A 75-year-old generally healthy man has noticed worsening problems maneuvering over the past 4 months. He has particular trouble getting out of low seats and off toilets. He most likely has which of the following?

a. Poor fine finger movements

b. Poor rapid alternating movements

c. Distal muscle weakness

d. Proximal muscle weakness

e. Gait apraxia

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.

Medical doctors with an M.D. degree are required to pass this examination before being permitted to practice medicine in the United States of America.

The correct answer is d; Proximal muscle weakness.[2]

With primary muscle diseases, such as polymyositis, weakness usually develops in proximal muscle groups much more than in distal groups. This means that weakness will be most obvious in the hip girdle and shoulder girdle muscles. The hip girdle is usually affected before the shoulder girdle. To get out of a low seat, the affected person may need to pull him – or herself up using both arms.

Persons with more generalized weakness or problems with coordination are less likely to report problems with standing from a seated position. Poor rapid alternating movements and poor fine finger movements usually develop with impaired coordination, such as that due to cerebellar damage.