American College of Physicians: Internal Medicine — Doctors for Adults ®


The MKSAP Challenge

From the March ACP Observer, copyright 2006 by the American College of Physicians.

Clinical scenario

A 55-year-old man is hospitalized because of a four-week history of progressive left-sided weakness, headaches and nausea.

Physical examination reveals papilledema, and neurologic examination reveals left-sided hemiparesis with an extensor plantar response. Brain MRI shows a large, irregular right frontal lobe lesion with extensive edema. Biopsy specimen of a lesion found on chest radiograph reveals adenocarcinoma of the lung.

His brain lesion is treated with corticosteroids and radiation therapy, after which his headaches resolve and his motor strength improves.

Which of the following is the most appropriate next step in preventing seizures in this patient?

A. No additional treatment
B. Phenytoin
C. Carbamazepine
D. Valproic acid



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