Question 12

(Source: Professor Yasser Metwally, 2008)

83 year old woman is brought to the clinic with abnormal movements of hand. She complains that she has difficulty in walking and doing things for some months. She denies any history of fever or neck stiffness. She has a past history of DM, HTN, Rheumatoid arthritis for several years. She is taking metformin, thiazide, aspirin and multivitamin daily. She lives with her son and daughter in law since her husband passed away 7 years ago and says that her kids are "very caring" and nice to her. During the interview, the physician notes that she shows no affect while talking, and her hands are constantly shaking. Her memory appears to be intact. When asked to walk she walks with a typical gait as shown above in the media. An appropriate diagnosis is made and treatment is begun. What is the pathophysiology of the disease under consideration?

A) Trinucleotide repeat
B) Degeneration of Substantia Nigra
C) Decreased Dopamine and increased Acetylcholine
D) Copper deposition
E) Iron deposition
F) Drug induced
G) Old age changes

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Question 11

Source: Professor Yasser Metwally, 2008)

An 85 year old male patient is brought to the clinic from the nursing home with symptoms of abnormal movement. He has recently completed a course for Tubeculous meningits for 9 months. He has no neck stiffness or fever. The neurological examination shown above in the media suggests a lesion in the brain which may be due to previous TB infection. Most likely, where should be the lesion located?

A) Occipital Lobe
B) Wernickes area
C) Brocas area
D) Subthalamic nuclei
E) Cerebeller tonsils
F) Cardiac vegetations
G) Trinucleotide repeat disorder in caudate

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