NEUROLOGY

Movement Disorders

Sections:
• Section 1: (G)old – 45 Questions

Sub-topics:
• Parkinson disease
• Parkinson-Plus syndromes
• Huntington disease
• Dystonia, spasticity, tremors, myoclonus
• Cerebellar disorders
 Section 1
G(old) – 45 Questions

1. When performing the Heel-to-Shin test, the examiner should start from the patient's:
A. Shoulder
B. Hip
C. Knee
D. Ankle

2. Which of the following is not a clinical symptom of cerebellar damage?

A. Tremor
B. Nystagmus
C. Dysarthria
D. Ataxia
E. Aphasia

3. Affection of the cerebellum may produce any of the following, EXCEPT:

A. Positive Romberg test
B. Positive heel to knee test
C. Positive finger to nose test
D. Positive Rinne & Weber test

4. The central feature of Parkinson's disease is:

A. Rigidity
B. Spasticity
C. Tremor
D. Bradykinesia
E. Tics

2
‫مفتاح اإلجابات‬
5. An otherwise healthy 43-year-old woman presents complaining of neck pain and inability
to hold her head straight for the past year. Examination reveals a tendency for her to hold
her A head tilted to the right and her chin turned to the left. She can voluntarily straighten
her head, but it then reverts to the abnormal position spontaneously. Her head straightens
painlessly when she touches her chin with her index finger. The most useful treatment is:
A. Physical therapy
B. Neck collar
C. Botulinum toxin injection
D. Paracetamol
E. Antidepressants

6. A 63-year-old woman presented to the clinic complaining of walking difficulties of 2

years’ duration that had worsened over time. She had first noticed less agility of her right
hand and felt her right foot was dragging slightly. She had always been a fast walker, but more
recently, she had noticed that she had significantly slowed down. She also complained that she
had a hard time projecting her voice, and her handwriting had gotten smaller. She denied
having tremor. On examination, she had reduced facial expression, reduced blinking
frequency, and moderate cogwheeling rigidity of the right upper extremities. There was mild
cogwheeling in the left upper extremity with facilitation. On gait examination, she had a
stooped posture, and reduced arm swing bilaterally, right more than left. She turned en bloc.
On the pull test (pulled backward by examiner while stationary), she was able to take one step
back and prevent herself from falling. No tremor was evident on examination. Finger tapping
was slow bilaterally, right more than left. What is the most likely diagnosis in this patient?
A. Idiopathic Parkinson’s disease
B. DLB
C. Vascular parkinsonism
D. Drug-induced parkinsonism
E. Progressive supranuclear palsy

3
‫مفتاح اإلجابات‬
7. A 64-year-old woman presented to the clinic with a 2-year history of falling that had
progressed over time. She reported she would just suddenly fall, without a trigger. She
noticed difficulty going down stairs. On examination, in primary gaze, she had subtle jerk
nystagmus. Her neck was hyperextended and she had difficulty flexing it. She had impaired
vertical gaze, predominantly on downward gaze. However, on vertical oculocephalic maneuver,
downward eye movements were normal. There was mild bilateral rigidity in the upper
extremities. On the pull test examiner pulls the patient backward, instructing the patient to
take a step back and prevent falling), she had significant retropulsion and would have fallen if
not caught by the examiner. What is the most likely diagnosis in this patient?
A. Idiopathic Parkinson’s disease with early falling
B. Multiple-system atrophy
C. Progressive supranuclear palsy
D. Normal-pressure hydrocephalus
E. Corticobasal ganglionic degeneration

8. In initial stage of Parkinson disease, the most typical involuntary movement is the following:
A. chorea
B. athetosis
C. tremor
D. dystonia

9. Symptoms typical for Parkinsonism are the following:

A. rest tremor
B. muscular “cog wheel” rigidity
C. muscular flaccidity
D. “mask” face
E. intention tremor
F. bradykinesia

4
‫مفتاح اإلجابات‬
10. Tourette syndrome is considered as a sub-type of which of the following Movement
Disorders:
A. chorea
B. Dystonia
C. Parkinson
D. Tics
E. tremor

11. Which are the common characteristics of the essential Tremor:

A. Resting Tremor
B. Action Tremor
C. Pronation-supination Tremor
D. Extension-flexion Tremor
E. Dystonic Tremor

12. Which of the following patients with Parkinson disease is the best candidate for deep brain
stimulation?
A. A 64-year-old woman on levodopa-carbidopa who continues to experience episodes of
B. freezing while walking.
C. A 68-year-old man with recurrent falls due to orthostatic hypotension.
D. A 70-year-old woman with severe tremor unresponsive to dopaminergic therapy.
E. A 71-year-old man with worsening symptoms of dementia.
F. All of the above patients will respond to deep brain stimulation

