CCS neuro - svenska101

[ArchivalUser]

(zkadhem 2 scenarios)

HPI no current medications

Vitals normal (no orthostasis)

Complete physical exam
results show (s/s suggestive of parkinson dis)
(bradykinesia, rigidity,micrographia etc)
mental status normal no hallucinations

order these tests as routine and schedule the pt to return in 7 days

BMP
UA
TSH
CT head
seum ceruloplasmin
24 hr urine copper

on follow up visit
interval history
vitals
results are normal

order bromocriptine po (although one can also order ropinirole po)

send the pt home

counsell
medication compliance
diet low protein
exercise
if pt smokes or drinks (then smoking cessation etc)

dx parkinson dis
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Consider hospitalizing patients with Parkinson's disease who have any of the following conditions
Hallucinations
Delirium
Profound fluctuations in mobility
Mania
Depression
Frequent or serious falls
Infection (e.g., urinary tract infection, aspiration pneumonia)
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Second scenario

same pt more than 50 years with some tremor involving hands but spares legs
in office vitals stable, no DM, no HTN
but drinks and reports that his tremor improves when he is drinking

complete physical exam
results normal except only tremor

order routine
BMP
UA

propanolol po

send the patient home re schedule after 15 days

Pt returns after 2 weeks
interval hx
pt reports improvement in his tremor

continue the beta blocker
case ends

dx benign essential tremor

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