Having trouble remembering all the important questions to ask during your patient encounter? Then try this Forgetfulness Mnemonic (Dementia) for USMLE Step 2 CS.
PHYSICAL EXAMINATION Forgetfulness Mnemonic:
NOTE: Make sure to wash your hands or wear gloves before you start physical examination. Make sure to ask for permission before you start each physical exam. Make sure to use proper draping (don’t forget to tie back patient’s gown). Make sure to explain each physical examination in layman’s term to your patient. Do NOT repeat painful maneuvers.
- Eye exam: Inspect pupils, Funduscopic exam.
- Neck exam: Carotid Auscultation, thyroid gland palpation
- Neuro exam: Mini-Mental Status Exam, CN (2-12), Motor, Sensory, Gait, DTRs, Romberg sign.
DIFFERENTIAL DIAGNOSIS Forgetfulness Mnemonic
- Alzheimer’s disease: Alzheimer’s disease usually has an insidious onset characterized by a steady, progressive decline in cognitive function over a period of years. The earliest findings are impairment in memory and visuospatial abilities. Alzheimer’s disease is a clinical diagnosis.
- Vascular “Multi-infarct” dementia: Vascular dementia often coexists with Alzheimer’s disease, and history of atherosclerotic vascular disease (eg, stroke, MI). There is classically more of a fluctuating, stepwise cognitive deterioration that is temporally related to a recent stroke.
- Pseudodementia (Dementia secondary to depression): In the elderly, depression can present atypically with symptoms of neurocognitive decline (vs. young patients, in whom dysphoria predominates)
- Hypothyroidism: This can cause neuropsychiatric symptoms (often a late finding) and must be ruled out in patients with dementia.
- Vitamin B12 deficiency: This can cause depression, irritability, paranoia, confusion, and dementia but is usually associated with other neurologic symptoms, such as paresthesias and leg weakness.
- Subdural Hematoma: Something to think about specially in elderly patient with recent history of falls.
DIAGNOSTIC WORK UP Forgetfulness Mnemonic:
- CBC: Used to look for macrocytic anemia in vitamin B12 deficiency.
- Electrolytes, Calcium, Glucose, BUN/Creatinine: To screen for medical conditions that can present with cognitive dysfunction (eg, hypernatremia, hypercalcemia, hyperglycemia, uremia).
- Serum B12, TSH, PRP: To screen for partially reversible causes of dementia (RPR can be restricted to patients who manifest signs of neurosyphilis).
- CT of head: to rule out intracranial bleeding, masses, strokes, or dilated ventricles (as in normal pressure hydrocephalus).
- MRI of brain: The most sensitive exam with which to look for focal CNS lesions or atrophy.
- EEG: Can differentiate delirium from depression or dementia, however it is rarely ever done.
- If patient does not remember the name of his/her medication, ask for the list of the medication. Patient should have a Paper with the list of medications.
- I would like to ask your permission to speak to your family and ask them a few questions.
- I would like you and your family to meet with our social worker to assess home safety and supervision.
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