Repeated USMLE Questions Step 1- 262

A 73-year-old man with a history of benign prostatic hyperplasia (BPH) presents to the emergency room complaining of repeated falls. His wife admits that during the past 3 weeks he has had unsteady gait, urinary incontinence and memory disturbances. His medical, surgical and family histories are unremarkable. He has never smoked or taken any recreational drugs. He drinks alcohol socially. His laboratory tests are all normal. A CT scan of the head shows slightly enlarged ventricles and slightly compressed gyri.

What is the most likely diagnosis of this patient’s condition?

A- Normal pressure hydrocephalus

B- Alzheimer’s disease

C- Middle cerebral artery stroke

D- Anterior pituitary adenoma

E- Trauma to the head due to elderly abuse


This is a typical presentation of normal pressure hydrocephalus. It is characterized by unsteady gait, urinary incontinence and dementia. The combination of these symptoms is diagnostic of this condition. Other options are characterized by one or two of these symptoms and other signs as well. A CT scan is always performed in old age with similar symptoms to exclude hematomas and confirm the diagnosis.

The correct answer is A

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