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Review Question - QID 107431

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QID 107431 (Type "107431" in App Search)
A 75-year-old female presents to your office with her daughter. The patient states that she feels perfectly well and that she does not know why she is present. The daughter states that over the last several years, the patient has become forgetful and recently forgot her grandchild's name, along with the groceries she was supposed to buy. She was also found lost 10 miles away from her house last week. The daughter also states that the patient has had urinary incontinence over the last few months and has been seeing little children in the morning that are not present. The patient denies any recent falls. Her vitals are normal and her physical exam does not reveal any focal neurological deficits. Her mini-mental status exam is scored 22/30. What is the most accurate test for this patient?

MRI scan of head

80%

4/5

CT scan of head

20%

1/5

Lumbar puncture

0%

0/5

PET scan of head

0%

0/5

CT angiography of head

0%

0/5

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An elderly female with dementia, urinary incontinence, and hallucinations does not have a clear diagnosis for her deficits. Since she denies any recent trauma, a MRI scan will provide the most information for diagnosis and ruling out other causes.

Dementia increases in prevalence with old age. Risk factors for dementia include family history of dementia, apolipoprotein E4 genotypes, cardiovascular disease, lower educational levels, and chronic anticholinergic use. Commonly, a mini-mental exam is used to differentiate between those who have dementia or normal aging, and scores below 24/30 suggest the former. Lewy body dementia typically presents with cognitive decline along with hallucinations while dementia due to normal pressure hydrocephalus presents with the triad of ataxia, dementia, and urinary incontinence. In the case above, the patient's diagnosis is unclear and therefore requires a MRI to evaluate and rule out other causes.

Incorrect Answers:
Answer 2: The patient denies any recent falls and does not have focal neurological deficits. All of her symptoms have been present for some time and do not seem acute. Therefore, MRI is a better answer as it provides more detail.
Answer 3: The patient does not have a fever or any symptoms of meningitis. A lumbar puncture may be useful when assessing CNS pressure, but an MRI should be the next test so rule out potential herniation if that is a concern.
Answer 4: The patient does not present with symptoms of a malignancy and does not need a PET scan.
Answer 5: The patient has no focal neurological symptoms and therefore is unlikely to require angiography for a stroke.

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