Q: Cause of repeated falls

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Q: Cause of repeated falls

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fongch
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04/21/07 - 09:40 PM

Another Q from Kaplan Qbook. Please provide your reasoning in your answer. I do NOT want spend 5 minute typing just to get a single letter reply.

An 82-year-old woman is accompanied to the physician by her daughter because repeated falls w/o apparent cause. She reports that she fell because a suddent loss of strength in her legs w/o losing consciousness or feeling dizzy. She lay on the floor for a few minutes until he recovered strength and became able to stand up and walk again. She is otherwise in good health and takes alendronate for osteoporosis. PE finds mild resting tremor of her hands, but no rigidity or slowing of movement. BP 125/80mmHg, pulse 68/min, RR 13/min. A bruit is heard over the right carotid artery. Which of the following is the most likely cause of this patient's fall?
A. Adverse drug reaction
B Lateral medullary infarction
C Parkinson
D Postural hypotension
E Transient ischemia in the carotid territory
F Transient vertebrobasilar ischemia

Keep in mind to provide your reasoning when you reply.
Thanks.

dr.wad
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04/22/07 - 02:53 AM

D_ postural hypotension.

u ask foe reason sad

, ok let me think.....all the other causes cause transient syncopal attacks with other manifestations as transient blindness , dysarthria , ataxia , vertigo
etc.... all these manifestations are denied .

so not sure but i suggest postural hypotension...

vanshita
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04/22/07 - 07:12 AM

E because its without loose of consciousness she completely recover afer attak

Justice
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04/22/07 - 07:49 AM

Well, I think this is (F) Transient vertebrobasilar ischemia, and here are my reasons:

A-no history of drug use
B-the Pt would not recover from that, at least within one hour
C-clinical presentation missing key neurological points
D-Absolute stability of hemodynamics is present
E-would be accompanied by focal symptoms, unilateral most likely, and by visual disturbances

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fongch
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04/22/07 - 08:30 AM

But a key feature of vertebrobasilar involvement is dizziness or vertigo, which is clearly absent in this woman. Therefore I consider E.

vradojc1
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04/22/07 - 10:06 AM

F - affecting posterior column system and proprioception?

Justice
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04/22/07 - 11:26 AM

Cited: "...But a key feature of vertebrobasilar involvement is dizziness or vertigo, which is clearly absent in this woman..." end of citation

Not necessarily... I am providing a link that lists common presentations of the transient ischemia http://www.aafp.org/afp/20040401/1665.html smiling face

To me, the (E) id disfavored by bilateral presentation in the Pt smiling face

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dr.wad
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04/22/07 - 12:51 PM

so what is the answer.

fongch
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04/23/07 - 11:24 AM

the answer provided is F

Justice
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04/23/07 - 12:14 PM

#10

fongch wrote:
the answer provided is F

Fongch,
thank you...

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