A 67-Year-Old Man Is Brought to the Office by His

question 1498

Multiple Choice

A 67-year-old man is brought to the office by his wife due to a month of increasing forgetfulness.  Over the last 2 weeks, she has noticed that his gait has been unsteady.  The patient reports increased fatigue.  He has hypertension and hyperlipidemia, and is compliant with all medications.  Over the last month, the patient has taken over-the-counter stool softeners for constipation.  He worked as an automobile mechanic for 30 years before retiring last year.  The patient smokes a pack of cigarettes daily and usually has a beer after dinner, but recently started drinking home-distilled whiskey.  Blood pressure is 120/80 mm Hg, and pulse is 76/min.  Examination shows clear lung fields and normal first and second heart sounds.  The abdomen is soft and nontender without organomegaly.  There is weakness on dorsiflexion of bilateral wrists and feet.  Pinprick sensation is reduced over the hands and feet.  Upper and lower limb deep tendon reflexes are 1+.  Laboratory results are as follows: Which of the following underlying mechanisms is most likely associated with this patient's clinical presentation?

• A)Cerebral amyloid deposition
• B)Degeneration of substantia nigra
• C)Impaired amino acid metabolism
• D)Impaired demethylation of tetrahydrofolate
• E)Impaired heme synthesis
• F)Increased glycosylation of end-products
• G)Lacunar basal ganglia infarctions

---

Definitions:

Cohesive

Possessing the ability to stick together or form a unified whole, often referring to the unity or bond within a group or organization.

Group Think

A phenomenon where a group's desire for harmony or conformity results in an irrational or dysfunctional decision-making outcome.

Individual

Pertaining to a single person or thing, separate from others, emphasizing the importance of personal identity.

Agenda

A list or plan outlining items to be discussed or acted upon in a meeting or gathering.