AccessMedicine's Case of the Week: Neurology

From: Graber and Wilbur’s Family Medicine Examination and Board Review, 4th Edition

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A 70-year-old male presents to your office as a new patient. He is with his wife, who assists in providing the history. His appetite is reduced, and he has lost 10 lb in the past 6 months. His only medication is aspirin, and he has no significant past medical history.

On examination, his vital signs are normal, and he is in no acute distress. His gait is slow, and he takes eight steps to turn. He has retropulsion (takes two steps backward when you pull him from behind). There is a resting tremor in both hands but more prominently in the right. You find cogwheel rigidity in both arms as well, but again more prominently displayed on the right. His cognitive screening tests are normal.

Question 1 of 10

The most likely diagnosis is:

 A - Essential tremor

 B - Parkinson disease

 C - Normal pressure hydrocephalus (NPH)

 D - Progressive supranuclear palsy

 E - Stroke 

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Julie Grishaw, ACNP

Senior Editor, McGraw-Hill Education