MKSAP: 86-year-old woman with pain

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. An 86-year-old woman is evaluated in her assisted-living facility for pain. Four weeks ago, she developed herpetic lesions on her right posterior thorax in a T7 distribution. She was treated with acyclovir, and the lesions healed; however, she has persistent severe burning pain. The pain is so severe that she is unable to leave her bed to attend meals. Medical history is remarkable for hypertension, mild cognitive impairment, and osteoporosis. She ambulates short distances but uses a walker for longer distances. Medications are amlodipine and as-needed acetaminophen. She cannot tolerate opioid medications because they have caused delirium in the past. On physical examination, the patient is afebrile, blood pressure is 140/86 mm Hg, pulse rate is 62/min, and respiration rate is 14/min. BMI is 18. Examination of the back reveals allodynia and hyperalgesia in the right posterior T7 dermatome. All zoster skin lesions have resolved. On neurologic examination, she exhibits short-term memory impairment, which her family reports is her baseline. The remainder of the examination is unremarkable. Which of the following medications is the most appropriate pharmacologic therapy for this patient’s pain? A: Fentanyl patch B: Oral gabapentin C: Oral tramadol D: Topical lidocaine Continue reading ... Your patients are rating you online: How to respond. Manage your online re...
Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: Tags: Conditions Neurology Source Type: blogs