Archive Of Standardized Exam Questions: Parkinson Disease (PD)

OVERVIEW

This page is dedicated to organizing various examples of standardized exam questions whose answer is Parkinson disease (PD). While this may seem a odd practice, it is useful to see multiple examples of how PD will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a traditional question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.

KEY CHARACTERISTICS OF THIS CONDITION (ON EXAMS)

When it comes to standardized exams, each topic has its own “code” marked by key buzzwords, lab findings, clues, etc. If you are well versed in this code you will be able to more quickly identify the condition that is being discussed, and get the right answer on the exam you are taking. Below is the “code” for PD. 

  • Resting tremor: referred classically as a pill rolling tremor. 
  • Slow movements (bradykinesia): others may complain of this behavior. 
  • Muscle rigidity: is classic. Can be increased on physical exam (lead pipe rigidity/cogwheel rigidity). 
  • Shuffling gait: is classic
QUESTION EXAMPLES

Question # 1

A 70 year old woman comes to the clinic with her husband because of a 6-month history of a resting tremor in her right arm. Her husband explains that her movements have been slower then usual, and that she appears less stable while walking around the house. A physical exam shows increased muscle tone in the upper extremities that is greater on the left side than on the right. There is a decreased left arm swing observed by the physician. The patient’s gait is slow and shuffling in nature. What is the likely diagnosis in this patient? 

Explanation # 1

Resting tremor + slow movements + shuffling gait = PD

Question # 2

 

Explanation # 2

TESTABLE FACTS ABOUT THIS TOPIC (BEYOND ITS IDENTIFICATION)

Many questions on standardized exams go beyond simply recognizing the underlying topic. Often there are specific testable facts regarding some aspect of the topic’s pathophysiology/management/clinical implications that are commonly asked. Some of these are listed below:

  • Cause: loss of dopaminergic neurons in the Substantia nigra (found in the pons)
  • Histological appearance: Lewy bodies which contain cellular aggregates of α-synuclein intracellularly (eosinophilic)
  • Treatment options: 
    • Levodopa/Carbidopa: this is the gold standard treatment option. This drug combination provides the patient with an exogenous dopamine pre-cursor (L-Dopa) while also blocking the peripheral conversion of L-Dopa to dopamine (action of carbidopa). These both work together to elevate levels of dopamine within the central nervous system.
    • Dopamine agonists (bromocriptine): are used to restore dopamine signaling to the patient.

 

Page Updated: 02.20.2017