Topic: Normal Pressure Hydrocephalus
Subject: Medicine
An 81-year-old female is brought to your office by her son. He reports a decrease in his mothers memory and prolonged delays in her responses to questions. She also has developed urinary incontinence. MRI shows dilated ventricles, but no other pathology, and a lumbar puncture reveals a normal opening pressure.
Which one of the following would provide additional evidence of normal pressure hydrocephalus?
Monocular visual loss
Internuclear ophthalmoplegia
Headache
Apraxia of gait
Correct Answer :
D. Apraxia of gait
Gait instability (sometimes referred to as apraxia of gait), urinary incontinence, and dementia are typical signs and symptoms of normal pressure hydrocephalus (NPH). A decrease in the absorption of cerebrospinal fluid (CSF) results in ventricular enlargement, but no significant increase in CSF pressure. Although it accounts for less than 5% of dementia cases, it is important to recognize NPH because it may be effectively treated by shunting in some patients. Monocular visual loss and headache are symptoms of benign intracranial hypertension (pseudotumor cerebri), and internuclear ophthalmoplegia is a sign of multiple sclerosis. Motor weakness is not a sign of NPH.
Related Questions
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Subject: Medicine
A 36-year-old female presents with the sudden onset of severe headache, nausea, and photophobia. Her level of consciousness is progressively diminishing. Which one of the following would be the most appropriate next step?
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Foley catheterization
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Subject: Medicine
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Topic: Postherpetic Neuralgia
Subject: Medicine
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Imipramine (Tofranil)
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Topic: Alzheimer's Disease
Subject: Medicine
A 62 year old woman has demonstrated increasing loss of recent memory over a 5 year period, now associated with reduced affect and nominal dysphasia. She dresses neatly and social amenities are preserved. There are no localizing motor or sensory findings.
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Hydrocephalus
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Topic: Brain Death
Subject: Medicine
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Subject: Medicine
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T12
L1
L2
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Topic: Trigeminal Neuralgia
Subject: Medicine
A 55-year-old man complains of extremely severe, sharp, shooting pain in his face. He describes the episodes as being like a bolt of electricity that are brought about by touching a specific area, last about 60 seconds, and occur many times during the day. Neurologic examination is completely normal, but it is noted that part of his face is unshaven because he fears to touch that area. Gadoliniumenhanced MRI shows no abnormalities of the trigeminal nerve.
Which of the following is the most appropriate initial treatment?
Anticonvulsants
Aspirin
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Vasoconstrictors
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Subject: Medicine
A 75-year-old female presents with a 2-month history of bilateral headache, diffuse myalgias, and diplopia. On examination she has substantially diminished vision in her left eye, but no other neurologic findings. A moderately tender, cordlike structure is palpable just anterior to her ear and extending up to her lateral scalp. Blood tests show a markedly elevated erythrocyte sedimentation rate.
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Clopidogrel (Plavix)
High-dose corticosteroids
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Dipyridamole/aspirin (Aggrenox)
Topic: Seizure
Subject: Medicine
A 52-year-old male with a history of seizure attacks suffered from loss of consciousness and tonic and clonic muscular contractions. His tongue fell back into the throat and he choked. What is the most likely diagnosis of this presentation?
Petit mal seizure
Grand mal seizure
Myoclonic seizure
Atonic seizure