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 Parkinson’s Disease – Exam Presentation

How to present a patient with Parkinsonian symptoms for doctors, medical school exams, OSCEs, MRCP PACES and USMLE


  • From the end of the bed, Mr Singh had hypomimia, decreased blinking, and a resting tremor, which disappeared on movement to shake my hand. This was more marked on the right than the left.
  • On examination of the upper limbs there was increased tone, specifically cogwheel rigidity.
  • Power was difficult to assess due to the rigidity.
  • His movements were bradykinetic.
  • Reflexes were normal bilaterally.
  • His gait was slow to start and shuffling, with reduced arm-swing on the right and difficultly turning.
  • In summary, the rigidity, bradykinesia, resting tremor and gait apraxia would be consistent with Parkinsonism.
  • Though the most common cause would be Parkinson’s Disease, I would like to take a full history as well as examining for autonomic instability [suggestive of multisystem atropy] and vertical gaze palsy [suggestive of progressive supranucler palsy] that may be suggestive of a Parkinson’s Plus syndrome.


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Perfect revision for medical student finals, OSCES and PACES