A 72-year-old man presents with progressive difficulty walking, urinary incontinence, and memory impairment over the past 6 months. His family describes his gait as "shuffling" and "magnetic." Neurological examination reveals a wide-based, unsteady gait and mild cognitive deficits. Brain MRI shows ventriculomegaly disproportionate to sulcal atrophy. Which of the following is the most appropriate next step in management?

The correct answer to the question "A 72-year-old man presents with progressive difficulty walking, urinary incontinence, and memory impairment over the past 6 months. His family describes his gait as "shuffling" and "magnetic." Neurological examination reveals a wide-based, unsteady gait and mild cognitive deficits. Brain MRI shows ventriculomegaly disproportionate to sulcal atrophy. Which of the following is the most appropriate next step in management?" is Option A: Lumbar puncture with CSF removal.

The other options — B) Donepezil prescription, C) Carbidopa/levodopa trial, D) Deep brain stimulation — are incorrect for this USMLE Exam Prep question. As explained above: The triad of gait disturbance, urinary incontinence, and cognitive impairment, along with ventriculomegaly, is classic for Normal Pressure Hydrocephalus (NPH). A diagnostic and often therapeutic lumb…