13. You are seeing Mr. Williams today in the clinic. You note a tremor, which he says is
new. Which of the following pathologies is matched CORRECTLY with the tremor type below:
A. Essential tremor: resting tremor.
B. Parkinson disease: action tremor.
C. Cerebellar dysfunction: resting tremor.
D. Enhanced physiologic tremor: occurs with caffeine ingestion.
E. All of the above are incorrectly matched

5
‫مفتاح اإلجابات‬
14. You are seeing Mrs. Fajedo, a 74-year-old woman with a recently worsening tremor. She
notes that it predominantly affects her hands and is worse with action such as trying to eat. It
is not present at rest. It is improved by drinking 1–2 beers. She has no other symptoms. On
examination, her resting heart rate is 52 beats/min (she is an avid runner and physically fit)
with normal vital signs otherwise. Which of the following is the best initial therapy?
A. Bilateral hand botulinum toxin injections
B. L-dopa
C. Primidone
D. Propranolol
E. Two beers per night

15. Which of the following statements regarding Parkinson disease is TRUE?

A. Cigarette smoking reduces the risk of developing the disease.
B. Older age at presentation is more likely to be associated to genetic predisposition.
C. Parkinson disease has been identified as a monogenetic disorder related to mutations in the
α-synuclein protein.
D. The hallmark pathologic feature of Parkinson disease is presence of neurofibrillary tangle
and tau protein in the substantia nigra pars compacta.
The typical age of onset of symptoms is above 70 years

16. All of the following regarding psychogenic tremor is true, except:

A. Sudden onset with maximal tremor
B. Tremor may fluctuate and have a period of remission
C. worsens with distraction
D. No underlying structural abnormality
E. All of the above are true.

17. The most common form of chorea in pediatrics is:

A. Huntington chorea
B. Tourette syndrome
C. Hemiballismus
D. Sydenham chorea
E. Benign hereditary chorea syndrome

6
‫مفتاح اإلجابات‬
18. All of the following can be considered as a cause of cortical myoclonus, except:
A. Lithium
B. Alzheimer's disease
C. Dementia with Lewy bodies
D. Juvenile myoclonic epilepsy
E. B+C

19. The most reliable predictor of a risk of fall in a patient with Parkinson disease is:
A. L-dopa test
B. video EEG
C. SPECT scan
D. Pull test
E. Table tilt test

20. Which of the following anti-parkinsonian drugs can cause impulse control disease?
A. Levodopa/Carbidopa
B. Trihexyphenidyl
C. Pramipexole
D. Selegiline
E. B+C

21. Deep brain stimulation of the ventral intermediate nucleus of the thalamus can be useful in
case of:
A. Parkinson disease
B. Huntington disease
C. Refractory Essential tremor
D. Hemichorea
E. Dystonia

7
‫مفتاح اإلجابات‬
22. A 43-year-old man presents to your office complaining of periodic involuntary head turning
and head fixation to the right side. Physical examination reveals a hypertrophied left
sternocleidomastoid muscle. What is the most likely diagnosis?
A. Parkinson's disease
B. Essential tremor
C. Dystonia
D. Hemiballismus
E. Myoclonus

23. A 45-year-old Caucasian male presents in the office with a movement disorder and
behavioral disturbance. For the past month, he has been having frequent, sudden, jerky and
irregular movements of his upper extremities. He has become irritable, and does
not visit his family or friends. He is a business executive, and co-workers have commented on
the serious decline in his performance. His father had similar problems and died in a nursing
home. CT scan is ordered. Which of the following is a typical CT finding in such patients?
A. Atrophy of frontal lobes
B. Atrophy of lenticular nucleus
C. Atrophy of the caudate nucleus
D. Atrophy of temporal lobes
E. A+C

24. A 63-year old male patient prescribed selegiline for his Parkinson disease. What is the
mechanism of action:
A. Antimuscarinic
B. Monoamine Oxidase-B inhibitor
C. Catechol-O-Methyl Transferase inhibitor
D. Dopamine receptor antagonist
E. Dopamine receptor agonist

8
‫مفتاح اإلجابات‬
25. A 65-year-old man presents to your clinic after falling several times within the past few
months. On examination, his most notable findings are an unstable, wide-based gait. He does
have bradykinesia with masked facies and dysarthria. You find no evidence of cogwheeling or
resting tremor. His symptoms do not respond to levodopa/carbidopa. During the next few
months, the patient developed vertical ophthalmoplegia. The most likely diagnosis:
A. Pontocerebellar degeneration.
B. Multiple system atrophy.
C. Progressive supranuclear palsy.
D. Normal pressure hydrocephalus
E. Parkinson's disease.

