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MRI scan of head
80%
4/5
CT scan of head
20%
1/5
Lumbar puncture
0%
0/5
PET scan of head
CT angiography of head
Select Answer to see Preferred Response
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.
3.4
(22)
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