Movement Disorders — MCQs
All the following apply to Parkinson disease except
Fine tremors are primarily associated with which of the following conditions?
Subcortical dementia is seen in all EXCEPT:
A patient is having a continuous tremor and he has tendency to fall. Lesion is most commonly seen in?
Following statement are true about tremors except:
A 60-year-old man has resting tremor, pill-rolling movements, rigidity, and bradykinesia. Which of the following is most likely to be decreased in this man?
A young male patient is on 5 mg haloperidol for many days. Recently, for the last 4 days, he has inner restlessness and urges to move. Diagnosis is?
Which of the following is a single gene autosomal recessive disease?
A 55-year-old man presents with a tremor that occurs when his hands are at rest. He has a slow, shuffling gait and difficulty initiating movement. His symptoms improve with levodopa. What is the most likely diagnosis?
An otherwise healthy 43-year-old woman comes to the physician because of several episodes of involuntary movements of her head over the past few months. They are sometimes associated with neck pain and last minutes to hours. Neurologic examination shows no abnormalities. During examination of the neck, the patient's head turns horizontally to the left. She states this movement is involuntary, and that she is unable to unturn her head. After 5 minutes, her head re-straightens. Which of the following best describes this patient's disorder?
Movement Disorders Indian Medical PG Practice Questions and MCQs
Question 1: All the following apply to Parkinson disease except
- A. tremors at rest and muscular rigidity
- B. secondary involvement of the parietal cortex (Correct Answer)
- C. involvement of dopaminergic neurons
- D. primary involvement of the substantia nigra
Explanation: ***secondary involvement of the parietal cortex*** - Parkinson disease primarily affects the **basal ganglia** and associated dopamine pathways, leading to motor symptoms [1]. - While cognitive decline can occur, it's typically more related to **frontal-subcortical circuits** and less directly to secondary parietal cortex involvement [2]. *tremors at rest and muscular rigidity* - **Resting tremor** (often described as "pill-rolling") and **muscular rigidity** (lead-pipe or cogwheel rigidity) are two of the cardinal motor symptoms of Parkinson disease [1]. - These symptoms result from the **loss of dopaminergic neurons** in the substantia nigra [1]. *involvement of dopaminergic neurons* - The hallmark pathological feature of Parkinson disease is the **degeneration of dopaminergic neurons** in the substantia nigra pars compacta [1]. - This loss leads to a significant **reduction in dopamine** levels in the striatum, causing the characteristic motor symptoms [1]. *primary involvement of the substantia nigra* - The **substantia nigra** is the primary site of neurodegeneration in Parkinson disease [1]. - The degeneration of dopaminergic neurons within this brain region is the **origin of the motor deficits** observed in the disease [1].
Question 2: Fine tremors are primarily associated with which of the following conditions?
- A. Parkinson's disease
- B. Multiple sclerosis
- C. Essential tremor (Correct Answer)
- D. None of the options
Explanation: Essential tremor - Essential tremor is characterized by **fine, rhythmic tremors** that often affect the hands and can worsen with activity or stress. - It's typically an **action tremor**, meaning it occurs during voluntary movement, contrasting with resting tremors seen in other conditions. *Parkinson's disease* - Parkinson's disease primarily presents with a **resting tremor**, which is most noticeable when the affected limb is at rest [1]. - The tremor in Parkinson's is often described as a **"pill-rolling"** tremor, distinct from the fine action tremor of essential tremor [1]. *Multiple sclerosis* - Tremors in multiple sclerosis are typically **intention tremors**, meaning they appear or worsen during goal-directed movements, such as reaching for an object [2]. - These tremors are often **coarser and more irregular** than the fine tremors associated with essential tremor [2]. *None of the options* - This option is incorrect because essential tremor is a specific condition well-known for its characteristic fine tremor.
