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