American Board of Internal Medicine (ABIM) Certification Practice Exam

Which symptoms are commonly associated with Normal Pressure Hydrocephalus (NPH)?

1. Abdominal pain and weakness

2. Severe headaches and vomiting

3. Gait abnormalities and cognitive decline

4. Fatigue and sleep disturbances

The correct answer is: Gait abnormalities and cognitive decline

Normal Pressure Hydrocephalus (NPH) is characterized by a classic triad of symptoms: gait abnormalities, cognitive decline, and urinary incontinence. The correct answer highlights two of these key features, specifically gait abnormalities and cognitive decline. Gait abnormalities often present as a shuffling or unsteady walking pattern, and may resemble Parkinsonian gait. Residents with NPH often experience difficulty in initiating movement, with some describing the feeling of their feet being 'stuck' to the floor. Cognitive decline in NPH may manifest as memory issues, confusion, or reduced executive functioning, which can impact day-to-day activities and social interactions. This decline can sometimes be mistaken for more typical forms of dementia, but it’s crucial to recognize that the reversible nature of NPH may provide an opportunity for recovery if appropriately treated through interventions such as a ventriculoperitoneal shunt. The other options present symptoms that do not align with the typical presentation of NPH. Abdominal pain and weakness, severe headaches and vomiting, and fatigue and sleep disturbances are not defining features of NPH, and if present, might suggest alternative diagnoses or conditions rather than NPH itself.