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  1. #1
    kalra is offline Newbie 510 points
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    Can someone please explain this one?

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    A 72-year-old woman complains of difficulty "finding the right word" when she is speaking. Her daughter notes that she also frequently complains that her neighbour is stealing he newspapers when this is not the case in actuality.Recently the patient has been having difficulty balancing her checkbook as well.On physical examination her BP is 160/100 mm hg and her heart rate is 90/min.The exam of other is unremarkable.Over the course of next three years, the pt develops a severe memory deficit, and suffers from poor sleep , slowness of movement ,shuffling gait and urinary incontinence.
    Which is the most likely diagnosis?

    A. Alzheimer dementia
    B. Dementia with lewy body
    C. Multiinfarct dementia
    D.Vit B12 defeciency
    E. Normal pressure hydrocephalus
    F. Hypothyroidism
    G.Thiamine deficiency
    H. Huntington disease
    I. Pseudodementia
    J.Chronic subdural hematoma
    K.Drug induced dementia
    Last edited by kalra; 09-09-2008 at 10:37 AM.

  2. #2
    soweto is offline Junior Member 510 points
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    ...I'll go for (E) NPH....

  3. #3
    kalra is offline Newbie 510 points
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    Thanx for your response.Actually this is a question from Usmle world.I also gave the same answer u did but the correct answer was "Alzheimer dementia".I donnot understand why?

  4. #4
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    Knight__1 is offline Newbie 510 points
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    This is confusing

  5. #5
    Rossgrad2011 is offline Junior Member 510 points
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    i dont think NPH doesnt have behavioral problems... that could be the distinction and it has more a magnetic gait... feet are stuck and the back and the front pull up a bit on each step...
    shuffling gait is like small steps.

    I think it could be alzheimers due to that... behavioral symptoms issue and the progression.... can u read the answer in usmle world and tell us what it is...

  6. #6
    Statia Graduate is offline Junior Member 510 points
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    The answer:

    I agree it is a confusing question. But the clues are in the question itself.

    NPH does not start out with dementia-type symptoms such as forgetfulness, difficulty with math, etc. NPH presents with the physical symptoms first-the gait, bladder, and such. NPH does progress to dementia if left untreated, but usually irreversible by that point.

    Common early findings in Alzheimer's include word-finding difficulty and checkbook issues. The classic is a patient who gets lost when driving home, or in a town they have lived in for 40 years. Later findings include difficulty with gait, incontinence, and sundowning.

    The question can also be confused with Parkinson's. In Parkinson's, the tremor, gait, masked facies appear first. Later findings include dementia.

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