Which one of the following should you do next? A. A CBC, creatinine level, TSH level, vitamin B12 level and VDRL are all normal. His Mini-Mental State Examination (MMSE) score is 22 out of 30. A neurologic examination reveals the patient to be oriented x 3, with a somewhat flat affect and a wide-based, slow, shuffling gate. The son states that his father seems more forgetful, slower of speech, and not as full of life as he used to be. The patient admits to going more often, and sometimes without warning. The review of systems is normal, except for increasing problems with his prostate in the last 6 months, with dribbling and accidents at times. His description is vague, but he says that he notices the dizziness when he tries to walk. The patient complains of dizziness that has slowly been worsening over the past year. Topic: Normal Pressure Hydrocephalus Subject: Medicine A 76-year-old male is brought to your office by his son. MRI of the lumbosacral spine Answer : DĢ2. Digital disimpaction of the rectum, and Fleet enemas until clear D.
Hospitalization for intravenous antibiotics C. Which one of the following must be done urgently in this patient? A.
Ultrasonography shows a post-void residual volume of 250 mL (normal for age <100). Urinalysis shows trace protein and 10-20 WBCs/hpf. A rectal examination reveals a large amount of hard stool in the rectum a markedly enlarged (4+), boggy, tender prostate gland laxity of the anal sphincter and numbness in the perianal area. There is no abdominal tenderness and no masses are detected.
He is afebrile and vital signs are normal. Examination shows a healthy-appearing male who is moderately overweight. Other symptoms include upper respiratory congestion for 3 days which he has treated with an over-thecounter decongestant with some relief, constipation with no passage of stool in the past 9 days, and increasing low back pain incompletely relieved with ibuprofen, with associated weakness in both legs. The symptoms have become increasingly severe over the past week. He says that his bladder will feel full when he needs to urinate, but the urine stream is weak and his bladder does not feel as if it has emptied completely. Topic: Cauda Equina Syndrome Subject: Medicine A 65-year-old male presents with a 1-month history of problems passing urine.
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