Organic mental disorders: progressive supranuclear palsy: practice question

A Psychiatry 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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Psychiatry · Organic mental disorders: progressive supranuclear palsy

Sample item

A 68-year-old man has frequent unexplained falls backwards, difficulty looking downwards, a stiff neck and trunk, apathy and slowed thinking. Levodopa gives little benefit. MRI shows midbrain atrophy. What is the most likely diagnosis?

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

The answer and the reasoning

A. Progressive supranuclear palsy

Progressive supranuclear palsy is a tauopathy with early postural instability, vertical gaze palsy (downgaze first), axial rigidity and frontal-type cognitive and behavioural change, with a poor levodopa response. Midbrain atrophy produces the 'hummingbird' sign.

Option by option

  • A. Progressive supranuclear palsy (correct)

    Correct. Early falls, vertical gaze palsy, axial rigidity and midbrain atrophy define the syndrome.

  • B. Parkinson disease

    Parkinson disease responds to levodopa and has early tremor with late falls.

  • C. Multiple system atrophy

    Multiple system atrophy features prominent autonomic failure and cerebellar signs.

  • D. Normal pressure hydrocephalus

    Normal pressure hydrocephalus presents with magnetic gait, incontinence and ventriculomegaly.

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 Psychiatry question

What is the answer to this Psychiatry question?

The best answer is A, Progressive supranuclear palsy. Progressive supranuclear palsy is a tauopathy with early postural instability, vertical gaze palsy (downgaze first), axial rigidity and frontal-type cognitive and behavioural change, with a poor levodopa response.

Why is "Parkinson disease" not the answer?

Parkinson disease responds to levodopa and has early tremor with late falls.

Why is "Multiple system atrophy" not the answer?

Multiple system atrophy features prominent autonomic failure and cerebellar signs.

Why is "Normal pressure hydrocephalus" not the answer?

Normal pressure hydrocephalus presents with magnetic gait, incontinence and ventriculomegaly.

What concept does this question test?

It tests Organic mental disorders: progressive supranuclear palsy in Psychiatry. Midbrain atrophy produces the 'hummingbird' sign.

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 Organic mental disorders: progressive supranuclear palsy?

Learn each diagnosis by its core features and its first-line treatment. Then use the flashcards and the other Psychiatry 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.