Neurology Movement Disorders: Review Questions Gokhan L. Akfirat, MD Dr. Akfirat is an assistant professor of neurology, New York Medical College Metropolitan Hospital, New York, NY. Choose the single best answer for each question.
	Questions 1 to 3 refer to the following case. A 56-year-old man with a history of hypertension presents to the clinic with complaints of progressive hand tremor. The patient is left-handed. He first noticed the tremor 9 months ago, mostly when he is at rest. On examination, the patient has resting tremor with rigidity that is worse on the left side and decreased facial expressions. Rapid alternating movements are slow on the left side. Sporadic Parkinson’s disease is suspected. 1. All of the following may help to identify this patient’s diagnosis EXCEPT HIV history Laboratory tests, including complete blood count Manganese exposure Medication history Trauma history Click here to compare your answer. 2. All of the following are cardinal features of Parkinson’s disease EXCEPT Bradykinesia Dementia Postural instability Rigidity Tremor Click here to compare your answer. 3. All of the following are appropriate treatment options for this patient EXCEPT Amantadine Carbidopa-levodopa Duloxetine Pramipexole Selegiline Click here to compare your answer. 4. A 72-year-old man presents to the emergency department after a fall. He states that he has fallen frequently over the past 8 months. On examination, he has no tremor, but he has generalized rigidity (mostly axial), bradykinesia, increased gag reflex, and difficulty with vertical gaze. What is this patient’s most likely diagnosis? Corticobasal degeneration Multiple system atrophy Parkinson’s disease Parkinsonism-dementia-amyotrophic lateral sclerosis Progressive supranuclear palsy Click here to compare your answer. 5. Alien limb phenomenon is typically seen in which of the following disorders? Corticobasal degeneration Essential tremor Huntington’s disease Multiple system atrophy Parkinson’s disease Click here to compare your answer. 6. All of the following statements regarding essential tremor are correct EXCEPT Essential tremor is the most common adult-onset movement disorder Essential tremor is secondary to decreased dopaminergic neurotransmission in the basal ganglia Symptoms may improve with alcohol intake Symptoms respond to propranolol and primidone Tremor is typically postural and kinetic Click here to compare your answer.		7. Which of the following movement disorders persists during sleep? Dementia with Lewy bodies Essential tremor Huntington’s disease Palatal tremor Parkinson’s disease Click here to compare your answer. 8. A 37-year-old man presents to the clinic with clumsiness and infrequent jerking of all limbs. He has a recent history of admission to the psychiatry unit for paranoia. Family history is significant for dementia at young age and suicide. Magnetic resonance imaging (MRI) reveals atrophy of the caudate nucleus. What is this patient’s most likely diagnosis? Brief psychotic episode Essential tremor Huntington’s disease Paranoid schizophrenia Tardive dyskinesia Click here to compare your answer. Questions 9 and 10 refer to the following case. A 72-year-old woman is admitted to the psychiatry unit with agitation and visual hallucinations. The patient’s symptoms started 1 year ago, and 6 months later, the patient started to have fluctuating cognitive impairments. Physical examination reveals tremor and rigidity. 9. Which of the following is this patient’s most likely diagnosis? Alzheimer’s disease Corticobasal degeneration Dementia with Lewy bodies Multi-infarct dementia Progressive supranuclear palsy Click here to compare your answer. 10. Which of the following medications is the most appropriate for the long-term management of the patient’s visual hallucinations and agitation? Amitriptyline Chlorpromazine Haloperidol Quetiapine Thioridazine Click here to compare your answer. 11. Wilson’s disease is most accurately diagnosed with which of the following? Biopsy of the liver Computed tomography MRI Serum ceruloplasmin Urinary copper excretion Click here to compare your answer.
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