A 77-year-old woman is brought to the physician by her son f

Discussion in 'Step 3' started by Guest, Jan 7, 2009.

  1. Guest

    Guest Guest

    A 77-year-old woman is brought to the physician by her son for a routine health maintenance examination. She says that she feels well. Her son reports that 1 month ago, she got lost while driving home from the local supermarket. Two weeks ago, she forgot to turn off the stove after cooking dinner. She has been wearing bilateral hearing aids since audiometry 2 years ago showed bilateral high-frequency hearing loss. Her visual acuity corrected with glasses is 20/25 in both eyes. Neurologic examination shows mild fine tremors of the hands when the arms are outstretched; the tremor is not present at rest. Muscle strength is 5/5 in all extremities. Deep tendon reflexes are decreased at the ankles and 2+ elsewhere. Her gait is normal. Sensation to vibration is mildly decreased over the toes. On mental status examination, she is awake, alert, and conversant. Her language function is normal. She is oriented to person, place, and time and recalls one out of three objects after 10 minutes. Which of the following findings in this patient warrants further evaluation?

    A ) Decreased deep tendon reflexes at the ankles

    B ) Decreased sensation to vibration over the toes

    C ) High-frequency hearing loss

    D ) Memory loss

    E ) Tremor of the outstretched hands
  2. Guest

    Guest Guest

    D) memory loss - definitely not benign memory loss..it's dementiaaaaa
  3. Guest

    Guest Guest

    Answer seems to be memory loss.

    tremor which is absent at rest and not associated with gait abnormilities rules out parkinsons and related motor disorders.

    Presbycusis, which is age related hearing loss occours because of damage or wear and tear of hair cells of inner ear. so there a is difficulty with sounds of higher frequency.

    The two major types of presbycusis are sensory and strial. Sensory presbycusis is caused by the loss of outer hair cells in the inner ear and it is associated with high frequency loss of hearing. Most people who have sensory presbycusis can still hear speech, but usually have difficulty in understanding it. Their auditory sensitivity is fine, but their speech discrimination is impaired because it depends on high frequency hearing ability. Most hearing aids can correct high frequency sound loss, helping you to hear properly.

    Strial or metabolic presbycusis isn't as common as sensory presbycusis and it affects both low and high sound frequencies. This type of hearing loss is caused by pathology of the stria vascularis; which, through its metabolism, is the source of electrical energy that drives the cochlea. Strial presbycusis is more common in women than in men and it has been linked with cardiovascular disease.

    over all prebycusis is more common in people living in noisy environment for long time.

    hope that helps.
  4. sweetsmitha

    sweetsmitha Guest

    slightly confusing the way it is asked!
    findings suggest vitamin b12 deficiency. So, i would pick the choice dementia as it does not look like a normal senile or alzheimers dementia. The next step is TSH, Vitamin b12 levels in this case , so we have to do more diagnostic tests for her memory loss

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