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The St. Louis University Mental Status Exam is a cognitive screening tool designed to assess attention, memory, and executive function. While it evaluates multiple cognitive domains, it does not specifically require patients to draw a clock or recall three items in the same structured manner as other tools.

The Montreal Cognitive Assessment evaluates multiple cognitive domains, including memory, attention, language, and executive function. It does include some tasks like recalling words, but it does not combine the clock-drawing and three-item recall in the same brief screening format.

The Geriatric Depression Scale is a screening instrument used to assess depressive symptoms in older adults. It does not include tasks like clock drawing or three-item recall, as its focus is on mood and affect rather than cognitive function.

Acute lower back pain is not an absolute contraindication for lumbar puncture. While it may cause discomfort or technical difficulty, lumbar puncture can often still be performed safely with careful positioning and analgesia.

Osteoporosis is a relative concern for lumbar puncture due to potential fragility of vertebrae, but it is not an absolute contraindication. Special technique may be used to minimize risk.

Decreased cardiac output is not a direct contraindication for lumbar puncture, though general hemodynamic instability may warrant caution. The primary concern is neurological safety rather than cardiovascular status.

Requesting an immediate surgical consult is appropriate because compartment syndrome is a surgical emergency. Prompt evaluation by an orthopedic surgeon can prevent permanent muscle and nerve damage.

Providing supplemental oxygen is a supportive intervention that may help tissue oxygenation while awaiting definitive treatment, though it does not address the primary ischemic cause.

Keeping the extremity at the level of the heart is appropriate because elevation above the heart can reduce arterial perfusion and worsen ischemia, while lowering below heart level may increase edema. Maintaining a neutral position optimizes blood flow.

Schizoaffective disorder involves a combination of mood symptoms (mania or depression) and psychotic symptoms, such as hallucinations or delusions, which are not described in this patient.

Bipolar II disorder is characterized by hypomanic episodes and major depressive episodes. This patient does not report full depressive episodes, so criteria for Bipolar II are not met.

Bipolar I disorder requires at least one manic episode, which the patient has not experienced. Therefore, Bipolar I is not appropriate.

Rolling the patient into the recovery position is appropriate to maintain airway patency and prevent aspiration during a seizure.

Maintaining the patient's airway is critical during a seizure to prevent hypoxia and aspiration, making this an essential intervention.

Obtaining IV access, if possible, is appropriate to allow administration of medications or fluids once seizure activity is controlled, but it should not be forced during active convulsions.

Aortic stenosis typically produces a harsh, crescendo-decrescendo systolic murmur radiating to the carotids, not a soft blowing murmur at the apex.

Tricuspid stenosis produces a diastolic murmur best heard at the lower left sternal border, not a systolic apex murmur.

Austin-Flint murmur is associated with severe aortic regurgitation, producing a mid-to-late diastolic rumble at the apex, not a systolic blowing murmur.

The right hemisphere primarily governs spatial awareness, attention, and nonverbal processing. Difficulty with language and motor planning is less likely to result from right-sided lesions.

The brainstem controls basic vital functions, cranial nerves, and motor/sensory pathways but is not the primary center for language or fine motor planning.

The cerebellum coordinates movement, balance, and motor learning. Cerebellar lesions typically produce ataxia, dysmetria, and tremor, but not language deficits or apraxia.

Lewy body dementia presents with cognitive fluctuations, visual hallucinations, and parkinsonism, but the acute onset of myoclonus and multifocal MRI findings are not typical.

Alzheimer’s disease presents with gradual cognitive decline rather than sudden onset of ataxia and myoclonus, making it less likely.

Huntington’s disease is a hereditary neurodegenerative disorder with chorea, psychiatric symptoms, and gradual cognitive decline, not acute multifocal neurologic deficits.

Aspirin is not indicated for acute peripheral facial nerve palsy and would not address inflammation or nerve edema causing symptoms.

Antibiotics are indicated for bacterial infections, but the acute onset and clinical features suggest idiopathic peripheral facial nerve palsy (Bell’s palsy), not infection.

Surgery is rarely indicated for Bell’s palsy and is reserved for severe, refractory cases; immediate intervention is not warranted.

While a history of fragility fracture indicates high risk, treatment is often initiated based on bone density criteria even in the absence of fracture.

Patients with osteopenia may receive treatment based on fracture risk, but the threshold is typically higher than 1%, and clinical guidelines focus on t-score criteria or significant risk factors.

Age alone, even if older than 65, is not sufficient for treatment unless accompanied by diagnostic criteria or fractures. Symptomatic presentation is not the primary trigger for therapy.