A 68-year-old man presents with a 1 year history of impotence progressive difficulty in passing urine

Question Number 0534

Question:
A 68-year-old man presents with a 1 year history of impotence progressive difficulty in passing urine. For the last 2 months he has felt dizzy when rising from his bed in the mornings. On 2 occasions in the past, he had lost consciousness for about 1 minute. Physical examination reveals a mild left-sided tremor of the hand. Cardiac examination is normal. Neurological examination reveals an ataxic gait and bilateral pyramidal signs on examination of the limbs. What investigation will be most helpful in ascertaining the diagnosis?

a) Chest x-ray
b) Blood culture
c) Anti-Toxoplasma gondii IgM antibodies
d) Blood glucose
e) Valsalva manoeuvre


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