Welcome to your 5. 🧠 Movement Disorders, Parkinson's Disease, Ataxia, Headache & Migraine Arena — 40 Integrated MCQs
1.
A 46-year-old woman with recurrent migraine has recently experienced frequent disabling attacks. She is started on amitriptyline for prevention. At follow-up, she complains of excessive daytime sleepiness and dry mouth. Which pharmacological property most likely explains these symptoms?
2.
A 69-year-old man with Parkinson's disease reports that his walking becomes severely impaired in crowded places and when approaching doorways. He describes episodes in which his feet seem stuck to the floor despite wanting to move. Examination also reveals a shuffling gait and reduced arm swing. Which intervention is most appropriate alongside optimization of medical treatment?
3.
A 30-year-old woman presents with a new severe headache two weeks after delivery. Her previous headaches were mild and infrequent. She now describes a progressively worsening headache with blurred vision. Blood pressure is markedly elevated. Which clinical decision is most appropriate?
4.
A 38-year-old woman with recurrent migraine attends primary healthcare because of increasing headaches. She has normal neurological findings but reports using several different analgesics frequently. The clinician suspects that her medication use contributes to the increased headache burden. Which management strategy is most appropriate?
5.
A 10-year-old child has recurrent headaches that interfere with school attendance. The attacks are accompanied by nausea, and the child prefers to sleep during episodes. Neurological examination is normal. Compared with adults, which feature of pediatric migraine is particularly important when interpreting this presentation?
6.
A 24-year-old man receiving haloperidol for an acute psychiatric illness develops painful neck spasms and sustained jaw contractions. He receives appropriate parenteral treatment, and his symptoms resolve rapidly. The treating physician is planning ongoing psychiatric management. Which next step is most appropriate to reduce recurrence?
7.
A 27-year-old woman receives metoclopramide for persistent vomiting and develops sudden involuntary upward eye deviation, neck muscle spasm, and intense distress. Her consciousness remains normal. A colleague initially suspects a behavioral reaction. Which clinical finding most strongly supports an acute medication-related dystonic reaction?
8.
A 32-year-old woman with a five-year history of migraine now reports increasing attack frequency and reduced ability to work. Her neurological examination is normal, and her symptoms remain typical of migraine. Which additional information is most useful before deciding on preventive treatment?
9.
A 50-year-old man presents with progressive gait unsteadiness and difficulty coordinating hand movements. Examination shows dysmetria and intention tremor. He is taking several long-term medications, including an antiseizure drug. Laboratory investigations reveal no significant metabolic abnormality. Which component of clinical assessment is particularly important before diagnosing a primary degenerative cerebellar disorder?
10.
A 51-year-old patient with Huntington's disease has severe involuntary movements that interfere with eating and walking. Tetrabenazine is being considered. His psychiatric history reveals a recent episode of severe depression accompanied by suicidal thoughts. Which factor most strongly affects the safety of this treatment choice?
11.
A 39-year-old woman develops increasingly frequent headaches. She reports using sumatriptan on approximately 13 days per month for four consecutive months. Her headache is now present on most days. Which mechanism best explains the worsening pattern?
12.
A 44-year-old woman with migraine is prescribed sumatriptan after inadequate relief with simple analgesics. Which pharmacological action is most directly responsible for its therapeutic effect?
13.
A 62-year-old man receiving levodopa/carbidopa develops increasingly short periods of satisfactory mobility. His neurologist adds entacapone. During follow-up, the patient develops more frequent involuntary movements. Which explanation best accounts for this observation?
14.
A 65-year-old man with established Parkinson's disease has been taking levodopa/carbidopa for six years. He develops irregular involuntary movements involving his trunk and limbs, particularly when his mobility is at its best after medication. These movements interfere with eating and dressing. Which mechanism most likely explains this complication?
15.
A 58-year-old man presents with progressive gait difficulty and stiffness. Examination reveals symmetrical bradykinesia and rigidity. He has experienced several unexplained falls within the first year of symptoms and has marked difficulty moving his eyes vertically. His response to levodopa has been poor. Which interpretation is most appropriate?
16.
A 76-year-old man with advanced Parkinson's disease has progressive difficulty swallowing, a weak voice, frequent coughing during meals, and unintentional weight loss. His daughter is concerned that he may develop pneumonia. Which management intervention should be prioritized to reduce an important preventable complication?
17.
A 31-year-old woman reports headaches on 18 days each month for the last five months. On approximately 10 days each month, the headache is accompanied by nausea, photophobia and worsening with physical activity. Neurological examination is normal. She does not regularly use analgesics. Which classification best describes her headache disorder?
18.
A 57-year-old man develops sudden severe dizziness, vomiting, and inability to walk without support. Examination demonstrates marked limb incoordination and nystagmus. Initial CT imaging does not reveal a definite abnormality. The physician remains concerned about an acute posterior circulation infarction. Which investigation is most appropriate to improve diagnostic detection?
19.
A 71-year-old man presents with progressive slowness of walking, reduced facial expression, and difficulty performing daily activities over three years. He has bilateral rigidity and bradykinesia. His daughter reports that he has recently developed visual hallucinations and difficulty remembering appointments. The physician is considering treatment adjustments. Which factor is most important when selecting additional dopaminergic therapy?
