75-year-cid man is brought to the office by his wife due to worsening psychosis The patient has a hisl<XY of Parkinson disease treated with carbidopa-levodopa and pramipexole Dosages of both medications were increased 6 months ago to target worsening tremor and bradykinesia, resulting in significant improvement in motor symptoms However, over the ensuing moriths, the patient began experiencing paraooia and hallucinations. He has been verbally assaultive toward the mail carrier, claiming that she is stealing
from him. The patient has also been observed talking to himself and is often distracted by visual stimuli that are invisible to others Dose reduction of his antiparkinson medications resulted in significant rebound motor symptoms, requiring resumption of the prereduction doses. Temperature is 36.7 C (98 F), blood pressure is 118/82 mm Hg, and pulse is 62/min. The patient appears suspicious of the examiner and mumbles to himself throughout the examination. Mild rigidity, tremor, and gait instability are present Which of the following is the most appropriate next step in management of this patient?
- QA Amantadine
- QB Haloperidol
- QC Quetiapine
- Q D Risperidone
- Q E Selegiline
0 voters
29-year-old woman, gravida 2 para 0, comes to the physician for a routine prenatal visit She previously had regular menses every 28 days and is at 18 weeks gestation based on her last menstrual period and physical examination. The patient had a first-trimester miscarriage during her prior pregnancy She takes prenatal vitamins but otherwise has no medical problems and takes no medications. Her pre-pregnancy weight was 54 kg (119 lb) and she has gained 1 kg (2 2 lb) during this pregnancy Vital signs and physical examination are normal. The uterus is soft and palpable just below the umbilicus. The maternal serum a-fetoprotein protein
level obtained last week is significantly elevated. Which of the following is the most likely abnormality associated with this finding?
- Q A F508 mutation
- Q B. Fetal abdominal wall defect
- Q C. Fetal cardiac anomaly
- Q D. Maternal hepatic neoplasm
- Q E. Meiotic nondisjunction of fetal chromosome 18
- Q F Multiple gestation
- Q G. Robertsonian translocation involving fetaJ chromosome 21
0 voters