26. A 55-year-old man is referred to the neurology clinic due to tremor and an abnormal gait.
All of following features would point towards a diagnosis of Parkinson's disease except:
A. Tremor occurs at rest, improves with movement and disappears during sleep.
B. intention tremor which produced with purposeful movement toward a target.
C. Shuffling gait.
D. Bradykinesia.
E. Postural in stability and muscle rigidity.

27. A 61-year old male patient comes to the office complaining of involuntary shaking of his
hand is started on the right side but his left hand shakes as well. the shaking disappears with
purposeful activity and worsen with emotional stress. He does not have a family history of
tremors. physical examination reveals a resting hand tremor with a frequency of 3-4 cycle/
sec. There is some muscle rigidity of both arms. his gait and posture are normal. His mental
status exam yield score of 30/30. which of the following is most appropriate treatment for this
patient?
A. Trihexyphenidyl
B. Clonazepam
C. Primidone
D. Clozapine
E. Propranolol

9
‫مفتاح اإلجابات‬
28. A 65-year-old man presents with difficulty walking (postural instability), rigidity,
bradykinesia, vertical gaze palsy and progressive decrease of mental function. What is the
most likely diagnosis?
A. Cerebrovascular disease
B. Steele-Richardson syndrome
C. Shy-Drager syndrome
D. Parkinson's disease
E. Wilson's disease

29. What is the therapeutic deep brain stimulation leads placed for muscle rigidity in Parkinson
disease?
A. Globus pallidus
B. Caudate
C. Thalamus
D. Hypothalamus

30. A 33-year-old woman presents to the clinic complaining of tremor. She reports she had a
tremor since her teenage years, but it had not really bothered her until the prior year. Her
handwriting was starting to be "shaky" and she was not able to eat soup without spilling. She
worked in construction and often operated heavy machinery and was concerned that her
tremor was putting herself and others in danger, Her father and paternal grandfather had a
similar tremor. On examination, there was no tremor at rest. With outstretched arms, or while
pouring water from one cup to another, a prominent bilateral high-frequency tremor was
observed. What is the most likely diagnosis in this patient?
A. Hyperthyroidism
B. Essential tremor
C. Dystonic tremor
D. Task-specific tremor

10
‫مفتاح اإلجابات‬
31. A 15-year old boy presents with tremor of both hands, in the previous months he developed
a mild dysarthria. He has a history of a depressive psychotic nature. The most likely diagnosis
is
A. Gilles de la Tourette syndrome
B. Huntington disease
C. Parkinson's disease
D. Variant Creutzfeldt-Jakob disease
E. Wilson's disease

32. A 24-year old man is noted to have dance like movement of his arms and head. The best
test to diagnose Huntington’s disease is:
A. Cerebral PET scanning
B. Sing photon emission tomography scanning
C. Genetic testing
D. MRI
E. CT scan

33. A 70-year old epileptic female presents with visual problems. Examination reveals
constriction of the field to confrontation. Which of the following would be responsible for her
visual field defect?
A. Vigabatrin
B. Lamotrigine
C. Gabapentin
D. Phenytoin
E. Pregabalin

34. Which of the following is the least characteristic of dystonia?

A. Mirroring phenomena
B. Overflow phenomena
C. Jerky tremulous movement
D. Random, non-stereotypical movements
E. The presence of an alleviating sensory trick

11
‫مفتاح اإلجابات‬
35. Which of the following is considered typical of Parkinson's disease?
A. Onset in the seventh decade
B. Symmetrical Parkinsonian findings
C. Early visual hallucinations
D. Poor response to levodopa/carbidopa
E. High rates of comorbid depression

36. A 64-year-old man who is under investigation for parkinsonian symptoms is brought to the
GP by his wife. She is concerned he husband is becoming increasingly agitated. The GP
prescribes haloperidol. One week later the GP is called out to see the patient as his
parkinsonian symptoms have deteriorated markedly. What is the most likely underlying
diagnosis?
A. Lewy body dementia
B. Normal pressure hydrocephalus
C. Progressive supranuclear palsy
D. Multiple system atrophy
E. Dementia pugilistica

37. A 53-year-old woman comes to the physician with a mild hand tremor while performing
fine motor tasks such as pouring tea. The tremor disappears for a while after she drinks a
glass of wine. Her blood pressure is 150/90 mm Hg and heart rate is 80/min. Physical
examination shows no abnormalities. Repeat blood pressure is 147/90 mm Hg. Which of the
following is the most appropriate medication to treat this patient's hypertension?
A. Amlodipine
B. Chlorthalidone
C. Propranolol
D. Valsartan
E. Verapamil

