All of the following dementias can benefit from specific treatments, except:
Correct Answer D:
The dementias associated with NPH (normal pressure hydrocephalus), Alzheimer's, sarcoidosis, and vitamin B12 deficiency can be either cured or benefit from the following treatments: shunting of the ventricles in NPH; acetylcholinesterase inhibitors such as donepezil, rivastigmine and tacrine for Alzhiemer's; vitamin B12 replacement for B12 deficiency. Maximal surgical resection is the initial step in treatment of patients with suspected anaplastic oligodendroglial tumors.
Currently, Creutzfeldt–Jakob disease (CJD) cannot be cured, and its progress cannot be slowed. The disease is fatal, usually within months or a few years.
A 60-year-old white female presents for her annual physical examination. She tells you that since her last visit she has begun taking ginkgo biloba to improve her memory. She takes no other medications.
The evidence supporting a benefit from ginkgo biloba is best for which one of the following?
Correct Answer C:
Studies support the use of ginkgo biloba for tinnitus, dementia, and intermittent claudication. Those examining its use in patients with dementia are of the highest quality, and consistently demonstrate that ginkgo is more effective than placebo in delaying cognitive decline. The studies examining its use in tinnitus, claudication, and cognitive improvement in people with normal mentation are limited by bias and small numbers of studies with inconsistent results. Ginkgo is not appropriate for the treatment of benign prostatic hyperplasia.
A patient on lithium therapy develops weakness, lethargy and increased sensitivity to cold.
What investigation must be done?
Correct Answer B:
It is well established that lithium therapy can cause hypothyroidism in about 2-3 % of patients. Once hypothyroidism is diagnosed, treatment of the condition should be investigated rapidly with thyroxine.
Discontinuation of lithium therapy is an option but in most cases the psychiatric indication for continuing it is strong, as in this patient. Once treatment is begun, regular monitoring of TSH and FT4 will be required.
A 38-year-old woman presents to you convinced that she has chronic fatigue syndrome. The history reveals no evidence of fever or swollen glands, and no other symptoms other than fatigue and weight gain. Her physical examination is completely normal. She has a high thyroid-stimulating hormone level.
You would then suspect and subsequently confirm:
Hypothyroidism is under activity of the thyroid gland that leads to inadequate production of thyroid hormone and a slowing of vital body functions.
Insufficient thyroid hormone causes body functions to slow. Symptoms are subtle and develop gradually. They may be mistaken for depression, especially among older people. Facial expressions become dull, the voice is hoarse and speech is slow, eyelids droop, and the eyes and face become puffy. Many people with hypothyroidism gain weight, become constipated, and are unable to tolerate cold.
Hypothyroidism is common, especially among older people, particularly women; it affects about 10% of older women. It can, however, occur at any age. Very severe hypothyroidism is called myxedema.
Diagnosis is made by obtaining TSH and FreeT4 levels. Treatment is with thyroid replacement with synthroid.
A young woman presents a feature of cold intolerance, fatigue, anorexia, weight gain and dry skin. Her TSH is increased and freeT4 is low.
What is the most appropriate treatment?
Hypothyroidism is thyroid hormone deficiency. It is diagnosed by clinical features such as a typical facies, hoarse slow speech, and dry skin, and by low levels of thyroid hormones. Management includes treatment of the underlying cause and administration of thyroxine.
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