Which neurologic finding would be considered abnormal in an 88-year-old patient?

Dizziness and problems with balance

Slow papillary response to light

Jerky eye movements

Absence of the Achilles tendon jerk

Answer and Explanation

The Correct Answer is D

A. Dizziness and problems with balance

While dizziness and problems with balance can occur more frequently in older adults due to age-related changes in the vestibular system and other factors, persistent or severe dizziness or balance issues should be evaluated further as they could indicate underlying neurological or medical conditions.

B. Slow papillary response to light

This finding may be considered abnormal, especially if it represents a significant change from the individual's baseline. While age-related changes in pupil function can occur, a slow or sluggish pupillary response to light may indicate dysfunction of the oculomotor nerve or other neurological issues and should be investigated further.

C. Jerky eye movements

Jerky eye movements, such as nystagmus, can be abnormal and may indicate dysfunction of the vestibular system or other neurological conditions. While some degree of nystagmus can occur with age, persistent or severe jerky eye movements should be evaluated further.

D. Absence of the Achilles tendon jerk

This finding may also be considered abnormal. The Achilles tendon reflex, tested using the deep tendon reflex (DTR) examination, can diminish with age but should not be completely absent in the absence of specific medical conditions affecting the reflex arc or spinal cord function.

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Correct Answer is ["A","B","C","D","E","F"]

Explanation

A. Muscle tremors:

Muscle tremors, particularly resting tremors, are a hallmark feature of Parkinson's disease. These tremors typically occur in the hands, fingers, arms, legs, jaw, or head and may worsen with stress or inactivity.

B. Slow body movement (bradykinesia):

Bradykinesia refers to slowness of movement and is another key symptom of Parkinson's disease. Patients may have difficulty initiating movement, experience a decrease in spontaneous movement (hypokinesia), and demonstrate reduced range of motion.

C. Rigidity:

Rigidity, or stiffness of the muscles, is a common symptom of Parkinson's disease. It often affects the limbs and trunk and can contribute to difficulty with movement and posture.

D. Pill rolling:

Pill rolling refers to a specific type of tremor characterized by rhythmic, rolling movements of the thumb and fingers, resembling the action of rolling a pill between the fingers and thumb. This tremor is commonly seen in Parkinson's disease.

E. Lack of facial expression:

Parkinson's disease can lead to a reduced range of facial expressions, also known as hypomimia or "masked facies." Patients may have a fixed, expressionless facial appearance and reduced blinking.

F. Drooling:

Drooling, or excessive salivation, can occur in Parkinson's disease due to impaired swallowing function (dysphagia) and reduced control over oral and facial muscles.

A. Provide a suction setup at the bedside. B. Elevate the side rails when in bed. C. Place a bite stick at the bedside. D. Keep an oxygen setup at the bedside. E. Furnish restraints at the bedside.

Correct Answer is ["A","B","D"]

Explanation

A. Provide a suction setup at the bedside:

This is a relevant intervention as it ensures that suction equipment is readily available in case the client experiences excessive secretions or vomiting during or after a seizure. It helps maintain a clear airway and prevent aspiration.

B. Elevate the side rails when in bed:

Elevating the side rails can help ensure the client's safety during a seizure by preventing falls from the bed. It is a preventive measure to minimize the risk of injury.

C. Place a bite stick at the bedside:

Placing a bite stick at the bedside is not a recommended intervention. Bite sticks can potentially injure the patient's teeth or mouth during a seizure and are generally not recommended in current practice.

D. Keep an oxygen setup at the bedside:

This is an appropriate intervention as it ensures that oxygen is readily available in case the client experiences respiratory distress or hypoxia during or after a seizure. Oxygen therapy may be needed to support respiratory function.

E. Furnish restraints at the bedside:

Furnishing restraints at the bedside is not a recommended intervention for managing seizures. Restraints should only be used in exceptional circumstances when the client's safety or the safety of others is at risk and should be applied according to institutional policies and legal regulations.

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Which neurologic finding would be considered abnormal in an 88-year-old patient?

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