AANP Family Nurse Practitioner (FNP) Certification ExamAssessmentEasy
A 72-year-old female is brought to the clinic by her daughter due to concerns about her mother's progressive memory loss, difficulty with daily tasks, and occasional disorientation over the past year. The daughter reports no sudden onset of symptoms or focal neurological deficits. Which of the following is the most appropriate initial diagnostic workup for this patient?
- APositron Emission Tomography (PET) scan of the brain.
- BGenetic testing for Alzheimer's disease.
- CComplete blood count, thyroid-stimulating hormone, vitamin B12, and syphilis serology.
- DNeuropsychological testing only.
Show answer & explanationAnswer & explanation
Correct answer: C. Complete blood count, thyroid-stimulating hormone, vitamin B12, and syphilis serology.
When evaluating new-onset cognitive decline, it is crucial to rule out reversible causes. A comprehensive initial workup includes laboratory tests such as CBC, TSH, vitamin B12, and syphilis serology to identify conditions like anemia, hypothyroidism, B12 deficiency, or neurosyphilis, which can mimic dementia.
Why the other options are wrong
- A. A PET scan is an advanced imaging study typically used later in the diagnostic process to differentiate types of dementia, not as an initial screen.
- B. Genetic testing is not part of the initial workup for general dementia evaluation and is usually reserved for specific cases or research.
- D. Neuropsychological testing is important but should follow a basic medical workup to rule out treatable causes.
Dementia Initial Workup
The initial workup for suspected dementia focuses on identifying reversible causes of cognitive decline before pursuing more complex investigations for irreversible neurodegenerative conditions.
- Reversible causes include metabolic imbalances, nutritional deficiencies, infections, and certain medications.
- Standard lab tests include CBC, TSH, B12, and sometimes folate, syphilis serology, and metabolic panel.
- Imaging (CT/MRI) is often included to rule out structural brain lesions.
Memory trick: Dementia: Don't miss Easily Reversible Medical Things!