DrVirgo
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I'm thinking B!
Anyone else? Other input?
A. Decreased DTRs are normal in the elderly
B. Decreased Vibration in toes makes me think it’s a problem with the DCML –Vit B12 def. maybe? -because elderly have a poor diet.
C. Hearing loss also normally occurs, she has hearing aids already.
D. Memory Loss- what more eval can you do for that?
E. Tremors? –not resting so not Parkinsons. What more would we evaluate on this one?
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| robin082006
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D, the patient memory loss suggests Alzheimer-->need further investigation
All others are normal signs seen in elderly
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| DrVirgo
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Decreased vibration in toes is NORMAL in the elderly? 
And how would you 'further evaluate' Alzheimers?
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| radonc
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I agree with D. memory loss. It's little comfort to me because my memory is so short, I keep forgetting things all the time.
Decreased vibration in toes is normal in the elderly. Alzheimer's disease is diagnosed clinically, with adequate history esp from family members, and examination to ensure no focal neuro signs. CT/MRI of brain may be done, which will often show atropy of cortex globally.
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| dr in trouble
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memory loss seems right chice here.
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| khorshid
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B, (this q was just added to UW, isn't that strange?) Anyhow, it says that an element of memory loss is nl with aging, also many reflexes are kind of deminished, but there shouldn't be any sensory loss, it points to a diseases like tabes dorsalis or B12 def, and I agree, that's what I chose first
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| Justice
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B. Decreased Vibration
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| radonc
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You are right, khorshid. Answer is B. decreased vibration sense in the toes. Just read the usmleworld question.
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| hanialkhadher
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I think it is the usmle world problem again, LOSS OF VIBRATION SENSE IN THE ANKLE AND FEET IS A COMMON NORMAL FINDING IN THE ELDERLY
you can find this in BATE'S guide to physical examination
BE AWARE THAT MANY OF USMLE WORLD QS NEED CORRECTIONS
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| dr19
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While loss of vibration sense can be a part of aging process(BATES Guide to PE),dementia and Alzheimer D. are NOT.
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| radonc
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Suit yourself ... I stick by usmleworld, because I have been proven wrong many many times when i was sure i knew a certain information to be correct (but it's not!).
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| radonc
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"We are inclined to conclude that absence of vibration sense even in elderly people should therefore be considered as abnormal. ..."
From J Neurol Neurosurg Psychiatry 1998;65:743-747 ( November ) - Measuring vibration threshold with a graduated tuning fork in normal aging and in patients with polyneuropathy
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| DrVirgo
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Her memory loss consists of : got lost and forgot to turn off the stove... This could be dangerous for her, so maybe THIS TYPE of memory loss needs to be evaluated.
On the other hand, if decreased vibration sensation is normal in the elderly, how are we to distinguish between normal aging changes and a true neuropathy?
(Still confused between B and D).
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| hanialkhadher
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DrVirgo wrote:
Her memory loss consists of : got lost and forgot to turn off the stove... This could be dangerous for her, so maybe THIS TYPE of memory loss needs to be evaluated.
On the other hand, if decreased vibration sensation is normal in the elderly, how are we to distinguish between normal aging changes and a true neuropathy?
(Still confused between B and D).
I think in peripheral neuropathy there will be impairment in all affrent sensory and motor effrent , while in elderly it is a dorsal column problem ONLY and NEVER ABOVE ANKLE.
i hope this eleminates your confusion.
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| khorshid
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Even if you think that way, what can you do for her memory loss, usually not much, it's not "alarming", but if there is an etiology behind the vibration, you may be able to do something and to prevent more grave outcomes
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| hanialkhadher
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If you have an older adult who is suffering from self-neglect or abuse, it is mandated that you refer him/her to adult protective services for case management or follow up.
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| hanwin
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I saw this Q in UW yesterday.
My ans is memory loss.I read this forum before.
But, UW answer is loss of vibration sense in toes. ( I thought this is normal, but their explanation is loss of post column sensation is abnormal for elderly and we need to look at B12 deficiency.
Please comment.
( I found out UW and NBME Q are very similar)
U can do only one if u have no time.
My exam is 3 days to go.
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| DrVirgo
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Ok, i'm convinced that it is now Memory Loss that needs to be evaluated.
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| coolmavs
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No, I stick by the fact that it is Loss of Vibration that needs evaluation!
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| drxyz
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hello drvirgo
can u pls do me a favour?do u have nbme form 3 block 3&4 questions?can u pls send to my mail id?thanks for ur help.
here is tha mail id,
drswapna.xyz@gmail.com
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| DrVirgo
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Any other comments on this one?
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| sherry39
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I THINK...UW IS RITE...LOSS OF VIBRATION SENSE IS FIRST SIGN IN DIABETIC NEUROPATHY
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