Case Exemplar Patient Explained for Students (Easy Guide)
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Original Question
Case Exemplar: Patient With Tremor BH is a 72-year-old man brought by his brother to the clinic today for his annual checkup. The brother states BH has been tripping lately, has seemed to be nervous, and has almost fallen several times. He thinks BH may have early Parkinson’s disease and, in addition to his regular checkup, wants BH evaluated for PD. Past Medical History · Transient ischemic attack 2 years ago · Type 2 diabetes · Rheumatoid arthritis Medications Hydrochlorothiazide, 50 mg daily Captopril, 10 mg daily Acarbose, 50 mg daily Family History · Father: deceased, but had Parkinson’s · Mother: deceased, hypertension, breast cancer Social History · Smoked until 5 years ago, two packs per day · No alcoholic beverages · Played golf until earlier this year when he could not navigate course Physical Examination · Height: 73 inches; weight: 176 lb; blood pressure: 178/88; pulse: 78 · Tremor, left hand · Stooped posture · Delayed response in answering questions · Bowel sounds hypoactive all quadrants · Last bowel movement 4 days ago Labs · Liver function: normal Discussion Questions 1. What assessments and findings would help confirm a diagnosis of Parkinson’s in BH? 2. What pathophysiology underlies BH’s presentation of symptoms, and what medications should be prescribed if a diagnosis of Parkinson’s is confirmed? 3. What side effects of these medications might BH experience?
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