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)
Loss of short-term memory
Alzheimer’s disease
Vascular dementia
Word-finding difficulties
Correct Answer : A,B,D,E
Choice A reason: Loss of short-term memory is a hallmark of Alzheimer’s disease, as seen in the patient’s difficulty recalling recent events. This reflects early hippocampal damage, impairing new memory formation, making it a correct clinical manifestation for this diagnosis.
Choice B reason: Alzheimer’s disease is the most likely diagnosis, given progressive memory loss, word-finding difficulties, and an MMSE score of 20/30 in a 65-year-old. These symptoms align with Alzheimer’s neurodegenerative pattern, making this the correct diagnosis.
Choice C reason: Vascular dementia typically presents with stepwise cognitive decline and focal neurological signs, often with vascular risk factors. The patient’s gradual memory loss without such history better fits Alzheimer’s, making vascular dementia incorrect.
Choice D reason: Word-finding difficulties, as exhibited, are a hallmark of Alzheimer’s, reflecting language cortex involvement. This progressive aphasia, common in early stages, impairs communication, making it a correct clinical manifestation for this patient.
Choice E reason: Disorientation to time and place, though not explicitly stated, is a hallmark of Alzheimer’s, often emerging as memory declines. Given the patient’s MMSE score and symptoms, this is likely, making it a correct manifestation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Extending red blood cell lifespan is not a goal in polycythemia vera, where excessive red cell production increases blood viscosity. Treatment aims to reduce cell mass, not prolong cell life, as this would worsen hyperviscosity, making this an incorrect goal.
Choice B reason: Reducing the mean size of red blood cells is irrelevant, as polycythemia vera involves increased red cell count, not size. Treatment focuses on lowering hematocrit to decrease viscosity, not altering cell dimensions, making this an incorrect treatment goal.
Choice C reason: Reducing blood viscosity is the primary goal in polycythemia vera, achieved through phlebotomy or myelosuppressive therapy to lower red cell mass. This alleviates symptoms like itching and prevents thrombotic complications, directly addressing the disease’s pathophysiology, making this correct.
Choice D reason: Controlling hypertension is a secondary concern in polycythemia vera, often resulting from increased blood volume. While managed, the primary goal is reducing blood viscosity to prevent complications, as hypertension is a symptom, not the root cause, making this incorrect.
Correct Answer is C
Explanation
Choice A reason: Polycythemia involves an increased erythrocyte count, not a decrease. A low erythrocyte count causes anemia, leading to fatigue or hypoxia, not the neurological symptoms like headaches or dizziness seen in polycythemia, making this an incorrect cause.
Choice B reason: Tissue destruction by macrophages is not a primary feature of polycythemia. It may occur in inflammatory conditions, but polycythemia’s neurological symptoms stem from blood flow changes, not macrophage activity, making this an incorrect cause.
Choice C reason: Increased blood viscosity, due to elevated red blood cell mass in polycythemia, impairs cerebral blood flow, causing neurological symptoms like headaches, dizziness, and confusion. This sluggish circulation directly affects brain perfusion, making it the primary cause of these symptoms.
Choice D reason: Hypoxia occurs in conditions with inadequate oxygen delivery, like anemia or lung disease. Polycythemia increases oxygen-carrying capacity but causes symptoms due to viscous blood flow, not hypoxia, making this an incorrect primary cause.
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