Question 3: Subcortical dementia is seen in all EXCEPT:
- A. Wilson's disease
- B. Parkinsonism
- C. Alzheimer's disease (Correct Answer)
- D. Huntington's chorea
Explanation: ***Alzheimer's disease*** - This is primarily a **cortical dementia**, characterized by widespread **cortical atrophy**, particularly in the **hippocampus** and temporal and parietal lobes [1]. - Its clinical presentation typically involves significant **memory impairment**, **aphasia**, **agnosia**, and **apraxia**, which are hallmarks of cortical dysfunction [1]. *Wilson's disease* - This is a **subcortical neurodegenerative disorder** caused by impaired copper metabolism leading to copper accumulation in the **basal ganglia**. - It often presents with **dysarthria**, **dystonia**, **ataxia**, and **behavioral changes**, consistent with subcortical involvement. *Parkinsonism* - Characterized by degeneration of the **substantia nigra** and loss of dopaminergic neurons, affecting the **basal ganglia**. - Commonly associated with **bradykinesia**, **rigidity**, **tremor**, and **postural instability**, and cognitive deficits often manifest as subcortical dementia. *Huntington's chorea* - This is a **neurodegenerative disorder** primarily affecting the **basal ganglia**, especially the caudate nucleus and putamen. - It presents with **chorea**, **psychiatric disturbances**, and **subcortical dementia**, including issues with executive function and slowed thought processes.
Question 4: A patient is having a continuous tremor and he has tendency to fall. Lesion is most commonly seen in?
- A. Putamen
- B. Substantia Nigra (Correct Answer)
- C. Globus pallidus
- D. Caudate nucleus
Explanation: ***Substantia Nigra*** - A lesion in the **substantia nigra** leads to a deficiency of **dopamine**, which is characteristic of **Parkinson's disease** [1]. - Symptoms like **continuous tremor (resting tremor)**, **postural instability (tendency to fall)**, rigidity, and bradykinesia are hallmark features of Parkinson's disease, linked to substantia nigra degeneration [1], [2]. *Putamen* - While the putamen is part of the basal ganglia and involved in motor control, its primary lesion is not typically associated with the classic triad of **Parkinsonian symptoms** (tremor, rigidity, bradykinesia) [1]. - Lesions here might instead contribute to involuntary movements like **dystonia** or **chorea**, which are not described. *Globus pallidus* - The globus pallidus is involved in regulating voluntary movement, and lesions here can cause various movement disorders, including **dystonia**, **chorea**, or **hemiballismus** [2]. - However, isolated pallidal lesions are less commonly the primary cause of the specific combination of **resting tremor** and **falls** seen in Parkinson's. *Caudate nucleus* - The caudate nucleus plays a crucial role in cognitive and motor functions and is primarily affected in diseases like **Huntington's disease**, leading to **chorea** and cognitive decline [2]. - Lesions in the caudate nucleus do not typically present with a **continuous tremor** and **tendency to fall** as the predominant symptoms.
Question 5: Following statement are true about tremors except:
- A. Essential tremor is an uncommon movement disorder affecting 5%of population (Correct Answer)
- B. Normal individuals can have physiologic tremor that manifest as mild high frequency, postural or action tremors.
- C. PD is characterised by resting tremor
- D. Tremor consist of alternate contraction of agonist and antagonist muscle in oscillating rhythmic manner
Explanation: ***Essential tremor is an uncommon movement disorder affecting 5% of population*** - Essential tremor is, in fact, one of the most common movement disorders, affecting a significant portion of the population (often cited as 0.4% in the general population, with higher prevalence in older adults, ranging from 4-5%). - Therefore, stating it is "uncommon" contradicts its actual prevalence and epidemiological data. *Normal individuals can have physiologic tremor that manifest as mild high frequency, postural or action tremors.* - **Physiologic tremor** is a normal phenomenon present in healthy individuals, characterized by a low amplitude, high-frequency tremor. - It becomes more noticeable under conditions of **stress, fatigue, or stimulant use** and is typically seen as a **postural or action tremor**. *PD is characterised by resting tremor* - **Parkinson's disease (PD)** is classically associated with a **resting tremor**, meaning it occurs when the limb is at rest and supported, and often diminishes with voluntary movement [1], [2]. - This tremor usually presents as a **"pill-rolling"** movement of the fingers and thumb. *Tremor consist of alternate contraction of agonist and antagonist muscle in oscillating rhythmic manner* - Tremors are defined by their **oscillating, rhythmic, and involuntary movements** resulting from the alternating or synchronous contraction of **agonist and antagonist muscles** [1]. - This alternating muscle activity is what produces the characteristic shaking motion [2].