20.
A 36-year-old man presents with a sudden severe headache that reached maximum intensity within 30 seconds. Non-contrast CT brain shows no hemorrhage, but the clinician remains concerned about subarachnoid hemorrhage because the scan was obtained well after headache onset. Which is the most appropriate next management principle?
21.
A 47-year-old man presents with progressive involuntary movements, impaired concentration, irritability, and declining occupational performance. His father had a similar progressive illness. Huntington's disease is suspected. Which approach is most appropriate before proceeding with confirmatory genetic testing?
22.
A 68-year-old man with Parkinson's disease undergoes emergency abdominal surgery. During hospitalization, his regular antiparkinsonian medication is unintentionally omitted for two days. He subsequently develops severe generalized rigidity, fever, confusion, and autonomic instability. Which management principle is most appropriate?
23.
A 19-year-old woman presents with irregular involuntary movements of the limbs several weeks after an episode of sore throat. Examination reveals unpredictable choreiform movements, emotional lability, and difficulty maintaining a sustained hand grip. The physician suspects an immune-mediated movement disorder. Which associated condition should be evaluated?
24.
A 33-year-old woman presents to the emergency department with a severe migraine attack. She has already taken an appropriate acute medication but remains uncomfortable. She is alert, neurologically intact and hemodynamically stable. Which additional intervention is generally inappropriate for routine migraine treatment because of dependence and medication-overuse risks?
25.
A 45-year-old man develops progressive unsteadiness and slurred speech over several months. Neurological examination reveals gaze-evoked nystagmus, intention tremor, and poor coordination of voluntary movements. MRI demonstrates cerebellar volume loss. His history reveals long-standing excessive alcohol consumption. Which mechanism best explains his neurological findings?
26.
A 41-year-old woman has migraine attacks three times weekly. She has been prescribed sumatriptan and regularly takes it during attacks. Her medical history reveals a previous myocardial infarction treated with coronary stenting. Which aspect of her treatment requires particular reconsideration?
27.
A 63-year-old woman presents with difficulty maintaining balance and walking steadily. Examination reveals gait ataxia, reduced vibration and position sense in both feet, and impaired lower limb reflexes. Her balance deteriorates considerably when visual guidance is removed. Which investigation would be particularly relevant to identifying a potentially treatable underlying cause?
28.
A 74-year-old patient with Parkinson's disease has disabling tremor despite treatment. The physician considers adding trihexyphenidyl. However, the patient has significant memory impairment, chronic constipation, and urinary hesitancy. Which decision is most appropriate?
29.
A 25-year-old woman with migraine begins preventive treatment with topiramate. During counselling, she mentions that she is planning pregnancy. Which management consideration is most important?
30.
A 29-year-old woman presents to a family medicine clinic with recurrent headaches that are gradually becoming more frequent. She has no neurological deficits or systemic symptoms. The clinician plans ongoing management in primary healthcare. Which approach best reflects appropriate continuity of care?
31.
A 30-year-old woman has disabling migraines and requires preventive treatment. She has a history of bronchial asthma requiring regular inhaled medication. Which preventive drug would be less appropriate because of her comorbidity?
32.
A 37-year-old woman has recently started preventive treatment for frequent migraine. After ten days, she reports that attacks still occur and wishes to stop treatment. She has no significant adverse effects. Which counselling principle is most appropriate?
33.
A 35-year-old woman develops progressive shimmering visual symptoms over 15 minutes, followed by a typical migraine headache. The neurologist explains that the visual disturbance is related to a temporary wave of altered cortical neuronal activity. Which process is most closely associated with this phenomenon?
34.
A 73-year-old woman with Parkinson's disease complains of dizziness when standing and has recently experienced two falls. Her blood pressure decreases significantly on standing. She is receiving levodopa/carbidopa and a dopamine agonist. Which management approach is most appropriate?
35.
A 54-year-old man has progressive cerebellar ataxia with a broad-based gait, impaired coordination, and frequent falls. Investigation suggests a chronic degenerative cerebellar condition without an available disease-modifying treatment. Which management plan is most appropriate?
36.
A 34-year-old woman describes gradually expanding shimmering visual disturbances followed by a headache. During one episode, the visual disturbance persists for several hours rather than resolving within her usual 20 minutes. What is the most appropriate interpretation?
37.
A 59-year-old woman develops progressive gait instability and repeated falls. Examination reveals impaired finger-to-nose and heel-to-shin coordination on the right side, while the left limbs are relatively unaffected. Muscle strength is preserved. Which anatomical localization is most consistent with these findings?
38.
A 43-year-old woman develops a new progressive headache associated with vomiting. Fundoscopy shows bilateral papilledema. A junior doctor suggests performing lumbar puncture immediately to investigate the headache. Which is the most appropriate next step?
39.
A 13-year-old boy with recurrent migraine has increasingly frequent headaches. His parents request stronger medication. Further history reveals irregular sleep, excessive screen time, skipped breakfast and frequent use of painkillers. Which management approach is most appropriate?
40.
A 27-year-old woman experiences recurrent attacks of headache associated with nausea and sensitivity to light and sound. During an attack, she prefers to lie still because walking worsens the pain. The headache is bilateral and non-pulsating. Which feature most strongly supports migraine rather than tension-type headache?
