HY USMLEQ#10  Neurology Step 2CK

Level = Step 2CK/3 (inspired from Uworld Step 3 Qbank ) 

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An 80-year-old man comes to the physician with his daughter for memory loss over the last 7 to 11 months. He has become forgetful, distracted, and difficult with word finding. He has been having difficulty with his gait. 

What is the next best step in the management of this patient? 

A. Acetazolamide 
B. Carbidopa-Levodopa 
C. Donepezil 
D. Lumbar drainage of cerebrospinal fluid 
E. Ventriculoperitoneal shunting 

 

✅  Correct Answer: Lumbar drainage of cerebrospinal fluid 

Education Objective: Patient presents with Normal pressure hydrocephalus, and on the MRI, we can see ventriculomegaly. Hence, the next best step would be lumbar drainage of the CSF. 
❌ A. Acetazolamide --> use for Idiopathic Intracranial Hypertension. Inhibition of Carbonic Anhydrase, which plays a crucial role in cerebrospinal fluid (CSF) production at the choroid plexus within the brain.
❌ B. Carbidopa-Levodopa --> used to treat Parkinson's 
❌ C. Donepezil  --> Donepezil is an acetylcholinesterase inhibitor that can improve cognitive function and the activity of daily living. 
❌ E. Ventriculoperitoneal shunting --> If the patient improves with lumbar puncture, then we should proceed with the ventriculoperitoneal (VP) shunt placement.  If no improvement with the lumbar puncture, then there is no use of the Ventriculoperitoneal shunting. 

 

 

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