 |  NBME ,1, Think with me plz ,just week 4
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| Author | 13 Posts |
dr_jojo
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1. A 77-year-old woman is brought to the physician by her son for a routine health maintenance examination. She says that she feels well. Her son reports that 1 month ago, she got lost while driving home from the local supermarket. Two weeks ago, she forgot to turn off the stove after cooking dinner. She has been wearing bilateral hearing aids since audiometry 2 years ago showed bilateral high-frequency hearing loss. Her visual acuity corrected with glasses is 20/25 in both eyes. Neurologic examination shows mild fine tremors of the hands when the arms are outstretched; the tremor is not present at rest. Muscle strength is 5/5 in all extremities. Deep tendon reflexes are decreased at the ankles and 2+ elsewhere. Her gait is normal. Sensation to vibration is mildly decreased over the toes. On mental status examination, she is awake, alert, and conversant. Her language function is normal. She is oriented to person, place, and time and recalls one out of three objects after 10 minutes. Which of the following findings in this patient warrants further evaluation?
A
) Decreased deep tendon reflexes at the ankles
B
) Decreased sensation to vibration over the toes
C
) High-frequency hearing loss
D
) Memory loss
E
) Tremor of the outstretched hands
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| huyniid
Forum Elite
Topics: 9
Posts: 199
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D. Memory loss needs further investigation.
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| Dr_kholioo
Forum Junior
Topics: 9
Posts: 74
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guess tremor of outstretched hands . not sure
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| dr_jojo
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i think D , but some answer hearing loss !!!
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| robin082006
Forum Hero
Topics: 471
Posts: 5,125
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A most like anormal
B
) Decreased sensation to vibration over the toes: normal aging
C
) High-frequency hearing loss: normal aging (prebycuasis)
D
) Memory loss: normal aging or Alzheimer
E
) Tremor of the outstretched hands: normal aging
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The Key to Succeed is Patience.
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| dr_jojo
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A ----- is normal with old age
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| dr in trouble
Forum Guru
Topics: 60
Posts: 592
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I will go with tremors but not sure
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If u want to do something, do it today as there is no tomorrow.
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| nadiabarati
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this much memory loss is NOT normal with aging!
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| ram3
Forum Guru
Topics: 47
Posts: 510
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Diffuse hypoactive reflexes associated with other neurologic signs or symptoms require a neuropathy workup the answer is a decreased deep tendon reflexes at the ankle memory loss should be investigated when there is also a problem with language her language is normal
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| zeloc
Forum Junior
Topics: 11
Posts: 53
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I disagree. The memory loss needs to be investigated because she forgot to turn off her stove once which is potentially very dangerous if she does it again. The memory loss is currently the only thing which is life-threatening at this time. Decreased deep tendon reflexes at the ankles is a normal finding in elderly patients and since there are no other neurologic symptoms (the memory loss is unrelated), does not need to be worked up. Answer is D.
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| lakshya_0_7
Forum Elite
Topics: 24
Posts: 308
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D.....decreased ankle reflex in 77 yrs old is perfectly normal...
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| radonc
Forum Senior
Topics: 6
Posts: 175
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There is a similar question in uw. Initially, the answer was given as A. decreased vibratory senses at toes. But uw later changed it to D. memory loss. I am going with memory loss.
Apparently, it is normal to have reduced vibration from the ankles down. Memory loss alone is pretty 'normal', this includes forgetting minor, trivial details about things. But memory loss, coupled with disturbance of activities of daily living (forgetting to turn off stove, forgetting how to drive home from the supermarket, getting lost while getting home, buying 10 loaves of bread and not knowing how they get in the fridge) - that sort of memory loss is abnormal.
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| tamerbashir
Forum Elite
Topics: 20
Posts: 284
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D
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