A 55-year-old man is brought to the psychiatrist by his wife after she found him wandering outside their home wearing only his underwear. On exam, the patient notes that his memory is “not as good as it used to be.” Which of the following tests is most likely to be helpful in the diagnosis of this patient?
c. Serum glucose
d. Serum amylase
e. Urinary myoglobin
the answer is below…
The United States Medical Licensing Examination, or USMLE for short, is a three-part licensing examination that is required in order to receive a license to practice medicine within the United States.
The USMLE assesses a physician’s ability to apply knowledge, concepts, and principles, and to determine fundamental patient-centered skills that are important in health and disease and that constitute the basis of safe and effective patient care. Examination committees composed of medical educators and clinicians from across the United States and its territories prepare the examination materials each year.
This exam is designed by the Federation of State Medical Boards and the National Board of Medical Examiners to determine whether or not an individual understands and can apply the knowledge necessary to practice medicine safely and intelligently.
The USMLE is actually comprised of three different exams that are referred to as steps, which examine the individual’s knowledge of specific topics related to the field of medicine such as basic science, medical knowledge, medical skills, clinical science, and the application of all of these skills and areas of knowledge in the medical field.
All three steps of the USMLE include a series of computerized multiple-choice questions, but the format of the exam and the information covered in each multiple-choice section is different for each step of the USMLE. The USMLE Step II also has a clinical skills portion that examines an individual’s ability to work with real patients and the USMLE Step III has a computerized patient simulation portion in addition to the multiple-choice section of the exam. In order for an individual to receive a license to practice medicine, the individual must pass all three steps of the USMLE.
The correct answer is b.: MRI.
An MRI may be helpful in ruling out organic causes of an apparent dementia, especially tumors or subcortical arteriosclerotic encephalopathy.
An EEG is not sensitive for detecting dementia—it is often normal in the early and middle stages. (It is, however, quite sensitive for detecting delirium.)
Very low or high serum glucose levels can be associated with delirium, and hypoglycemia is also associated with panic attacks, anxiety, and depression, but not dementia.
Serum amylase may be increased in bulimia nervosa.
Increased urine myoglobin is seen in neuroleptic malignant syndrome, in a variety of drug intoxications, and in patients in restraints.