robin082006
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50. A 62-year-old man is brought to the physician for evaluation of a 6-month history of progressively strange behavior. He has been impulsive and distractible, has stopped bathing and combing his hair, and has become uncharacteristically rude and unkempt. Occasionally, when eating, he has stuffed food into his mouth with his fingers. He has had some mild problems with memory during this period. His only medical problem is a 1-year history of hypertension well controlled with atenolol. Neurologic examination shows no focal signs, but the grasp and snout reflexes are prominent. Which of the following is the most likely cause of this patient's condition?<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />
A) Arteriosclerosis
B) Dementia, Alzheimer's type
C) Huntington's disease
D) Normal aging
E) Pick's disease
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| Cedrick
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C
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| robin082006
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C is excluded because:
1. No family history (Hungtinton is AD)
2. age of patient and duration of disease (1 year only)
3. No chorea and/or athetosis
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| Cedrick
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maybe B
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| Cedrick
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check your mail
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| mjl1717
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robin082006 wrote:
C is excluded because:
1. No family history (Hungtinton is AD)
2. age of patient and duration of disease (1 year only)
3. No chorea and/or athetosis
i was going to mention #3, what is age of pt in Hungtington?? my gut reflex was ** "Alzheimer Disease" Also I thought of Alzheimer's profoundly affecting frontal lobe and Huntington more with putamen and caudate. Comments..
Edited by mjl1717 on 06/28/06 - 05:42 PM
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| alexaE
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I'd go for E, though it is very rare and i know that in questions this is probably not the right answer, but i dont think the other answers would fit.
vascular dementia has some of the features mentioned in the stem of the question, the age, the quick onset, history of hypertension, but the fact that the blood pressure is so well controlled with a beta blocker which also work better in elderly.. kind of excuded the answer.
I'm still somewhere between A and E, the only thing I'm concerned is that Pick is very rare. but since it is mentioned in the books, i suppose the usmle wont have a problem in asking about such rare diseases either.. they ask about all the lysosomal storage ones, that ill probably never be able to remember or if i do, ill forget all about them right after the exam, oh well.. im rambling..
so what do you think of E?
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| reet
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B.
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| sridevibandaru24
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pick's disease
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| mitty
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Yes E
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| robin082006
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I think E is the best choice
Brain vessel Arteriosclerosis is rare, the common order is abdomianl aortic---> coronary--->politeal--> carotid
By exclusion I rule out B) Dementia, Alzheimer's type, C) Huntington's disease, and D) Normal aging
E) Pick's disease: frontal and temporal lobes, similar to Alzheimer's but more severe, symptoms including dementia, changed behavior, changed personality
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| m2298
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E is the right answer look at the syptoms
Grasp and Suck--frontal lobe disease
Behavioral disturbances--Temporal lobe disease
Fronto temporal dementia
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| m2298
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Also memory problems point to temporal lobe involvement
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| dr_sarim
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E is correct.. i encountered somewhat similar question in q-bank
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| Cedrick
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So it is Pick's disease
Thank you
E
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| nadiabarati
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of course B
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| nadiabarati
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sorry I mean E pick
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| tolito
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it looks like best answer is pick. i picked huntington but i could not explain his frontal lobish behaviour. i was misinformed that pick occurs in children!!!
check out http://www.emedicine.com/NEURO/topic311.htm
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| tolito
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oops!!! i mixed it up witj nieman pick!!!
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