Neurology: progressive supranuclear palsy: 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: progressive supranuclear palsy

Sample item

A 68-year-old man has had repeated backward falls in the first year of illness, stiff neck and trunk, a staring expression and difficulty looking downwards. He has no tremor and levodopa gave little benefit. What is the most likely diagnosis?

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

The answer and the reasoning

C. Progressive supranuclear palsy

Progressive supranuclear palsy is a tauopathy causing early postural instability with falls, axial rigidity, vertical supranuclear gaze palsy (downgaze first), and poor levodopa response. Idiopathic Parkinson disease has asymmetric rest tremor and good levodopa response. Multiple system atrophy shows early severe autonomic failure, and corticobasal degeneration shows asymmetric apraxia and alien limb.

Option by option

  • A. Multiple system atrophy

    Multiple system atrophy is dominated by early autonomic failure or cerebellar signs.

  • B. Idiopathic Parkinson disease

    Parkinson disease typically has rest tremor, asymmetric onset, good levodopa response and late falls.

  • C. Progressive supranuclear palsy (correct)

    Early falls, downgaze palsy, axial rigidity and poor levodopa response define progressive supranuclear palsy.

  • D. Corticobasal degeneration

    Corticobasal degeneration presents with asymmetric limb apraxia, cortical sensory loss and alien limb.

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.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Progressive supranuclear palsy. Progressive supranuclear palsy is a tauopathy causing early postural instability with falls, axial rigidity, vertical supranuclear gaze palsy (downgaze first), and poor levodopa response.

Why is "Multiple system atrophy" not the answer?

Multiple system atrophy is dominated by early autonomic failure or cerebellar signs.

Why is "Idiopathic Parkinson disease" not the answer?

Parkinson disease typically has rest tremor, asymmetric onset, good levodopa response and late falls.

Why is "Corticobasal degeneration" not the answer?

Corticobasal degeneration presents with asymmetric limb apraxia, cortical sensory loss and alien limb.

What concept does this question test?

It tests Neurology: progressive supranuclear palsy in General Medicine. Idiopathic Parkinson disease has asymmetric rest tremor and good levodopa response. Multiple system atrophy shows early severe autonomic failure, and corticobasal degeneration shows asymmetric apraxia and alien limb.

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: progressive supranuclear palsy?

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.