A 70-Year-Old Man with a 10-Year History of Well-Controlled Parkinson

question 400

Multiple Choice

A 70-year-old man with a 10-year history of well-controlled Parkinson disease is brought to the clinic for evaluation of dizziness.  He was able to walk 1 mile daily until he developed occasional episodes of dizziness and syncope when standing.  His medications include levodopa, carbidopa, and a multivitamin.  Seated blood pressure is 120/70 mm Hg with a heart rate of 66/min; standing blood pressure is 89/60 mm Hg with a heart rate of 68/min.  Cardiopulmonary examination is normal.  Neurologic examination shows mild tremor and bradykinesia.  A complete blood count, basic metabolic panel, and ECG are normal.  Which of the following is the most likely cause of this patient's dizziness?

• A)Adrenal insufficiency
• B)Autonomic insufficiency
• C)Baroreceptor hyperreactivity
• D)Intravascular volume depletion
• E)Sinus node dysfunction

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