Neurology: Parkinson-plus syndromes: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Neurology: Parkinson-plus syndromes

Sample item

A man with parkinsonism poorly responsive to levodopa has severe orthostatic hypotension, urinary retention and cerebellar signs. Which is the likely diagnosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Multiple system atrophy

Multiple system atrophy combines parkinsonism or cerebellar signs with early prominent autonomic failure, and alpha-synuclein accumulates in oligodendroglia. Progressive supranuclear palsy shows vertical gaze palsy, falls and a tau pathology. Levodopa response is poor in both.

Option by option

  • A. Wilson disease

    Wilson disease occurs in the young with liver disease.

  • B. Idiopathic Parkinson disease

    Idiopathic PD responds well to levodopa and autonomic failure comes later.

  • C. Multiple system atrophy (correct)

    Correct. Early autonomic failure with cerebellar signs points to MSA.

  • D. Progressive supranuclear palsy

    PSP presents with vertical gaze palsy and early falls.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Multiple system atrophy. Multiple system atrophy combines parkinsonism or cerebellar signs with early prominent autonomic failure, and alpha-synuclein accumulates in oligodendroglia.

Why is "Wilson disease" not the answer?

Wilson disease occurs in the young with liver disease.

Why is "Idiopathic Parkinson disease" not the answer?

Idiopathic PD responds well to levodopa and autonomic failure comes later.

Why is "Progressive supranuclear palsy" not the answer?

PSP presents with vertical gaze palsy and early falls.

What concept does this question test?

It tests Neurology: Parkinson-plus syndromes in General Medicine. Progressive supranuclear palsy shows vertical gaze palsy, falls and a tau pathology. Levodopa response is poor in both.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neurology: Parkinson-plus syndromes?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.