of people or animals are more common. They may also have trembling hands, muscle stiffness, falls or difficulty in walking. Which is the best following answer?

45. Which is the following the major symptoms of delirium that may require pharmacological treatment?

Senario I - A 65-year-old woman presented with a 3 years history of being poor memory without inattention. She has become confused and disorientated. She has seen ghosts in her room and sometime has talked to them but it has not been regularly. Her husband reported that his wife repeated her speech and she has changed her personality. Her husband is very concerned and wants you to help her. 1-What is the most important information you need to explore?

Senario I - A 65-year-old woman presented with a 3 years history of being poor memory without inattention. She has become confused and disorientated. She has seen ghosts in her room and sometime has talked to them but it has not been regularly. Her husband reported that his wife repeated her speech and she has changed her personality. Her husband is very concerned and wants you to help her. 2-What is the more serious history you need to focus on?

Senario I - A 65-year-old woman presented with a 3 years history of being poor memory without inattention. She has become confused and disorientated. She has seen ghosts in her room and sometime has talked to them but it has not been regularly. Her husband reported that his wife repeated her speech and she has changed her personality. Her husband is very concerned and wants you to help her.3-Which examination do you think it is more important?

Senario I - A 65-year-old woman presented with a 3 years history of being poor memory without inattention. She has become confused and disorientated. She has seen ghosts in her room and sometime has talked to them but it has not been regularly. Her husband reported that his wife repeated her speech and she has changed her personality. Her husband is very concerned and wants you to help her.4-What is your provisional diagnosis?

Senario I - A 65-year-old woman presented with a 3 years history of being poor memory without inattention. She has become confused and disorientated. She has seen ghosts in her room and sometime has talked to them but it has not been regularly. Her husband reported that his wife repeated her speech and she has changed her personality. Her husband is very concerned and wants you to help her.5-Your friend who is medical fellow disagrees with your diagnosis. What is your explanation?

Senario I - A 65-year-old woman presented with a 3 years history of being poor memory without inattention. She has become confused and disorientated. She has seen ghosts in her room and sometime has talked to them but it has not been regularly. Her husband reported that his wife repeated her speech and she has changed her personality. Her husband is very concerned and wants you to help her.6-What is the characteristic of hallucination of dementia?

Senario I - A 65-year-old woman presented with a 3 years history of being poor memory without inattention. She has become confused and disorientated. She has seen ghosts in her room and sometime has talked to them but it has not been regularly. Her husband reported that his wife repeated her speech and she has changed her personality. Her husband is very concerned and wants you to help her.7- What is medication should we suggest to give our patient in order to help her condition better?

Senario 2 -A 75-year-old man is admitted for treatment of encephalitis. In the past 4 days, he has become confused and disorientated. He sees the pop stars in the room at night. He has a good past health and there is no past psychiatric history. His wife is very worried and wants to speak to your urgently.1-What is your provisional diagnosis?

Senario 2 -A 75-year-old man is admitted for treatment of encephalitis. In the past 4 days, he has become confused and disorientated. He sees the pop stars in the room at night. He has a good past health and there is no past psychiatric history. His wife is very worried and wants to speak to your urgently.2- Your friend who is medical fellow disagrees with your diagnosis. He thinks this patient has nothing wrong because the patient was alert with normal orientation. What is your explanation?

Senario 2 -A 75-year-old man is admitted for treatment of encephalitis. In the past 4 days, he has become confused and disorientated. He sees the pop stars in the room at night. He has a good past health and there is no past psychiatric history. His wife is very worried and wants to speak to your urgently.3- If the patient has mistaken the certain as a pop stars in the room at night, what is this phenomenon known as?

Senario 2 -A 75-year-old man is admitted for treatment of encephalitis. In the past 4 days, he has become confused and disorientated. He sees the pop stars in the room at night. He has a good past health and there is no past psychiatric history. His wife is very worried and wants to speak to your urgently.4- What is medication should we suggest to give the patient in order to help him sleep better at night?

