nbme question please explain

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Doc2b82

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Got a question about a 77yo F...forgets....left stove on....has hearing loss....fine tremos of outstretched hands....not present at rest....gait norma...DTR decreased....muscle strength ok....sensation to vibration decreased slightly over toes....awake, alert and conversant....language normal. What warrants further evaluation?

A) decreased DTR
B) decreased sensation to vibration
C) high frequency hearing loss
D) memory loss
E)tremor of outstretched hand

Correct answer- D....I dont understand why it wouldnt be E? I am probably missing something very obvious so please help shed some light...thanks
 
All other answers are expected age related changes, memory loss could be indicative of new onset Alzheimers or another degenerative condition. Remember that action tremors, a type of essential tremor, are relatively common elderly and new resting tremors are more worrisome.
 
All other answers are expected age related changes, memory loss could be indicative of new onset Alzheimers or another degenerative condition. Remember that action tremors, a type of essential tremor, are relatively common elderly and new resting tremors are more worrisome.


oh ok thank you....i thought the memory thing was also an age related thing....but I guess I see why that needs further looking into.
 
oh ok thank you....i thought the memory thing was also an age related thing....but I guess I see why that needs further looking into.

I think the question can be reasked as, "Which one of these conditions require some sort of intervention?". Alzheimer's require proactive intervention on the part of the clinician as well as family of patient...therefore, memory loss is something we should look for in the elderly. An essential tremor is likely benign and requires no intervention.
 
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