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Parkinson Disease — RACP Adult Medicine MCQ

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EasyNeurologyParkinson DiseaseRACP Adult Medicine

A 55-year-old man presents with unilateral resting tremor of the right hand (pill-rolling), bradykinesia, rigidity, and shuffling gait. Symptoms started on the right side and have gradually progressed over 2 years. He has anosmia and REM sleep behaviour disorder. What is the most likely diagnosis?

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Correct answer: E — Parkinson disease

Unilateral onset of resting tremor (pill-rolling), bradykinesia, rigidity with asymmetric progression, anosmia, and REM sleep behaviour disorder (a prodromal feature) is idiopathic Parkinson disease. MDS clinical diagnostic criteria: bradykinesia PLUS rest tremor or rigidity, with supportive features (unilateral onset, response to dopaminergic therapy, anosmia, RBD). Dopamine agonists or levodopa are first-line therapy.

Reference: MDS – 2024 – PD Clinical Criteria; eTG Neurology 2024