Return to Diagnosis ListShow Learning Points most relevant to Phase 1:

Tremor and parkinsonism

Clinical Discipline(s)/Organ System(s)
Nervous System, Neurology, Geriatric Medicine, Ethics
Progress Test Topic(s)
A 68 year old NZ European man presents complaining of trembling in his right hand progressing over the last 2 years. His wife has noticed that his writing has got worse and that he is 'slowing down', especially when getting up from his chair. Past medical history includes gastro-oesophageal reflux disease and hypertension, for which he takes omeprazole, metoclopramide and bendrofluazide.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Physiology of movement and neural control
   - Pathophysiology of movement disorders
   - The aetiology of Parkinson's disease and Parkinon's disease-like symptoms
   - Pharmacology of medications used to treat Parkinson's disease
Clinical and Communication Skills 
   - History of a patient with a tremor and worsening gait
   - Examination of the neurological system particularly noting gait analysis, cognition, tremor, rigidity, bradykinesia
   - Differential diagnosis of tremor and Parkinsonian features
   - Indications for neuroradiology and other investigations to elicit the cause of tremor and/or dyskinesia
   - Indications for medications in Parkinson's disease; effects of therapy on disease progression
   - Outline the surgical treatment options for advanced Parkinson's disease and dyskinesias
   - Role of rehabilitation and respite
   - Understand the prognosis of Parkinson's disease
Personal and Professional Skills 
   - Empathise with a patient with new diagnosis of a neurodegenerative condition
   - Facilitate involvement of the family/whānau in management
   - Ethics of medical management of neurodegenerative diseases
Hauora Māori 
   - Excess use of anti-Parkinson agents in Māori compared to non-Māori
Population Health 
   - Chronic disease management and social implications
Conditions to be considered relating to this scenario
Parkinson's disease, drug-induced parkinsonism, multiple system atrophy, benign essential tremor, multiple cerebral infarct
Less common but 'important not to miss'
space occupying lesion, hydrocephalus, progressive supranuclear palsy
Wilson's disease, Huntington's disease, Sydenham's chorea