Cognitive Disorders and

Consultation-Laison
Psychiatry
20 item questionnaire

Submitted to: Jenirose Castillo

Submitted By: Eisa Eleni Q. Palmes
1. True statements about post-cardiac surgery
delirium include all the following EXCEPT:
a. It most commonly develops 2 to 45 days
after surgery.
b. It is more common in dominant as opposed
to dependent personalities.
c. It is more common in patients who express
high preoperative anxiety.
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Explanation:
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(Rundell, pp 617-623.) Post-cardiac surgery delirium is the
most common psychiatric complication of cardiac surgery.
While it may occur immediately, more commonly it follows
a lucid period of 2 to 4 days. Patients with dominant
personalities appear more likely to develop delirium, as do
patients with low preoperative anxiety. This is probably due
to diffi culty in accepting the dependent sick role, while the
denial of anxiety serves as an ineffective defense
mechanism. Patients with a history of myocardial infarction
are at higher risk probably because of cerebral anoxia
secondary to diminished cardiac output.
Proceed
2. All the following are commonly found
in normal pressure hydrocephalus
EXCEPT:
a. Aphasia
b. Dementia
c. Apathy
(Yudofsky, 214, pp 614-615.) The classic syndrome
of normal pressure hydrocephalus consists of
dementia, incontinence, and gait disturbance. The
dementia frequently involves impaired attention,
poor leaping, and impaired abstraction and
judgment. The syndrome does not con monly include
aphasia, apraxia, or agnosia. These patients may
have a variety of psychiatric symptoms, including
anxiety, personality changes, and disturbance of
mood.
Proceed
3. Huntington’s disease is
associated with all the following
EXCEPT
a. acute onset
b. onset during adulthood
c. autosomal dominant inheritance
(Yudofsky, 2/e, pp 586-592.) Huntington's disease
is a rare illness that is inherited as an autosomal
dominant trait and typically manifests during
adulthood. It is characterized clinically by the
insidious onset of choreiform movements,
dementia, and personality changes. No effective
treatment is presently known. At autopsy, the brain
of affected persons atrophied, especially in the
caudate nucleus and putamen.
Proceed
4. The most common psychiatric
disturbance associated with
Cushing’s syndrome is:
a. Mania
b. Depression
c. Psychosis
(Isselbacher, 13/ e. pp 1960-1965.) Cushing's
syndrome often is associated with psychiatric
disturbances, Depression is the most common
disturbance and may range from moderate to
severe; as many organic as 10 percent mental
of disorder affected also persons can occur
attempt suicide. Mania, psychosis, and an
organic mental disorder also can occur.

Proceed
5. Olfactory hallucinations are relatively
rare and are most commonly
encountered in patients with:
a. Partial Complex Seizures
b. Wilson’s disease
c. Parietal tumors
Hallucinations involving smell, taste, or
kinesthetic experiences are rare. They are most
commonly encountered in patients with partial
complex seizures. They are also found at times
in other organic or psychiatric disorders such
as somatization disorder, psychosis, and
hypochondriasis. Tumors involving the olfactory
areas of the brain must also be considered.
Proceed
6. The odor of garlic on the breath
occurs soon after acute poisoning
with:
a. thallium
b. lead
c. arsenic
(Yudofsky, 2/ e, pp 547-548.) Acute arsenic
poisoning may occur by accidental, suicidal, or
homicidal ingestion. Within 30 min to 2 h the
initial symptoms of garlic breath and a
metallic taste will occur. This is followed by
gastrointestinal inflammation, circulatory
collapse, and CNS symptoms, which may
include headache, vertigo, stupor, delirium,
con vulsions, and coma.
Proceed
7. In which of the following age
groups is the incidence of
psychopathology the greatest:
a. Under 10 years
b. 25 to 45 years
c. Over 65 years
(Kaplan, 6/e, pp 360-361.) Persons older
than 65 years of age have a higher risk than
other persons of developing mental illness.
However, elderly persons are
underrepresented in the frequency of visits
to mental health clinics and in the receipt of
appropriate social services. Common
psychiatric problems in this population
include depression and Organic mental
disorders.
Proceed
8. The most common cause of
hyperprolactinemia in the
psychiatric patient is
a. Oral contraceptives
b. Neuroleptic medication
c. Pregnancy
(Yudofsky, 2/e, pp 537-538.) Even small doses of
neuroleptic medication can produce
hyperprolactinemia, and this is the most common
etiology found in psychiatric patients. Other
causes include severe systemic illness such as
cirrhosis or renal failure, pregnancy, stress,
neoplasm, and oral contraceptives.
Hyperprolactinemia due to tumors is much more
common in women than in men.

Proceed
9. All the following psychoactive
drugs should be avoided in
patients with porphyria EXCEPT
a. Phenobarbital
b. Cocaine
c. Chlorpromazine
(Isselbacher, 13/e, pp 407, 2076.) There are
a number of nonpsychiatric medications and
psychoactive drugs that should not be used
in patients with porphyria because of the
danger of precipitating an acute episode.
These include alcohol, oral contraceptives,
phenytoin, barbiturates, sulfonamides, and
valproic acid.
Proceed
10. All the following medical
conditions may result in depression
secondary to hypercalcemia EXCEPT:
a. Multiple myeloma
b. Renal tumors
c. General paresis
(Rundell. p 328.) There are a number of metabolic
diseases, including those secondary to vitamin
excess or deficiency, that may result in mood
disorders. All the listed diagnoses, except general
paresis, can by associated with hypercalcemia of
nonendocrine origin and can result in an anhedonic
retarded depression. General paresis is most often
associated with manic symptoms, but this is
commonly followed by depression and then
dementia. Proceed
11. A man given a placebo for mild pain
reports 30 min later that the pain has
resolved. The most appropriate
conclusion 1s that the man:
a. Has a conversion disorder
b. Responds to placebos
c. Had no real pain to begin with
(Rundell, p 1008.) The only conclusion
that can be reached about the man
described in the question is that he
responds to placebos. His response says
nothing about whether his pain is “real” or
psychogenic. Placebos have been shown
to decrease pain of both psychological
and physiologic origin. Proceed
12. A 62-year-old woman is admitted to a medical unit
because of an 11.4-kg (25-lb) weight loss over the last 3
months. She also reports anorexia, insomnia, fatigue, and
decreased sexual interest. She does not have depressed
affect, and her mental status is judged to be unimpaired.
Extensive medical evaluation is unremarkable. The most
likely diagnosis is senile dementia
a. Occult malignancy
b. Masked depression
c. Chronic anxiety
(Rundell, pp 316-321.) Depressive illness consists of both somatic and
psychological components. The somatic components include insomnia,
anorexia, weight loss, fatigue, motor retardation or agitation, and
decreased sexual interest. The psychological components include
depressed mood, pessimism, and feelings of worthlessness and guilt.
Not all components are present in every case. Patients who have a
masked depression present with primarily somatic symptoms and few
or no psychological one, Diagnosis often is made only after extensive
medical evaluation is unrevealing. The woman described in the question
did not have any signs of dementia; medical evaluation did not reveal
an organic disease process; and although hypochondriasis and chronic
anxiety could have caused many of her symptomy, they are not likely to
have caused the 11.4-kg weight loss.
Proceed
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 GREAT JOB
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