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NPH Diagnosis — RACP Adult Medicine MCQ

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HardGeriatric MedicineNPH DiagnosisRACP Adult Medicine

A 72-year-old has gait apraxia, urinary urgency, cognitive decline and ventriculomegaly out of proportion to cortical atrophy. Which bedside procedure best helps predict benefit from shunting?

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Correct answer: E — Perform a large-volume lumbar tap with standardised gait testing before and after CSF removal

The best answer is “Perform a large-volume lumbar tap with standardised gait testing before and after CSF removal”. A large-volume lumbar tap or, in selected cases, external lumbar drainage assesses whether CSF removal improves gait and supports shunt responsiveness. It does not “confirm” NPH with perfect sensitivity, so the full clinical and imaging picture remains important. Cognition alone is less immediately responsive, while EEG, empirical acetazolamide and biopsy are not standard predictive tests.

Reference: RANZCR: Appropriate use of medical imaging: https://www.ranzcr.com/our-work/quality-standards/appropriate-use-of-medical-imaging