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 C

Explanation

A. Lhermitte's sign:

Lhermitte's sign is a neurological symptom characterized by a sensation of electric shock-like pain that radiates down the spine and into the limbs, typically triggered by flexing the neck forward. It is often described as shooting or stabbing pain and is commonly associated with lesions or damage to the cervical spinal cord. Lhermitte's sign is not associated with a tightening sensation around the torso but rather with shooting pain down the spine and limbs.

B. Trigeminal neuralgia:

Trigeminal neuralgia is a neurological condition characterized by severe, shooting pain along the trigeminal nerve, which supplies sensation to the face. The pain is typically triggered by activities such as chewing, speaking, or touching the face. Trigeminal neuralgia causes sudden, intense, electric shock-like pain in the face, particularly in the areas supplied by the trigeminal nerve (e.g., cheek, jaw, forehead). It is not associated with a tightening sensation around the torso.

C. MS hug:

The "MS hug" is a symptom experienced by some individuals with multiple sclerosis, characterized by a sensation of tightness, pressure, or squeezing around the chest, abdomen, or torso. It can feel like a band tightening around the body and may be described as a constricting or girdling sensation. The MS hug is caused by spasms or tightening of the muscles surrounding the rib cage or the intercostal muscles due to damage to the nerves that control muscle function in MS.

D. Paroxysmal spasms:

Paroxysmal spasms refer to sudden, involuntary muscle contractions or spasms that occur intermittently. These spasms can affect various parts of the body and are commonly associated with conditions like multiple sclerosis. However, they typically present as brief, sudden contractions rather than a persistent tightening sensation around the torso.

A. Extension of the extremities B. Pronation of the hands C. Plantar flexion of the legs D. External rotation of the lower extremities

Correct Answer is C

Explanation

A. Extension of the extremities

Extension of the extremities is not consistent with decorticate posturing. Instead, it is more indicative of decerebrate posturing, where both the upper and lower extremities are typically extended.

B. Pronation of the hands

Pronation of the hands is not typically associated with decorticate posturing. In decorticate posturing, the hands are usually flexed with the wrists and fingers pointing towards the body.

C. Plantar flexion of the legs

Plantar flexion of the legs characteristic of decorticate posturing. Decorticate posturing mainly involves plantar flexion of the feet.

D. External rotation of the lower extremities

External rotation of the lower extremities is also not typically associated with decorticate posturing. In decorticate posturing, the lower extremities may exhibit extension or internal rotation, but external rotation is not a characteristic feature.

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

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