Kamsi
Forum Guru
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An 88-year-old man with a past history of hypertension and a previous myocardial infarction is admitted for syncope. His family says he was in a store and collapsed to the floor while looking at some books. He then proceeded to have a few jerking movements of both arms and legs, which disappeared spontaneously after a few seconds. A minute or so later, the patient awoke and could not recollect the event. He denies any chest pain, dizziness, or palpitations preceding the collapse. Current medications include aspirin, metoprolol, and hydrochlorothiazide. On examination, the blood pressure is 142/98 mm Hg, pulse is 65/min, and temperature is normal. His chest and abdomen are also normal. He has a 2/6 holosystolic murmur at the apex. An EKG shows a normal sinus rhythm at 62/min, with Q waves in leads V3-V6. There are no ST- or T-wave abnormalities. An echocardiogram shows segmental left ventricular systolic dysfunction and moderate mitral regurgitation. What is the most likely diagnosis for this patient's syncope?
(A) Neurocardiogenic (vasovagal)
(B) Paroxysmal ventricular tachycardia
(C) Orthostatic hypotension
(D) Tonic clonic seizure
(E) Hypovolemia
A 55-year-old man is brought to your office by his wife for complaints of general slowing of movements, frequent falls, and difficulty in turning over in bed or getting up from a sitting position. His wife also reports that he has difficulty sleeping, appears more depressed, fearful, and anxious, and refuses to join social gatherings. He has episodic symptoms of delirium. He works as an accountant and has been unable to work lately. He is more forgetful and is misplacing things. These symptoms have been present for a year. The patient has visual hallucinations. Physical examination shows a normal blood pressure and no signs of cardiac or vascular disease. Neurological examination reveals a slight impairment in cognition. He is unable to perform serial sevens. His speech is soft and slow, and there is normal upward and downward gaze, with micrographia, tremors, and
hypometria. The plantar responses are extensor, and there is a festinating gait. His memory is impaired. What is the most likely diagnosis?<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />
(A) Parkinson's disease
(B) Diffuse Lewy body disease
(C) Progressive supranuclear palsy
(D) Shy-Drager syndrome (multiple system atrophy)
(E) Corticobasal ganglionic degeneration
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| arlete
Intern in 2009!!!!!
Topics: 36
Posts: 2,592
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D
B
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When men make the rules, God decides the exceptions.
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| usmle-china
Forum Newbie
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1. B.
The best bet is arrhythmia syncope for an elderly patient with MI history, left ventricular dysfunction and hypertention.
2. B.
Lewy body dementia?
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| dr.wad
Forum Senior
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1_ A
the patient denies palpitaion prior to the syncope
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| elitoki
Forum Guru
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1. A agree with dr. wad.
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| Ivonne
Live your dreams
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1(A)
Seizurelike activity can occur with syncope if the patient is held in an upright posture.
2(B)
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"The question isn't who is going to let me; it's who is going to stop me. " ~ Ayn Rand
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| sukhs
Forum Senior
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1..B
2..B
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| arlete
Intern in 2009!!!!!
Topics: 36
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But he collapsed to the floor, and could not recollect the event...
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When men make the rules, God decides the exceptions.
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| jazmil
Forum Elite
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Posts: 298
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They took careful pains to describe a tonic clonic seizure with post-ictal amnesia, and without a hx of preceding palpitations,chest pain or dizziness. If it looks like a duck and quacks like a duck.....
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| neo235
Forum Newbie
Topics: 10
Posts: 30
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1...B
2...B
wats the correct answer ...kamsi
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| yasmeen
Forum Guru
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Posts: 940
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tonic clonic seizure
lewy body dementia
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| gr8doc
Forum Senior
Topics: 8
Posts: 210
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D
B
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