A 76-year-old man presents to the movement disorders outpatient clinic with a history of Parkinson’s disease. He is currently on co-beneldopa 650mg five times daily. The patient reports excessive drooling of saliva, which has not improved with speech and language therapy. What would be the best initial management plan for this patient?
You are preparing to conduct a search for all your elderly patients who need the yearly flu shot. Which of the following groups should not be included in the registry?
A 26-year-old man has scheduled an appointment at your clinic. He suffered a traumatic head injury in a car accident six months ago and has been recovering well. However, two months ago, he experienced a generalised tonic clonic seizure and was advised by a neurologist to seek further review if he had any more episodes.
Recently, he had another seizure at home and was taken to the emergency department. The on-call neurologist recommended starting levetiracetam and arranged an urgent clinic appointment in the coming weeks. He has been given a short supply of medication and would like to add it to his repeat prescriptions.
During the emergency department visit, he was told by the doctor that he should not drive, but he was not informed for how long. He holds an ordinary car licence and doesn’t drive for work.
What advice should you provide to him?
A 68-year-old man who is being treated for Parkinson’s disease is evaluated. What symptom should raise suspicion for a different diagnosis?
Which of the following statements about discontinuing anti-epileptic drugs (AED) is the most accurate?
During your weekly ward round at the local neurological rehabilitation care centre you see a 34-year-old man who has a background of depression, asthma and a traumatic spinal cord injury. The nurses report him being more distressed and agitated over the last two days.
On examination he is profusely sweating in the upper body and face, his blood pressure is 180/110mmHg, heart rate 60/min, oxygen saturations 99%, chest clear to auscultation and Glasgow coma scale 15, calves soft and non-tender, pupils equal and reactive. He admits to drinking 15 units/week and smokes 10 cigarettes/day. Regular medications include salbutamol, oxycodone, co-codamol 30/500 as required and prophylactic dose low molecular weight heparin.
What is the most likely underlying cause of the patient’s symptoms?
A 70-year-old male presents with bilateral paraesthesia in the radial aspects of both hands, over the thumbs and first fingers, as well as paraesthesia in the lateral aspects of both forearms and lower limb spasticity. His HBA1c level is 46 mmol/mol and nerve conduction studies and EMG show evidence of denervation. What is the most probable diagnosis?
A patient in their 60s with Parkinson’s disease presents with cognitive symptoms and is diagnosed with mild Parkinson’s-related dementia. Is there a licensed medication available to treat their cognitive impairment?
You are assessing a patient who is suspected of having classical migraine (migraine with aura). At what point is an aura considered atypical and a potential ‘red flag’ if it lasts longer than what duration?
What is a negative prognostic factor for individuals with multiple sclerosis?