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A 73 year-old male presents to the clinic with his wife.His wife has noticed that he has
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developed a resting tremor in his right hand and a shuffling gait over the last year.
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What finding on physical examination would support your suspected diagnosis?
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A Chorea
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B Dystonia
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C Masked facies
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D Hyperreflexia:C
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ThepatientsymptomsareconsistentwithParkinsonism.Physicalexamfindingsin- clude
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maskedfacies,micrographia,decreasedarmswing,andmonotonousspeech.
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1. A patient with an upper motor neuron lesion would exhibit which of the
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following findings?
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A Fasciculations
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B Areflexia
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C Muscular atrophy
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D Spasticity:D
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Spasticityisan uppermotor neuron lesion finding.Fasciculations,areflexia and muscle
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atrophy are consistent with lower motor neuron lesions.
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2. What test is the single most useful test in establishing the diagnosis of
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multiple sclerosis?
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, A Cerebral spinal fluid cell count and protein level
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B Cerebral spinal fluid immunoglobulin studies
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C Evoked potentials
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D Magnetic Resonance Imaging:D
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The presence of plaques on MRI is a key finding in establishing the diagnosis of MS.While
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cerebralspinalfluidcellcount,proteinlevels,andimmunoglobinsmaybe abnormal they
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are not specific for multiple sclerosis.
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Evoked potentialsaremost usefulin the detection of subclinical involvement of
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neuropathways in MS, but does not establish the diagnosis.
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3. A22-year-oldmalepresentstothecliniccomplainingofexcessivedaytime
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somnolence and strong desires to sleep at inappropriate times. He came in today
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because he had an episode of "feeling paralyzed" as he was falling asleep
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yesterday.Whatisthemostappropriatediagnostictesttoconfirmthis patient's
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diagnosis?
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A MRI of the brain
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B Electroencephalogram
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