Question 6: A 60-year-old man has resting tremor, pill-rolling movements, rigidity, and bradykinesia. Which of the following is most likely to be decreased in this man?
- A. GABA neurons in the caudate nucleus and putamen
- B. Serotonin neurons in the raphe nuclei
- C. Acetylcholine neurons in the forebrain
- D. Dopamine neurons in the substantia nigra (Correct Answer)
Explanation: ***Dopamine neurons in the substantia nigra*** - The symptoms described—**resting tremor**, **pill-rolling movements**, **rigidity**, and **bradykinesia**—are classic signs of **Parkinson's disease** [5]. - Parkinson's disease is pathologically characterized by the degeneration of **dopamine-producing (dopaminergic) neurons** in the **substantia nigra pars compacta**, leading to decreased dopamine levels in the **striatum** [1]. *GABA neurons in the caudate nucleus and putamen* - **GABAergic neurons** in the **caudate nucleus and putamen** are primarily affected in conditions like **Huntington's disease**, where their degeneration leads to increased involuntary movements (chorea) [4]. - While there can be secondary changes in these neurons in Parkinson's, the primary deficit is not in GABA but in dopamine. *Serotonin neurons in the raphe nuclei* - **Serotonin neurons** in the **raphe nuclei** are involved in mood regulation, sleep, and appetite, and their dysfunction is primarily linked to conditions like **depression**, anxiety, and certain sleep disorders [3]. - While some serotonergic involvement can occur in Parkinson's, it is not the primary neurological deficit explaining the motor symptoms. *Acetylcholine neurons in the forebrain* - **Acetylcholine neurons** in the **nucleus basalis of Meynert** (part of the forebrain) are primarily implicated in **Alzheimer's disease**, where their degeneration contributes to cognitive decline [2]. - While some cholinergic deficits may be present in advanced Parkinson's, they are not the hallmark pathology or the initial cause of the characteristic motor symptoms.
Question 7: A young male patient is on 5 mg haloperidol for many days. Recently, for the last 4 days, he has inner restlessness and urges to move. Diagnosis is?
- A. Akathisia (Correct Answer)
- B. Rabbit syndrome
- C. Tardive dyskinesia
- D. Acute Dystonia
Explanation: ***Akathisia*** - This condition is characterized by a subjective feeling of **inner restlessness** and an objective urge to move, which is a classic side effect of **dopamine receptor blocking agents** like haloperidol. - The onset of akathisia can be acute or chronic, often occurring within days to weeks of starting or increasing the dose of antipsychotic medication. *Rabbit syndrome* - This is a rare form of **tardive dyskinesia** characterized by rapid, fine perioral movements that resemble a rabbit chewing. - It does not primarily involve the subjective feeling of restlessness or the urge to move the entire body as described in the patient's presentation. *Tardive dyskinesia* - This condition typically involves **involuntary, repetitive body movements**, often affecting the face, lips, tongue, and limbs, and usually develops after prolonged exposure to antipsychotic medications (months to years). - While it can manifest as abnormal movements, the primary symptom of inner restlessness and urge to move is not characteristic of tardive dyskinesia but rather of akathisia, and its onset is typically much later. *Acute Dystonia* - Acute dystonia presents as **sustained muscle contractions** leading to twisting and repetitive movements or abnormal fixed postures, often affecting the neck, eyes (oculogyric crisis), and trunk. - This reaction typically occurs within hours or days of initiating or increasing neuroleptic medication and is characterized by involuntary muscle spasms, not a pervasive sense of inner restlessness.
Question 8: Which of the following is a single gene autosomal recessive disease?
