Which of the following was most likely the primary reason for the use of cisatracurium instead of tubocurarine in this patient?

Correct Answer: C

Rationale: The primary reason for using cisatracurium instead of tubocurarine in this patient is likely due to propofol induction, as cisatracurium is often preferred with propofol due to their compatibility. Liver or renal insufficiency or advanced age would not specifically dictate the choice between cisatracurium and tubocurarine. Diazepam administration is not directly related to the choice between these two neuromuscular blocking agents.

Correct Answer: A

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

Correct Answer: B

Rationale: In this case, the neurologist decided to add a second-generation antiepileptic drug that blocks voltage-gated Na+ and Ca2+ channels and may inhibit the synaptic release of glutamate. Among the choices, Lamotrigine fits this description as it is known to block voltage-gated sodium channels, making it the most likely drug prescribed for the patient.

Correct Answer: D

Rationale: The recently approved drug that acts with a novel mechanism of action, a noncompetitive blockade of AMPA receptors on brain neurons, is Perampanel. Given that the patient had poorly controlled seizures with valproic acid, adding Perampanel would provide a different mechanism of action to improve seizure control.

Correct Answer: B

Rationale: Carbidopa is a drug that inhibits the peripheral metabolism of levodopa, allowing more levodopa to reach the brain and be converted to dopamine. In this patient with decreased dopamine metabolism in the striatum, adding carbidopa to the regimen would further enhance the availability of levodopa in the brain, thereby improving symptoms of parkinsonism. The other options do not directly address the issue of decreased dopamine metabolism in the striatum.