stroke or dementia - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 09-07-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,866
Threads: 149
Thanked 2,249 Times in 1,096 Posts
Reputation: 2269
Post stroke or dementia

A 79-year-old woman was hospitalized 4 days ago after sustaining a right hip fracture in a fall. She underwent surgical repair with right hip replacement 3 days ago and did not fully awake from general anesthesia until 12 hours after extubation. As her alertness has increased, she has become increasingly agitated. The patient has a 4-year history of Alzheimer dementia. She has no other pertinent personal or family medical history. Current medications are donepezil, memantine, and low-molecular-weight heparin.


On physical examination today, temperature is 37.2C (99.0F), blood pressure is 100/68 mm Hg, pulse rate is 100/min and regular, and respiration rate is 18/min. The patient can move all four limbs with guarding of the right lower limb. She is inattentive and disoriented to time and place and exhibits combativeness alternating with hypersomnolence. The remainder of the neurologic examination is unremarkable, without evidence of focal findings or meningismus.


Which of the following is the most likely diagnosis?


(A) Acute stroke
(B) Acute worsening of Alzheimer dementia
(C) Meningitis
(D) Postoperative delirium
Reply With Quote Quick reply to this message



  #2  
Old 09-07-2012
Hitman's Avatar
USMLE Forums Master
 
Steps History: Not yet
Posts: 928
Threads: 17
Thanked 576 Times in 400 Posts
Reputation: 586
Default

ans D ........
Reply With Quote Quick reply to this message
  #3  
Old 09-07-2012
XpaezX's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,216
Threads: 41
Thanked 1,365 Times in 722 Posts
Reputation: 1380
Default

D, alternating between agitation and somnolence, post surgical patient after a big procedure with numerous co-morbidities
Reply With Quote Quick reply to this message
 
  #4  
Old 09-07-2012
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 791
Threads: 76
Thanked 703 Times in 330 Posts
Reputation: 721
Default

D...........altered sensorium.........delirium....acute presentation
Reply With Quote Quick reply to this message
  #5  
Old 09-07-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 851
Threads: 88
Thanked 748 Times in 399 Posts
Reputation: 758
Default

Answer D waxing and waning level of consciousness - delirium from sedative drug withdrawal or surgery itself
__________________
"Don't Forget they need us too"
Reply With Quote Quick reply to this message
  #6  
Old 09-07-2012
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 461
Threads: 279
Thanked 199 Times in 103 Posts
Reputation: 209
Default

Quote:
Originally Posted by Novobiocin View Post
A 79-year-old woman was hospitalized 4 days ago after sustaining a right hip fracture in a fall. She underwent surgical repair with right hip replacement 3 days ago and did not fully awake from general anesthesia until 12 hours after extubation. As her alertness has increased, she has become increasingly agitated. The patient has a 4-year history of Alzheimer dementia. She has no other pertinent personal or family medical history. Current medications are donepezil, memantine, and low-molecular-weight heparin.


On physical examination today, temperature is 37.2C (99.0F), blood pressure is 100/68 mm Hg, pulse rate is 100/min and regular, and respiration rate is 18/min. The patient can move all four limbs with guarding of the right lower limb. She is inattentive and disoriented to time and place and exhibits combativeness alternating with hypersomnolence. The remainder of the neurologic examination is unremarkable, without evidence of focal findings or meningismus.


Which of the following is the most likely diagnosis?


(A) Acute stroke
(B) Acute worsening of Alzheimer dementia
(C) Meningitis
(D) Postoperative delirium


D.) post-operative delirium
Reply With Quote Quick reply to this message
  #7  
Old 09-07-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,866
Threads: 149
Thanked 2,249 Times in 1,096 Posts
Reputation: 2269
Default

The most likely diagnosis is postoperative delirium. Patients with delirium have acute, fluctuating mental status changes, with difficulty in focusing or maintaining attention and disorganized thinking.


The possibility of acute stroke must be considered in a patient with a change in mental status. However, this patient has no clinical evidence of such an event, which makes this diagnosis extremely unlikely.


Surgery does not exacerbate Alzheimer dementia (or dementia of any other cause) but rather produces a superimposed delirium. Finally, dementia does not acutely worsen over several hours; the decline is steadily progressive.

Although not impossible, meningitis is highly unlikely in this setting, especially given the absence of any supporting physical examination findings, including meningeal irritation.
Reply With Quote Quick reply to this message



Reply

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in


Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Can you guess which type of Dementia! tyagee USMLE Step 2 CK Forum 5 07-20-2012 08:40 AM
Dementia and Amnestic disorders indigo USMLE Step 2 CK Forum 0 03-15-2012 07:30 AM
Diferential Diagnoses of Dementia jachahla USMLE Step 1 Forum 3 12-13-2011 12:54 PM
Dementia Q ag2011n USMLE Step 2 CK Forum 6 09-11-2011 01:00 PM

Find Us on Facebook
Powered by vBulletin® Version 3.8.8
Copyright ©2000 - 2020, vBulletin Solutions, Inc.
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2020 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2019)