frank100
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An 80 y/o man has had poor balance for 6 months. he has a history of hypertension treated with hydroclorothiazide. His blood pressure is 136/86, neurologic examination shows mild tremor of the hands when his arms are outstretched and decreased vibratory sensation at the knees. deep tendon reflexes of the quadriceps and Gastrocnemius-soleus muscles are hyperactive. Babinsky´s sign is present bilaterally. he is unable to stand with his eyes closed. wich of the following is most consistent with normal-age realted changes?
a) Babinsky´s sign.
b) hyperactive deep tendon reflexes of the gastrocnemius-soleus muscles.
c) inabilty to stand with the eyes closed.
d) reduced vibratory sensation at the knees.
e) Tremor of the outstretched hands.
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| mazinger
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I would go for E, but not a 100% sure... The rest of things are related to other neulogical deficits..
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| frank100
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a) upper motor neuron
b) lower motor neurons
c) cerebellum.
d) anterior spinal cord
E) Age related, or something else...
I agree with you. I chose E.
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| frank100
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what do you think mazinger?
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| yasmeen
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e senile tremors
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| mazinger
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a) agree
b) upper motor neuron gives hyperactive deep tendon reflexes and inversion of cutaneous reflexes.
c) vestibular>cerebellum
d) Posterior spinal chord (Cuneus and Gracillis give conscious propioception, point discrimination, vibration and pressure)
E) Agree
And thats it, I guess...
AAAA any corrections are welcome...
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| shadia
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i think it is E
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| shumaila
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i think it is E
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| webjeee
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d) reduced vibratory sensation at the knees. for sure.
although called senile tremors, now known as essential tremor
Quick Access >
From 2007 Current Consult: Medicine by Maxine A. Papadakis and Stephen J. McPhee
Tremor, Essential
Key Features
Tremor may begin at any age and is enhanced by emotional stress
Cause is uncertain
Sometimes inherited in an autosomal dominant manner
Clinical Findings
Postural tremor usually involves one or both hands, the head, or the hands and head, whereas the legs tend to be spared
Speech may also be affected if the laryngeal muscles are involved
Examination reveals no other abnormalities
Ingestion of a small quantity of alcohol commonly provides remarkable but short-lived relief by an unknown mechanism
Although the tremor may become more conspicuous with time, it generally leads to little disability, and treatment is often unnecessary
Occasionally, it interferes with manual skills and leads to impairment of handwriting
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| doyoudig
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reduced vbration at the knees is abn, testing reflexes is different from testing sensation at the knees, decreased Deep tendon reflexes is a normal part of aging but not reduced vibratory sensation
so ans should be EE
IntentionTremor alone (not associated w/any other findings) is begin and part of normal aging
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| radonc
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I agree with E.
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| dr in trouble
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E
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| Justice
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E
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The winner takes it all...
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| cirus
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Agree with E
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| kpmle2
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E..
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