- A. Wilson's disease (Correct Answer)
- B. Tuberous sclerosis
- C. Huntington's disease
- D. Schizophrenia
Explanation: ***Wilson's disease*** - This is an **autosomal recessive disorder** [1] characterized by excessive **copper accumulation** in the liver, brain, and other organs due to a mutation in the ATP7B gene. - Manifestations include **hepatic dysfunction**, neurological symptoms, and characteristic **Kayser-Fleischer rings** in the eyes [1]. *Tuberous sclerosis* - This is an **autosomal dominant disorder** caused by mutations in the TSC1 or TSC2 genes, leading to the formation of benign tumors in multiple organs. - Clinical features include **epilepsy**, intellectual disability, facial angiofibromas, and renal angiomyolipomas. *Huntington's disease* - This is an **autosomal dominant neurodegenerative disorder** caused by a CAG trinucleotide repeat expansion in the HTT gene. - It presents with **progressive chorea**, psychiatric symptoms, and cognitive decline, typically in mid-adulthood. *Schizophrenia* - This is a **complex psychiatric disorder** with a multifactorial etiology, involving a combination of genetic predisposition and environmental factors. - It is not a single gene disorder but rather involves many genes contributing to risk, indicating a **polygenic inheritance pattern**.
Question 9: A 55-year-old man presents with a tremor that occurs when his hands are at rest. He has a slow, shuffling gait and difficulty initiating movement. His symptoms improve with levodopa. What is the most likely diagnosis?
- A. Parkinson’s disease (Correct Answer)
- B. Huntington’s disease
- C. Essential tremor
- D. Multiple sclerosis
Explanation: ***Parkinson’s disease*** - The classic triad of symptoms—**resting tremor**, **bradykinesia** (difficulty initiating movement, shuffling gait), and **rigidity**—is highly characteristic of Parkinson's disease [1, 5]. - Significant improvement with **levodopa** is a hallmark of dopaminergic responsiveness seen in Parkinson's disease. *Huntington’s disease* - Characterized by **chorea** (involuntary, jerky movements), cognitive decline, and psychiatric symptoms, which are not described in this patient. - The onset is typically earlier, and the tremor is not primarily a resting tremor. *Essential tremor* - Primarily an **action tremor** [1] that occurs during voluntary movement, unlike the resting tremor described in the patient. - While it can be debilitating, it typically does not present with **bradykinesia** or **shuffling gait**. *Multiple sclerosis* - A demyelinating disease presenting with a wide range of neurological symptoms depending on lesion location, such as sensory disturbances, weakness, visual problems, and **ataxia**. - While tremors can occur (often intention tremors), the clinical presentation of a **resting tremor**, **shuffling gait**, and **bradykinesia** is not typical of MS.
Question 10: An otherwise healthy 43-year-old woman comes to the physician because of several episodes of involuntary movements of her head over the past few months. They are sometimes associated with neck pain and last minutes to hours. Neurologic examination shows no abnormalities. During examination of the neck, the patient's head turns horizontally to the left. She states this movement is involuntary, and that she is unable to unturn her head. After 5 minutes, her head re-straightens. Which of the following best describes this patient's disorder?
- A. Dystonia (Correct Answer)
- B. Athetosis
- C. Akathisia
- D. Hemiballismus
- E. Chorea
Explanation: ***Dystonia*** - This patient presents with **sustained, involuntary muscle contractions** causing repetitive, twisting movements and abnormal postures [1], which are characteristic features of **dystonia**, specifically **cervical dystonia (torticollis)**. - The description of the head turning involuntarily to the left and inability to unturn it, lasting minutes to hours, fits the pattern of intermittent or spasmodic dystonia. *Athetosis* - **Athetosis** involves slow, sinuous, **writhing involuntary movements**, particularly affecting distal limbs [1]. - These movements are often continuous and slow, unlike the more sudden, sustained contractions seen in the patient. *Akathisia* - **Akathisia** is characterized by an internal feeling of **restlessness** and a strong urge to move, often described as an inability to sit still. - It results in fidgeting and pacing, rather than sustained, involuntary posturing of a specific body part. *Hemiballismus* - **Hemiballismus** involves **large-amplitude, involuntary, flinging movements** of one side of the body [1]. - This symptom typically arises from lesions in the **subthalamic nucleus** and is distinct from the sustained, twisting movements described [1]. *Chorea* - **Chorea** presents as **brief, irregular, rapid, and unpredictable involuntary movements** that flow randomly from one body part to another [1]. - Unlike the sustained, fixed posturing seen in dystonia, choreiform movements are often described as "dance-like" and are not maintained.
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