A 65-year-old woman presents to her primary care physician with complaints of new-onset memory loss. Her family reports that she has been forgetting recent events, repeating questions, and misplacing items more frequently over the past few months. She has no significant medical history but has noticed a decline in her cognitive abilities. On examination, she demonstrates difficulty recalling recent events and exhibits word-finding difficulties. Her Mini-Mental State Examination (MMSE) score is 20/30. What is the most likely diagnosis for this patient, and what are the hallmark clinical manifestations? (Select all that apply)

 

Choice A reason: Retching is the involuntary attempt to vomit, involving abdominal muscle contractions without expelling stomach contents. The patient is actively expelling contents, which defines vomiting, not just the effort of retching, making this an incorrect term for documentation.

Choice B reason: Expectorate refers to coughing up and spitting out mucus or sputum from the respiratory tract. The patient is expelling stomach contents, not respiratory secretions, making expectorate an incorrect term for this gastrointestinal event.

Choice C reason: Regurgitation is the passive return of undigested food or liquid from the stomach or esophagus, often without force. The forceful expulsion of stomach contents described indicates vomiting, not regurgitation, making this an incorrect documentation term.

Choice D reason: Vomiting is the forceful expulsion of stomach contents through the mouth, driven by coordinated abdominal and diaphragmatic contractions. The patient’s active expulsion into a basin matches this definition, making vomiting the correct term for documentation.

Choice A reason: Hyperventilation leads to respiratory alkalosis, causing symptoms like dizziness, paresthesia, or tetany due to decreased carbon dioxide levels. It does not cause renal colic, which involves severe, spasmodic flank pain typically from ureteral obstruction. This makes hyperventilation an incorrect cause for the patient’s acute pain presentation.

Choice B reason: Nephrolithiasis, or kidney stones, is the most likely cause of renal colic in a young male. Stones obstruct the ureter, triggering severe, intermittent flank pain radiating to the groin, often with hematuria or nausea. This matches the described acute pain, making nephrolithiasis the correct diagnosis for the patient’s symptoms.

Choice C reason: Urinary tract infections may cause dysuria, frequency, or suprapubic discomfort but rarely produce the severe, colicky flank pain characteristic of renal colic. While infections can coexist with stones, the primary presentation of acute, severe pain points to nephrolithiasis, making this a less likely primary cause.

Choice D reason: Trauma can cause renal pain or hematuria but typically presents with a history of injury and signs like bruising or hemodynamic instability. Renal colic’s hallmark is spontaneous, severe pain without trauma history, making trauma an unlikely cause for this patient’s acute presentation.