MKSAP: 68-year-old man with Parkinson disease

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 68-year-old man is seen for follow-up evaluation of Parkinson disease, which was diagnosed 10 years ago. Although his symptoms initially were well controlled with medications, he has experienced increasing fluctuations in motor symptoms, specifically tremor at rest and slowness, within the past 3 years. Medications are carbidopa-levodopa, entacapone, and amantadine. He notes marked symptom improvement after taking these medications, but the benefit lasts only for 2 hours. Increased dosing of carbidopa-levodopa causes visual hallucinations. On physical examination performed 3 hours after the patient took carbidopa-levodopa, blood pressure is 130/65 mm Hg and pulse rate is 85/min. Masked facies, an asymmetric upper extremity tremor at rest, marked bradykinesia, and cogwheel rigidity are noted. Gait is slow, but cognitive assessment findings are normal. Repeat examination performed 1 hour after the patient took carbidopa-levodopa reveals notable improvement in bradykinesia, rigidity, and gait and the emergence of prominent dyskinesia. Which of the following is the most appropriate treatment of this patient’s motor complications? A. Deep brain stimulation B. Discontinuation of entacapone C. Increased amantadine dosage D. Ropinirole E. Selegiline Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social me...
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Conditions Neurology Source Type: blogs