Senario 3-A 47 year- old man, married, 2 children, physician, from Kampot province. He was accompanied by his family and was admitted for treatment of meningitis. In the last 3 days he had been angry and had slept disturbance. He talked to self, had agitation and he had seen ghost in his room. His relatives were very concerned about his condition. They said that he has a good past health. Your colleague called you to help him.1- What is the most important information you need to explore:

Senario 3-A 47 year- old man, married, 2 children, physician, from Kampot province. He was accompanied by his family and was admitted for treatment of meningitis. In the last 3 days he had been angry and had slept disturbance. He talked to self, had agitation and he had seen ghost in his room. His relatives were very concerned about his condition. They said that he has a good past health. Your colleague called you to help him.2- What are the most relevant history you need to focus on:

Senario 3-A 47 year- old man, married, 2 children, physician, from Kampot province. He was accompanied by his family and was admitted for treatment of meningitis. In the last 3 days he had been angry and had slept disturbance. He talked to self, had agitation and he had seen ghost in his room. His relatives were very concerned about his condition. They said that he has a good past health. Your colleague called you to help him.3- What are the most common symptoms you need to explore :

Senario 3-A 47 year- old man, married, 2 children, physician, from Kampot province. He was accompanied by his family and was admitted for treatment of meningitis. In the last 3 days he had been angry and had slept disturbance. He talked to self, had agitation and he had seen ghost in his room. His relatives were very concerned about his condition. They said that he has a good past health. Your colleague called you to help him.4- What is your tentative diagnosis?

Senario 3-A 47 year- old man, married, 2 children, physician, from Kampot province. He was accompanied by his family and was admitted for treatment of meningitis. In the last 3 days he had been angry and had slept disturbance. He talked to self, had agitation and he had seen ghost in his room. His relatives were very concerned about his condition. They said that he has a good past health. Your colleague called you to help him.5- What is the most probable differential diagnosis you need to rule out?

Senario 3-A 47 year- old man, married, 2 children, physician, from Kampot province. He was accompanied by his family and was admitted for treatment of meningitis. In the last 3 days he had been angry and had slept disturbance. He talked to self, had agitation and he had seen ghost in his room. His relatives were very concerned about his condition. They said that he has a good past health. Your colleague called you to help him.6- What is medication should we suggest to give the patient in order to help him sleep better at night?

Senario 3-A 47 year- old man, married, 2 children, physician, from Kampot province. He was accompanied by his family and was admitted for treatment of meningitis. In the last 3 days he had been angry and had slept disturbance. He talked to self, had agitation and he had seen ghost in his room. His relatives were very concerned about his condition. They said that he has a good past health. Your colleague called you to help him.7- A preventive strategy, what should you educate staffs?

Senario 3-A 47 year- old man, married, 2 children, physician, from Kampot province. He was accompanied by his family and was admitted for treatment of meningitis. In the last 3 days he had been angry and had slept disturbance. He talked to self, had agitation and he had seen ghost in his room. His relatives were very concerned about his condition. They said that he has a good past health. Your colleague called you to help him.8- What is your comments related to the post delirium treatment?

1-The level conscience of the delirium’s patients is:

2- It is produces particular problems with memory and thinking impairment . Learning new information becomes harder – can't remember recent events, appointments or phone messages.

3. When the arteries supplying blood to the brain become blocked, There may be memory loss, poor concentration, word finding difficulties, mood swings and depression. Some people have hallucinations (where they see or hear something that is not there). It ls:

4. The level of confusion can vary during the course of the day, but visual hallucinations of people are more common. They may also have trembling hands, muscle stiffness, falls or difficulty in walking. It is:

5- Delirium is defined as :

6- Dementia is defined as :

7-Beyond the diagnostic evaluation, the role of the general medical physician in the care of dementia patient is as follow except:

8-What is the except of most common causes of dementia in individuals older than 65 years of age:

9- The neurotransmitters that are most often implicated in the pathophysiological condition of Alzheimer's disease are:

10-The two major symptoms of delirium that may require liaison treatment are: