A 63 year old male is brought in by his wife who states that her husband has been acting "bizarre". He states that his ability to recall recent events has diminished in the last year and he can no longer concentrate as well. He has no history of seizures. Physical exam reveals normal vital signs and he is oriented in person but is not oriented in time and place. He does exhibit impaired immediate and recent memory; there are no focal sensory or motor neurologic deficits. There are no choreiform movements or myoclonus. His speech is normal but occasionally the content of his answers is inappropriate. Laboratory values reveal normal CBC, liver function studies, electrolytes, glucose, TSH, T₃U, T₄ and urinalysis. An EKG reveals normal sinus rhythm.

1.The next step in evaluating this patient is:

A. Order serum B-12, folate, and thyroid panel.

B. Try to rule out depression

C. Obtain a CT-scan

D. Order serologic test for syphilis

E. All of the above

A CT of the brain reveals global atrophy and enlarged ventricles.

2.The patient’s most likely diagnosis based on this clinical presentation is:

A. Cerebral ischemia

B. Demyelinating disorder

C. Spongiform encephalopathy

D. Alzheimer disease

E. Depression with pseudodementia

3. The histologic features found in the brain's of patients with this disease process are:

A. Ischemic neurons, gliosis and reparative changes

B. Demyelination of white matter

C. Spongiform changes of the cerebral cortex

D. Neurofibrillary tangles, neuritic amyloid plaques, and amyloid angiopathy

E. Normal histology

4. The following statement(s) regarding Creutzfeldt-Jakob Disease is/are true:

A.It is caused by an abnormal protein (prion) and has a long incubation time.

B. Clinically it is a rapidly progressive dementia associated with myoclonus.

C. It has been transmitted to patients through dura mater allografts, corneal transplants, cadaveric growth hormone and EEG electrodes.

D. It shows a familial predisposition

E. Kuru has similar features and was described in New Guinea due to tribal cannibalism.

F. All of the above

5. The following statement(s) regarding Alzheimer disease is/are true:

A. Alzheimer disease is the most common cause of dementia in the elderly.

B. The quantity of neurofibrillary tangles correlates better with clinical impairment than does quantity of neuritic plaques.

C. Neurofibrillary tangles, neuritic plaques and amyloid angiopathy are not pathognomonic of Alzheimer disease.

D. Hirano bodies may be found in patients with Alzheimer disease.

E. All of the above.