USMLEGladiator
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14. An 80-year-old man has had poor balance for 6 months. He has a history of hypertension treated with hydrochlorothiazide. His blood pressure is 136/86 mm Hg. 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. Babinski's sign is present bilaterally. He is unable to stand with his eyes closed. Which of the following is most consistent with normal
age-related changes?
O A) Babinski's sign
O B) Hyperactive deep tendon reflexes of the gastrocnemius-soleus muscles
O C) Inability to stand with the eyes closed
O D) Reduced vibratory sensation at the knees
0 E) Tremor of the outstretched hands
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| Aashi
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D) Reduced vibratory sensation at the knees
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| DrVirgo
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I think its E) Tremor of the outstretched hands
But D was my second choice.
Can you explain please aashi.???
My reasoning was that old peole just are not that steady and could have small tremors in their hands... I have seen it. 
Decreased vibration -ok, maybe in an aging person this would be present as peripheral neuropathy of the extremities as the nerves age, but WHY in the KNEES only?
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| DrVirgo
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Old thread discussing same Q:
http://www.prep4usmle.com/forum/thread/48141/
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| USMLEGladiator
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any gud site link on aging changes?
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| DrVirgo
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Well, I found this...
Tremor in ostensibly normal elderly people Dr. Rodger J. Elble, MD, PhD * Department of Neurology and the Center for Alzheimer's Disease and Related Disorders, Southern Illinois University School of Medicine, Springfield, Illinois, U.S.A.
*Correspondence to Rodger J. Elble, The Department of Neurology, Southern Illinois University School of Medicine, PO Box 19230, Springfield, IL 62794-1413, U.S.A.
Keywords Physiologic tremor • Essential tremor • Aging • Movement disorders Abstract Tremor in ostensibly normal people, aged 70-91, was assessed clinically and electrophysiologically with the goal of estimating the prevalence of abnormal tremor. Fifty Men and 50 women, mean age 76.0 ± 4.7 yrs, were recruited through advertisements for healthy volunteers (n = 50  biased control subjects) and from the spouses of patients referred to us for dementia or Parkinson's disease (n = 50 unbiased control subjects). All participants were interviewed and examined by the author. Tremor was assessed quantitatively with rating scales, triaxial accelerometry, electromyography, a digitizing tablet, and spectral analysis. Twenty-three people (23%) were judged clinically to have mildly abnormal tremor resembling mild essential tremor. Twelve people with abnormal tremor belonged to the biased group and 11 were in the unbiased group. The clinical diagnosis of abnormal hand tremor correlated well with the presence of motor unit entrainment in the forearm EMG and with writing or drawing tremor that was measurable with a digitizing tablet. Only 10 of 23 people with abnormal tremor were aware of their tremor, and none had been diagnosed previously by a physician. Nine of 77 people (11.7%) with normal tremor, and five of the 23 people (21.7%) with abnormal tremor had this family history. Mild undiagnosed tremor, resembling essential tremor, is common in this age group.
Received: 12 August 1997; Revised: 22 December 1997; Accepted: 5 January 1998Digital Object Identifier (DOI)
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