guest ques-8 - stefan78

[ArchivalUser]

A 69-year-old Caucasian woman is brought to the primary care clinic by her son. He complains that his mother increasingly has difficulty remembering recent events or the names of family members, and adds that she struggles to complete simple daily tasks and is slow to process information. Causing further frustration is his mother's new tendency to leak urine before she reaches the restroom, which necessitates the use of adult diapers. The son also notes that his mother has trouble taking the first step when walking and when navigating around furniture. He worries that one of her frequent falls will result in a broken hip. Medical history is significant for hypertension, osteoporosis, hiatal hernia, and remote breast cancer. She had a mastectomy twelve years ago and has had no known cancer recurrences. She does not smoke cigarettes or drink alcohol at this time, although she has a remote history of using both. Vital signs include temperature of 37.0C (98.6F), blood pressure of 140/90 mm Hg, pulse of 82/min, and respirations of 15/min. Physical examination demonstrates an elderly, thin, alert and oriented woman who uses few words. Her gait is wide-based and shuffling. Motor strength, sensation, and reflexes are all normal. Cranial nerves 11”XII are normal. Mini-Mental Status Examination (MMSE) reveals deficits in short-term memory, concentration, and executive functioning. Recent laboratory evaluation includes normal complete blood count, normal thyroid function tests, normal vitamin B12 level, and negative syphilis serology. CTscan of the head shows enlarged ventricles without significant atrophy of the sulci. A Miller Fisher test is performed to confirm the diagnosis. Which of the following measures will be of greatest benefit to this patient?
c A. Prescribe folic acid
c B. Prescribe levodopa/carbidopa
r C. Tell her son that no further treatment is available
¢ D. Refer for ventriculoperitoneal shunting
c E. Prescribe donepezil

[ArchivalUser]

D,NPH.

[ArchivalUser]

dddddddddd

[ArchivalUser]

dd