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Author [[PageAuthor::Ahmed Zaghw, M.D. [1]]]
Exam Type USMLE Step 2 CK
Main Category Internal medicine
Sub Category Neurology, Neurology
Prompt A 50 year old man has been brought to the office by his family for noticeable decrease in his functional status over the last few months. He has a down syndrome and has been semi-independent all his adult life. For the last 6 years, he has been in vocational training, where he has been coping well till 8 months ago, when he started to be so forgetful and losing orientation of time and place around him. He has been rounding around the neighbor’s residence. His family reports that he lost his vocabulary when he speaks. His laboratory tests do not reveal any abnormalities. What is the clinical pattern consistent with the patient symptoms?
Answer A Huntington dementia
Answer A Explanation [[AnswerAExp::Incorrect-Huntington dementia is a striatal neurodegeneration, and the classic features are early onset dementia (between 35 - 50 years of age), progressive choreiform movements of all limbs, grimacing and ataxic gait.]]
Answer B Parkinson dementia
Answer B Explanation [[AnswerBExp::Incorrect-Parkinson's disease is characterized by a progressive loss of nigrostriatal dopaminergic neurons. The characteristic clinical features are bradykinesia, resting tremors, cogwheel rigidity, classic shuffling gait and masked facies.]]
Answer C Vascular dementia
Answer C Explanation [[AnswerCExp::Incorrect- Vascular dementia (also called multi-infarct dementia) commonly occurs in old age and associated with a carotid bruit. However, the absence of any focal neurological signs and the clinical setting indicate that alzheimer is a more likely diagnosis.]]
Answer D Alzheimer type senile dementia
Answer D Explanation [[AnswerDExp::Correct- Alzheimer's dementia is a neurodegenerative disorder that is characterized by the following histopathological findings: amyloid plaques, neurofibrillary tangles, and selective loss of cholinergic neurons. The most commonly recognized symptom of early Alzheimer's disease is memory loss, usually the forgetting of recently learned facts. As the disease advances, symptoms include confusion, irritability and aggression, mood swings, language breakdown, long-term memory loss, and the general withdrawal of the sufferer as their senses decline.]]
Answer E Dementia due to renal failure
Answer E Explanation Incorrect-
Right Answer C
Explanation [[Explanation::Alzheimer's dementia is a neurodegenerative disorder that is characterized by memory loss, usually the forgetting of recently learned facts, confusion, irritability, aggression, mood swings, language breakdown, and long-term memory loss.

Educational Objective: Alzheimer's dementia is a neurodegenerative disorder with progressive memory loss.
References: First Aid USMLE 2CK]]

Approved No
Keyword Dementia, Parkinson's disease
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