MCQs on Movement Disorders

MCQ Bank Neurology

Written by Dr. James Whitfield (MBBS, FRACGP) – General Practitioner

Question 1

George, a 68-year-old retired carpenter, presents with a 1-year history of slowness in daily activities and stiffness in his right arm. His wife has noticed that he doesn’t swing his right arm when walking and that his facial expression appears flat. On examination, he has resting tremor in his right hand, cogwheel rigidity in the right upper limb, and bradykinesia. His gait is slow and shuffling, and he has difficulty turning quickly.

Which of the following is the most likely diagnosis?

A) Essential tremor
B) Parkinson’s disease
C) Progressive supranuclear palsy
D) Multiple system atrophy
E) Corticobasal degeneration

Correct Answer: B) Parkinson’s disease

Explanation:
This patient has classic features of Parkinson’s disease, including:

  • Resting tremor (pill-rolling)
  • Bradykinesia
  • Cogwheel rigidity
  • Asymmetrical onset
  • Reduced arm swing
  • Masked facies
  • Shuffling gait

Diagnosis is clinical and based on the presence of bradykinesia plus either tremor or rigidity. Early Parkinson’s typically begins asymmetrically.

Why the other options are incorrect:

  • A) Essential tremor: Typically bilateral, postural/action tremor without rigidity or bradykinesia. Improves with alcohol.
  • C) Progressive supranuclear palsy: Early postural instability, vertical gaze palsy, axial rigidity.
  • D) Multiple system atrophy: Early autonomic dysfunction (orthostatic hypotension, urinary incontinence) and cerebellar or pyramidal signs.
  • E) Corticobasal degeneration: Alien limb phenomenon, cortical sensory loss, and apraxia—features not seen in this patient.

Question 2

Maria, a 62-year-old woman with recently diagnosed idiopathic Parkinson’s disease, presents to discuss treatment options. She has mild bradykinesia and right arm tremor, but no significant functional impairment. Her symptoms are not affecting her work or daily routine. She is otherwise healthy.

Which of the following is the most appropriate initial treatment?

A) Carbidopa-levodopa
B) Deep brain stimulation
C) Amantadine
D) Dopamine agonist
E) Selegiline

Correct Answer: D) Dopamine agonist

Explanation:
In younger patients (<65 years) with mild symptoms, dopamine agonists (e.g., pramipexole, ropinirole) are often used as first-line treatment to delay the need for levodopa and reduce the risk of long-term motor complications such as dyskinesias.

Why the other options are incorrect:

  • A) Carbidopa-levodopa: Most effective for symptom relief but reserved for older patients or those with functional impairment due to long-term side effects.
  • B) Deep brain stimulation: Used in advanced Parkinson’s with motor fluctuations or tremor not controlled by medications.
  • C) Amantadine: Weak symptomatic benefit; used more for levodopa-induced dyskinesia.
  • E) Selegiline: MAO-B inhibitor with mild benefit; usually an adjunct in early stages or as add-on therapy.

Question 3

Nathan, a 55-year-old accountant, presents with a 2-year history of hand tremor that worsens when he writes or drinks from a cup. The tremor affects both hands and improves after he consumes a small amount of alcohol. He denies any slowness of movement, stiffness, or gait problems. There is a positive family history of similar tremor in his father.

Which of the following is the most appropriate first-line treatment for this patient?

A) Carbidopa-levodopa
B) Propranolol
C) Clonazepam
D) Trihexyphenidyl
E) Deep brain stimulation

Correct Answer: B) Propranolol

Explanation:
This patient’s symptoms are consistent with essential tremor:

  • Bilateral postural tremor
  • Improves with alcohol
  • No rigidity or bradykinesia
  • Family history common

Propranolol (a non-selective beta-blocker) is the first-line treatment for essential tremor. It reduces tremor amplitude and improves function.

Why the other options are incorrect:

  • A) Carbidopa-levodopa: Used in Parkinson’s disease, not essential tremor.
  • C) Clonazepam: Sometimes used as a second-line option but not preferred due to sedation and dependence.
  • D) Trihexyphenidyl: Anticholinergic used occasionally in younger Parkinson’s patients, not for essential tremor.
  • E) Deep brain stimulation: Reserved for severe, drug-resistant tremor.

Previous Next

1. Neurology Module

1.1 Cerebrovascular Disorders

1.2 Cranial Nerves

1.3 Spinal Cord

1.4 Peripheral Nerves

1.5 Headaches

1.6 Seizure Disorders

1.7 Movement Disorders

1.8 Neuroimaging

Back to MCQ Bank