#february2020mccqe1
A 62-year-old woman with a history of depression and hypertension presents complaining of recurrent falls over the past 6 months. She had been having difficulty with complex tasks at work and was recently asked to leave. On examination, her mental status is unremarkable. Her cranial nerve examination is notable for limited downward gaze. She has prominent, symmetric bradykinesia with more axial than limb rigidity. There is no resting tremor. Her gait is stiff with “en bloc” turning. Reflexes are normal, with downgoing toes. An MRI of the brain is read as showing a small lacunar infarct in the left putamen. She has recently been started on L-dopa/carbidopa but has had little to no improvement in her symptoms. Which of the following is the most likely diagnosis?
(A) Basal ganglia stroke
(B) Carbon monoxide poisoning
(C) Cervical stenosis
(D) Parkinson disease
(E) Progressive supranuclear palsy
A 62-year-old woman with a history of depression and hypertension presents complaining of recurrent falls over the past 6 months. She had been having difficulty with complex tasks at work and was recently asked to leave. On examination, her mental status is unremarkable. Her cranial nerve examination is notable for limited downward gaze. She has prominent, symmetric bradykinesia with more axial than limb rigidity. There is no resting tremor. Her gait is stiff with “en bloc” turning. Reflexes are normal, with downgoing toes. An MRI of the brain is read as showing a small lacunar infarct in the left putamen. She has recently been started on L-dopa/carbidopa but has had little to no improvement in her symptoms. Which of the following is the most likely diagnosis?
(A) Basal ganglia stroke
(B) Carbon monoxide poisoning
(C) Cervical stenosis
(D) Parkinson disease
(E) Progressive supranuclear palsy
