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70yo M with hx of OA, preDM, and HTN presents with difficulty getting out of bed. Initially had some associated shoulder and back pain; which has improved with treatment of diclofenac gel and exercises. He mostly reports the weakness when getting up from sitting position and when trying to move in bed.

Exam with Gait was somewhat slow; but not shuffled; little arm movement.
Grossly equal and 5/5 strength in all extremities; normal sensation as well (other than deficits due to prior left tibia surgery). Reflexes were normal without clonus.

Labs: Normal sed rate and CRP, CBC, CMP, Thyroid testing. Patient has a calcified nodule found in his abdomen on an x-ray; pending further workup. Has occult blood in stool; pending workup as well.

He additional reports some resting tremor of left leg for past few months; none in his hands. No recent falls.

Based on his appearance and gait; I was concerned for Parkinson’s. He actually brought this up himself as well as a possible concern. I have ordered MRI without contrast of brain and referred to neurology.

Question: Is his presentation consistent enough with Parkinson’s to start Sinemet now? Also, he was given trazodone one month ago for insomnia with great improvement – wondering if trazodone or doxepin would be better for treatment of insomnia in patients with concern for Parkinson’s?

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