52 year-old woman with Parkinsonʼs Disease
A 52 year-old woman comes to the office “worried that I have Parkinsonʼs Disease,” because of tremor in
her hands for several years. She is not sure if it is worse in her right hand or if sheʼs more conscious of it
because she is right-handed. Writing or especially holding a cup makes it worse. She has taken to filling
cups halfway so that she doesnʼt spill the contents. She is very self-conscious about the tremor, which is
worse when she is stressed or nervous. She takes hydrochlorothiazide for hypertension and has a
remote history of depression. Sitting in the exam room, she appears composed, with no abnormal
movements evident.
1) Summarize the case briefly, including neuroanatomic localization and pathogenesis.
2) What is the most likely diagnosis? Name 1-2 alternative diagnoses, and discuss briefly why these
are less likely.
3) What additional information (history, exam, laboratory or other studies, consultations) would you
obtain? What laboratory findings would you expect if your most likely diagnosis is correct?
4) Assuming your most likely diagnosis is correct, how would you manage this patient? Include doses
for one medication you might prescribe, along with an estimate of the cost of a month of your
proposed therapy. How would you counsel the patient about her condition and about any proposed
therapy?
A 52 year-old woman comes to the office “worried that I have Parkinsonʼs Disease,” because of tremor in
her hands for several years. She is not sure if it is worse in her right hand or if sheʼs more conscious of it
because she is right-handed. Writing or especially holding a cup makes it worse. She has taken to filling
cups halfway so that she doesnʼt spill the contents. She is very self-conscious about the tremor, which is
worse when she is stressed or nervous. She takes hydrochlorothiazide for hypertension and has a
remote history of depression. Sitting in the exam room, she appears composed, with no abnormal
movements evident.
1) Summarize the case briefly, including neuroanatomic localization and pathogenesis.
2) What is the most likely diagnosis? Name 1-2 alternative diagnoses, and discuss briefly why these
are less likely.
3) What additional information (history, exam, laboratory or other studies, consultations) would you
obtain? What laboratory findings would you expect if your most likely diagnosis is correct?
4) Assuming your most likely diagnosis is correct, how would you manage this patient? Include doses
for one medication you might prescribe, along with an estimate of the cost of a month of your
proposed therapy. How would you counsel the patient about her condition and about any proposed
therapy?Get work done