AANP Family Nurse Practitioner (FNP) Certification ExamAssessmentMedium
A 72-year-old female presents with a 6-month history of progressive memory loss, difficulty with daily tasks, and mood changes. Her family reports she often gets lost on familiar routes and has trouble managing her finances. On mental status examination, she scores 18/30 on the Mini-Mental State Examination (MMSE). All routine blood work (CBC, CMP, TSH, B12) is within normal limits. What is the most appropriate next step in her diagnostic workup?
- APrescribe an acetylcholinesterase inhibitor (e.g., donepezil)
- BOrder an MRI of the brain
- CRefer for neuropsychological testing
- DInitiate a trial of antidepressant medication
Show answer & explanationAnswer & explanation
Correct answer: B. Order an MRI of the brain
Before diagnosing a specific type of dementia and initiating treatment, it is crucial to rule out reversible causes of cognitive impairment and structural brain abnormalities. An MRI of the brain can identify structural changes, tumors, or vascular lesions that might mimic or contribute to dementia symptoms.
Why the other options are wrong
- A. Treatment should not be initiated before a definitive diagnosis and ruling out reversible causes.
- C. Neuropsychological testing can further characterize the cognitive deficits but typically follows initial screening and ruling out structural causes.
- D. While mood changes are present, treating depression without a full dementia workup is premature and could mask a progressive neurodegenerative condition.
Dementia Workup - Imaging
Brain imaging (MRI or CT) is a critical step in the diagnostic workup for dementia to identify structural causes of cognitive decline or rule out other conditions.
- Rules out reversible causes (e.g., hydrocephalus, tumor).
- Identifies vascular lesions or atrophy patterns.
- Helps differentiate types of dementia (e.g., Alzheimer's vs. vascular).
Memory trick: Cognitive Decline: Rule Out, Look In, Then Diagnose