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.
Click here for neuro exam main page and here for the neuro exam questions page
Perfect revision for medical student finals, OSCES and PACES