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MS vs Spondylotic Myelopathy — SCE Neurology MCQ

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HardMultiple Sclerosis & CNS InflammationMS vs Spondylotic MyelopathySCE Neurology

A patient with Parkinson disease continues to have symptomatic orthostatic hypotension after dehydration is corrected and ramipril, amitriptyline and excess dopaminergic dosing are reviewed. Supine BP is 128/76 mmHg and there is no urinary retention. Which pharmacological sequence best follows NICE?

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Correct answer: E — Use midodrine with supine-BP monitoring, reserving fludrocortisone for failure or intolerance

Explanation lettering: B = shown as A · C = shown as B · A = shown as C · E = shown as D · D = shown as E

D is correct. NICE first requires review of contributory antihypertensives, dopaminergic agents, anticholinergics and antidepressants; after that, midodrine is considered with monitoring for supine hypertension. Fludrocortisone follows when midodrine is contraindicated, not tolerated or ineffective, with cardiac-risk review. A reverses sequence. B and E invent NICE first-line recommendations. C reinstates a plausible contributor.

Reference: NICE NG71 — Parkinson disease recommendations: https://www.nice.org.uk/guidance/ng71/chapter/Recommendations