A 61-year-old woman presents to her primary care doctor with her son who reports that his mother is not acting like herself. She has gotten lost while driving several times in the past 2 months and appears to be talking to herself frequently. Of note, the patient’s husband died from a stroke 4 months ago. The patient reports feeling sad and guilty for causing so much trouble for her son. Her appetite has decreased since her husband died. On examination, she is oriented to person, place, and time. She is inattentive, and her speech is disorganized. She shakes her hand throughout the exam without realizing it. Her gait is slow and appears unstable. This patient’s condition would most likely benefit from which of the following medications?
ABromocriptine
BRivastigmine
CReserpine
DSelegiline
ELevodopa
A 70-year-old woman is brought to the office after her nurse noticed her being apathetic, easily distracted, and starting to urinate in bed. Her medical history is relevant for hypertension, under control with medication. Physical examination reveals a blood pressure of 138/76 mm Hg, a heart rate of 70/min, and a respiratory rate 14/min and regular. On neurological examination, she has a broad-based shuffling gait, and increased muscle tone in her limbs that is reduced by distracting the patient. There is decreased coordination with exaggerated deep tendon reflexes, decreased attention and concentration, and postural tremor. Which of the following additional features would be expected to find in this patient?
ADegeneration of the substantia nigra pars compacta
BCaudate head atrophy
CAccumulation of Lewy bodies in cortical cells
DDilation of the ventricular system
EAccumulation of amyloid plaques and neurofibrillary tangles in the cerebral cortex
A 72-year-old woman comes to the physician because she is seeing things that she knows are not there. Sometimes she sees a dog in her kitchen and at other times she sees a stranger in her garden, both of which no one else can see. She also reports a lack of motivation to do daily tasks for the past week. Three years ago, she was diagnosed with Parkinson disease and was started on levodopa and carbidopa. Her younger brother has schizophrenia. The patient also takes levothyroxine for hypothyroidism. She used to drink a bottle of wine every day, but she stopped drinking alcohol 2 months ago. Neurologic examination shows a mild resting tremor of the hands and bradykinesia. Her thought process is organized and logical. Which of the following is the most likely underlying cause of this patient's symptoms?
AAlcohol withdrawal
BAdverse effect of medication
CMajor depressive disorder
DSchizophrenia
EPoorly controlled hypothyroidism
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