A 40-year-old man complains to his doctor of impotence.
Which one of the following medication could be implicated?
Correct Answer B:
Sertraline is an SSRI used in the treatment of depression. Some of the various side effects of selective serotonin re-uptake inhibitors include:
A 72-year-old man has suffered a fall. His daughter reports that, for several months, she has noticed that he walks with smaller, shuffling footsteps and that his spine and arms seem always to be flexed when walking.
All of the following may be found in this patient, except:
Correct Answer A:
Parkinson's disease is an idiopathic, slowly progressive, degenerative CNS disorder characterized by resting tremor, muscular rigidity, slow and decreased movement, mask-like face expression, and postural instability. Diagnosis is clinical. Treatment is with levodopa plus carbidopa, other drugs, and, for refractory symptoms, surgery.
A resting tremor of one hand is often the first symptom. The tremor is characterized as follows: Often involving the wrist and fingers in movements similar to those used to manipulate small objects or pills (pill-rolling tremor) Usually, the hands, arms, and legs are most affected, in that order. Dementia can occur. Hypokinesia and impaired control of distal musculature cause micrographia (writing in very small letters) and make activities of daily living increasingly difficult.
Intention tremor is a dyskinetic disorder consisting of wide tremor during voluntary movements. A tremor that gets worse when a person is moving or reaching for an object is called an intention tremor. It is the result of dysfunction of the cerebellum.
In differentiating early Parkinson’s disease from variants such as drug-induced parkinsonism, progressive supranuclear palsy, and multiple system atrophy, which one of the following is the most important clue?
Resting tremor is the most common presentation of Parkinson’s disease. It is rare in progressive supranuclear palsy and multiple system atrophy, and less common in drug-induced parkinsonism.
A 75-year-old male has not seen a physician in 25 years and presents with advanced Parkinson’s disease.
The mainstay of treatment would be:
Correct Answer E:
Carbidopa/levodopa (choice E) is better for initial therapy in older patients, and those who present with more severe symptoms. Slow-release versions of this combination may decrease motor fluctuations.
> Stereotactic thalamotomy (choice A) is used to ameliorate tremors that have become disabling. This procedure has been replaced by other surgical options such as pallidotomy and high-frequency, deep-brain stimulation of specific nuclei.
> While anticholinergics such as benztropine (choice C) and amantadine (choice B) may provide some improvement of symptoms, these effects wane within a few months. Such medications are not a good option in this patient with advanced disease.
> Dopamine agonists (choice D) provide some improvements in motor complications, but are mainly used to delay the introduction of levodopa in younger patients, to avoid levodopa-related adverse reactions.
Which one of the following is more consistent with Parkinson’s disease than with other variant parkinsonian syndromes?
Tremor is characteristically an early manifestation of Parkinson’s disease. It is less pronounced in other variant parkinsonian syndromes. Examples of these syndromes include multiple system atrophy and progressive supranuclear palsy. Initial motor findings, including tremor, are often unilateral in Parkinson’s disease.
Early falls, autonomic dysfunction, and symmetric motor findings are more typical of variant parkinsonian syndromes. Compared to Parkinson’s disease, these syndromes respond poorly to levodopa.
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