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* NBME 5 Question - Multi infarct dementia
 #863986  
  step3_2013 - 12/26/20 16:35
 
  A 70-year-old woman is brought to the office by her son because of a 1-year history of progressively decreasing mental
acuity and sluggishness. She lives alone in a 100-year-old home. She has a history of type 2 diabetes mellitus treated with
diet, and rheumatoid arthritis treated with a nonsteroidal anti-inflammatory medication (NSAID). She underwent total
abdominal hysterectomy 20 years ago, and she takes estrogen therapy and a calcium supplement. She is 160 cm (5 ft 3 in)
tall and weighs 54 kg (120 lb); BMI is 21 kg/m2. Vital signs are temperature 36.4 C (97.5 F), pulse 60/min, respirations
10/min, and blood pressure 140/96 mm Hg. She is alert and oriented to person, place, and year. Funduscopic examination
discloses no abnormalities. The thyroid is small but palpable. Lungs are clear to auscultation. Cardiac examination
discloses no abnormalities. Ankle reflexes are delayed. She is able to recall one of three objects after 5 minutes. Results of laboratory studies are shown:

Serum Blood
Urea nitrogen 22mg/mL Hematocrit 34 %
Creatinine 1.4 mg/dL Hemoglobin 11.2 g/dL
Na+ 142 mEq/L WBC 5500/mm3
K+ 4.0 mEq/L MCV 84 m3
HCO3- 102 mEq/L
TSH 100 U/mL
Thyroxine (T4) 2.4 g/dL

Which of the following is the most likely underlying cause of this patientís condition?
A. Chronic lead poisoning
B. Vitamin B12 (Cobalamin) deficiency
C. Hashimoto thyroiditis
D. Multiple cerebral infarcts
E. Neurosyphilis

Why is the answer D, and not C or A?
 
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