NBME 7 Q please help.. :/ - drmell2015

[ArchivalUser]

A previously healthy 82-year-old woman comes to the physician because she is concerned that she has Parkinson disease. Over the past 6 months, she has had occasional difficulty finding the word that she wants to use, and her ability to distinguish smells has decreased. She repo同s that her reaction time to shifts in posture seems slow, and she needs to use a hand rail to steady herself while walking on stairs. She lives alone and is able to manage her own finances.T he pupils are 3 mm. There is mild reduction of upward gaze and brisk rotatory nystagmus on left lateral gaze. Audiometry shows mild high-frequency hearing loss. There are no tremors or rigidity. Her gait is normal. Her Mini-Mental State Examination score is 29/30.
Which of the following neurologic findings warrants further evaluation?
A) Brisk rotatory nystagmus on left lateral gaze
B) Decreased sense of smell
C) Decreased upward gaze
D) High-pitched tone hearing loss
E) Small symmetric pupils

ANYONE WHO HAS TAKEN IT ONLINE CAN YOU PLEASE HELP ME OUT?

[ArchivalUser]

I got it wrong it's May be A

[ArchivalUser]

Thank you, can you please tell me what you picked?

[ArchivalUser]

I put d

[ArchivalUser]

I failed, I put B

[ArchivalUser]

I would say B. Cause it's the only sense that doesn't pass through the small Brian route. All others do?

[ArchivalUser]

I think D is correct because in parkinson disease if patient have upward limitation, you should have PSP as your DDX.

[ArchivalUser]

she is an 82 i think prebycusis choice d is normal due to aging i think A
smell has nothing to do with parkinsons