12
‫مفتاح اإلجابات‬
38. A 76-year-old man is review in the Elderly Medicine clinic. She is concerned about his
increasing forgetness over the past six months. His daughter notes he has generally 'slowed
down' and struggles to follow conversations. Over the past month she has noted increasingly
frequent episodes of urinary incontinence, has also had one episode of faecal incontinence in
the past week. On examination he is noted to have delayed reflexes and a short, shuffling gait.
No cerebellar signs are noted What is the most likely diagnosis?
A. Multiple system atrophy
B. Urinary tract infection
C. Parkinson's disease
D. Normal pressure hydrocephalus
E. Pick's disease

39. What percentage of patients with Parkinson's disease (PD) suffer from depression?
A. 70%
B. Up to 50%
C. 7%
D. More than 25%
E. Less than 10%

40. A 46-year-old man is being evaluated for a gait disorder, He was referred to the
community health center by social workers at the local emergency department due to
frequent falls. His symptoms began gradually about year ago and have become progressively
worse. The patient's history is notable for chronic alcoholism, and he i currently homeless with
sporadic stays in a nearby shelter. On examination, he has a broad-based, unsteady gait A
single tap on his patellar tendon elicits persistent, slow, back-and-forth swinging of the leg.
Nystagmus and truncal ataxia are also present Which of the following additional findings
would most likely be seen in this patient?
A. Hearing loss
B. Clasp knife spasticity
C. Goiter
D. Bradykinesia
E. Babinski sign
F. Intention tremor

13
‫مفتاح اإلجابات‬
41. A 86-year-old female is brought to the office by her concerned son due to increasing
contusion, loss of mobility and stiff limbs. She tends to cry out for no reason, She often
screams and sees a lion roaring in the backyard She often sees cats in her room, even though
her son does not see any. She has significant memory loss. She never had "joint problems'
before. She was previously treated with haloperidol, but this only aggravated her rigidity. She
is a non-smoker. She has no significant past psychiatric history. In the office, she appears alert,
but disoriented and quite agitated. Her blood pressure is 138/72 mm Hg, pulse is 98/min, and
respirations are 18/min Physical examination reveals impaired visuospatial abilities, increased
tone, normal reflexes, and coarse resting tremors in the extremities. Her CBC, electrolytes,
creatinine, glucose, LFTs, TSH and B12 levels are within normal range. The serology for syphilis
is negative. What is the most likely diagnosis?
A. Pick's disease
B. Multi infarct dementia
C. A Lewy body dementia
D. Alzheimer's disease
E. Neurosyphilis

42. A 63-year-old male patient was prescribed pramipixole for his Parkinson’s disease. What is
the mechanism of action?
A. Dopamine receptor antagonist.
B. Dopamine receptor agonist.
C. Antimuscarinic.
D. Monoamine Oxidase-B inhibitor.
E. Catechol-O-Methyl Transferase inhibitor.

43. ………… is considered to be the central hallmark feature of and the necessary condition for a
diagnosis of Idiopathic Parkinson’s Disease:
A. Bradykinesia
B. Tremor
C. Rigidity
D. Postural instability
E. Gaze palsy

14
‫مفتاح اإلجابات‬
44. A 71-year-old patient complains of increasing stiffness and difficulty swallowing.
Examination reveals generalized rigidity most prominent in the axial muscles, retrocollis, mild
symmetrical rest tremor, dysphagia, and restricted voluntary vertical eye movements
corrected by the oculocephalic maneuver. Sagittal brain MRI shows prominent midbrain
atrophy and the Hummingbird sign. Your initial diagnosis is:
A. Parkinson Disease
B. Multi-system Atrophy (MSA)
C. Lewy Body Dementia
D. Progressive supranuclear Palsy (PSP)
E. Tourette syndrome

45. Which of the following symptoms is considered the most characteristic of Multiple System
Atrophy?
A. Autonomic dysfunction
B. Chorea
C. Visual hallucinations
D. Prominent tremor
E. Seizures

15
‫مفتاح اإلجابات‬
 ‫مــفــتــاح اإلجــابــات‬
Questions No. Answer Questions No. Answer

1 26

2 27

3 28

4 29

5 30

6 31

7 32

8 33

9 34

10 35

11 36

12 37

13 38

14 39

15 40

16 41

17 42

18 43

19 44

20 45

21 46

22 47

23 48

24 49

25 50

Last Update: Tuesday, March 11, 2025

16
‫مفتاح اإلجابات‬