A 76-Year-Old Man Is Brought to the Physician by His

question 889

Multiple Choice

A 76-year-old man is brought to the physician by his son for unsteadiness and several near-falls over the last 2 weeks.  The patient has been less interactive lately and prefers to stay in his room.  His symptoms have been slowly worsening over the last 2 weeks.  He has had no recent illness, fever, chills, or headaches.  His medical problems include mild dementia, ischemic stroke without significant residual deficit, and seizure disorder.  His medications include aspirin, phenytoin, levetiracetam, and vitamin D.  He was recently started on omeprazole for reflux symptoms.
The patient's vital signs are within normal limits.  Physical examination shows a narrow-based, unsteady gait with poor balance.  His speech is slightly slurred.  The patient has horizontal nystagmus and poor coordination with rapid alternating movements and finger-to-nose maneuvers bilaterally.  His strength and sensation are intact.
Which of the following is the most likely diagnosis?

• A)Benign paroxysmal positional vertigo
• B)Cerebellar stroke
• C)Masked depression
• D)Medication toxicity
• E)Vitamin deficiency

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Definitions:

New England Colonists

Early European settlers in the northeastern part of the United States, particularly noted for their role in establishing some of the first successful British colonies.

England

A country that is part of the United Kingdom, situated on the island of Great Britain.

King Philip's War

A conflict between American Indian inhabitants of New England and English colonists and their allies in 1675–78, one of the bloodiest wars per capita in U.S. history.

Puritan Society

A society influenced by Puritans, who were English Protestants in the 16th and 17th centuries, emphasizing strict religious discipline and a simple, morally stringent lifestyle.