10-04-2010, 05:48 PM
A 68-year-old man presents to your office for evaluation of tremor. He has had this problem for 3 years and it is beginning to affect his work. He has difficulty writing and has begun to notice wavering in his voice when dictating letters (now his preferred method of correspondence). He denies having any history of regular alcohol consumption but keeps a bottle of scotch in his desk because it “steadies his nerves” before important meetings. On examination, he has a relatively fast tremor of the right hand that is enhanced significantly with finger-to-nose testing. His voice has a shaky, quivering quality. His gait is normal, but his handwriting is very difficult to read because of shaking when he writes.
Which of the following medications is most likely to help this patient?
A. Carbidopa-levodopa
B. Valproic acid
C. Selegiline
D. Amitriptyline
E. Propranolol
Which of the following medications is most likely to help this patient?
A. Carbidopa-levodopa
B. Valproic acid
C. Selegiline
D. Amitriptyline
E. Propranolol