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A 46-year-old woman comes to the office for management of a 4-mm left middle cerebral artery aneurysm. The aneurysm was found when the patient had magnetic resonance angiography and imaging for evaluation of a chronic headache disorder. Medical history is limited to chronic migraine headaches and smoking. Neurologic examination is normal.
Which of the following is the most appropriate next step in this patient™s management?
A. Arteriography
B. Computed tomographic angiography
C. Follow-up magnetic resonance angiography in 6 months
D. Aneurysm clipping

8
A 71-year-old man comes to the office because of slowness, tremor, stiffness, and difficulty with dexterity, such as buttoning clothes. The problems developed insidiously over the last few years, and have caused him to curtail his activities severely. On examination, he has a shuffling gait, tremor of one hand while walking, and reduced arm swing (right more than left). Rapid alternating movements are very slow, especially in the right limbs. Passive movement of his limbs reveals rigidity. Neurologic examination is otherwise normal.
Which of the following is the most appropriate management for this patient?
A. No treatment
B. Selegiline
C. Amantadine
D. Carbidopa/levodopa
E. Entacapone

D..
D...

_ Q1: DDD

_ Q2: DDD

D
D

d
d?

8dsimple
This man has signs and symptoms of parkinsonism, and very likely Parkinson™s disease, that are causing him to restrict his lifestyle. Treatment is indicated to keep him engaged in activities appropriate for his age. Carbidopa/levodopa is the appropriate first choice of medication. Dopamine agonist medications, such as pramipexole, ropinirole, pergolide, or bromocriptine, are not as effective as carbidopa/levodopa and may be insufficient to counter his increasing parkinsonian symptoms. Selegiline and amantadine are unlikely to have a major impact upon his symptoms. Entacapone is ineffective in the absence of levodopa treatment and hence has no role in initial treatment

7c
This patient has a 4-mm asymptomatic intracranial aneurysm. The natural history of asymptomatic aneurysms less than 10 mm in diameter is usually benign, with a very low risk of rupture. In general, these patients should probably not undergo surgical therapy unless the aneurysm enlarges or changes shape. Periodic noninvasive testing is appropriate. Computed tomographic angiography has little to add to the magnetic resonance angiography that has already been performed in this patient. Catheter angiography is associated with additional risk and does not improve assessment of asymptomatic aneurysm

CCC / DD? will give c a shot
DD

thanks showman

one more point for question regarding parkinsonism though not given in question......

anticholinergics should be avoided in older patients (more than 60) due to undesirable side effects such as dry mouth, urinary retention, constipation and as such anticholinergic are more usefull when the patient has intact functional status (less bradycardia)

sixer from jayasurya ...thnx