A 64 year-old female, Mrs.Jane, comes to your office for her annual health checkup. For the last few months, she has been having difficulty remembering the names of her friends. She struggles to remember even the names of some of her grandchildren. Sometimes she struggles to find the right words to express her thoughts. Sometimes she wonders whether she has taken her regular blood pressure medication even after she took it. Two weeks ago, her niece called her to attend her birthday party over the weekend, but after two days, she completely forgot about it. She was planning to go to Orlando, Florida for a business conference. She was able to register to attend the conference, was able to buy the plane tickets but forgot to book a hotel room. Until recently, she used to do these things so systematically and effortlessly. She is sleeping well, feeling good about herself and her financial situation. There is no change in sexual life. Her family members have not noticed anything different in her but she feels that ‘something is not right with my memory and planning’. Noone complained about her behavior – no impulsivity, no aggressiveness, no inappropriate conversations. She is still able to take care of herself. She reports that she is able to cook, drive, go to work, go to gym, do gardening and work on her computer. There is no change in her performance at house and work. Her vital signs are normal. As you observe her, you see a well-dressed, well behaved individual. Her physical examination including nervous system is normal. Of the following, which is the most likely explanation for this patient’s symptoms and signs?
A 47-year old male is brought to your office by his wife for psychological evaluation. She reports that for the last 6 months, she has been noticing changes in her husband’s personality, behavior and speech. There is a gradual decline in his memory. He has become more suspicious of her, washing hands repeatedly, checking the doors and windows more than usual. He is struggling to find the right words to express himself. He is undressing in public places and cracking inappropriate jokes. In the last month, he had fallen several times, become incontinent of urine, and had difficulties with basic activities of daily living such as brushing his teeth and dressing. He developed a voracious appetite, eating 4-5 pieces of cheesecake at a time. A magnetic resonance imaging scan of the brain demonstrated enlarged sulci and ventricles and cortical and white matter atrophy of the frontal lobes and temporal lobes. What is the pathological hallmark of this disorder?
A 69-year-old man is brought in by his son for a psychiatric evaluation. His son is concerned because the patient is getting lost while driving in familiar areas like his neighborhood. He is not able to organize his finances and pay his utility bills. He finds it difficult to find the right word to express himself. He cannot remember the names of his grandchildren. He gets irritated when asked about his memory lapses. His past medical history is significant for a few episodes of delirium during hospitalizations and vitamin B12 deficiency successfully treated with medications. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which of the following is part of the criteria required to diagnose this individual with major neurocognitive disorder?
George is a 55 year-old male who came to your office for an annual health check up. He has a history of hypercholesterolemia, hypertension, diabetes mellitus, and obesity. Of the following, which has been associated with a greater risk of developing Alzheimer’s disease in later life?
A 58-year-old man describes a temporary weakness in his right hand that occurred 3 days ago while driving his truck. He was unable to move his arm for 30 minutes, but he progressively regained his strength. He also had difficulty speaking around the same time with transient loss of vision. All symptoms are resolved now. His temperature is 98.4⁰ F, heart rate is 71 beats per minute, respiratory rate is 16 breaths per minute, oxygen saturation 97%, and blood pressure is 172/101 mm Hg. His past medical history is significant for diabetes, hypertension and coronary artery disease with stable angina. He has been smoking since he was 15 years-old and he currently smokes one pack of cigarettes a day. His current medications include aspirin, insulin, sublingual nitroglycerin, and metoprolol. On examination, bruits can be auscultated over both carotid arteries. The remainder of his physical examination is unremarkable. CT scan of the head is normal. Carotid artery ultrasound revealed 78% occlusion in the left carotid artery and 52% occlusion in the right carotid artery. What is the optimal timing for intervention in this patient?
A 58-year-old man describes a temporary weakness in his right hand that occurred 3 days ago while driving his truck. He was unable to move his arm for 30 minutes, but he progressively regained his strength. He also had difficulty speaking around the same time with transient loss of vision. All symptoms are resolved now. His temperature is 98.4⁰ F, heart rate is 71 beats per minute, respiratory rate is 16 breaths per minute, oxygen saturation 97%, and blood pressure is 172/101 mm Hg. His past medical history is significant for diabetes, hypertension and coronary artery disease with stable angina. He has been smoking since he was 15 years-old and he currently smokes one pack of cigarettes a day. His current medications include aspirin, insulin, sublingual nitroglycerin, and metoprolol. On examination, bruits can be auscultated over both carotid arteries. The remainder of his physical examination is unremarkable. CT scan of the head is normal. Carotid artery ultrasound revealed 78% occlusion in the left carotid artery and 52% occlusion in the right carotid artery. Which of the following is the most appropriate management for this patient?
A 58-year-old man describes a temporary weakness in his right hand that occurred 3 days ago while driving his truck. He was unable to move his arm for 30 minutes, but he progressively regained his strength. He also had difficulty speaking around the same time with transient loss of vision. All symptoms are resolved now. His temperature is 98.4⁰ F, heart rate is 71 beats per minute, respiratory rate is 16 breaths per minute, oxygen saturation 97%, and blood pressure is 172/101 mm Hg. His past medical history is significant for diabetes, hypertension and coronary artery disease with stable angina. He has been smoking since he was 15 years-old and he currently smokes one pack of cigarettes a day. His current medications include aspirin, insulin, sublingual nitroglycerin, and metoprolol. On examination, bruits can be auscultated over both carotid arteries. The remainder of his physical examination is unremarkable. Of the following, what is your next step in management of this patient?
A 58-year-old man describes a temporary weakness in his right hand that occurred 3 days ago while driving his truck. He was unable to move his arm for 30 minutes, but he progressively regained his strength. He also had difficulty speaking around the same time with transient loss of vision. All symptoms are resolved now. His temperature is 98.4⁰ F, heart rate is 71 beats per minute, respiratory rate is 16 breaths per minute, oxygen saturation 97%, and blood pressure is 172/101 mm Hg. His past medical history is significant for diabetes, hypertension and coronary artery disease with stable angina. He has been smoking since he was 15 years-old and he currently smokes one pack of cigarettes a day. His current medications include aspirin, insulin, sublingual nitroglycerin, and metoprolol. On examination, bruits can be auscultated over both carotid arteries. The remainder of his physical examination is unremarkable. Of the following, which is the most likely diagnosis in this patient?
