A 72-Year-Old Man Is Brought to the Office Due to Visual

question 43

Multiple Choice

A 72-year-old man is brought to the office due to visual disturbances that are causing significant distress.  The patient describes seeing prowlers in the bushes outside of his windows at night that disappear when he tries to move in for a closer look.  He asked his daughter over to see if she could also see these people, and she could not.  The patient says, "I am really worried because I've never experienced anything like this before."  He has Parkinson disease, for which he takes carbidopa-levodopa, and generalized anxiety disorder, for which he takes sertraline.  Temperature is 36.9 C (98.4 F) , blood pressure is 127/77 mm Hg, pulse is 68/min, and respirations are 14/min.  The patient is alert and oriented.  He has a mild resting tremor but very minimal rigidity.  His movements are slightly slowed.  Which of the following is the most appropriate next step in management?

• A)Add low-dose haloperidol
• B)Add pramipexole
• C)Increase carbidopa-levodopa
• D)Increase sertraline
• E)Reduce carbidopa-levodopa
• F)Reduce sertraline

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