Movement Disorders, Neurodegenerative Diseases, and Dementia — WACS Viva & Clinical Scenarios (Neurology)

Exam-style movement disorders, neurodegenerative diseases, and dementia viva scenarios with examiner probes and model answers for Internal Medicine candidates.

Scenarios covered

• SCENARIO 1: A 64-year-old retired civil servant presents with a 14-month history of progressive slowness of movement, resting tremor in the right hand that worsens during stress, stiffness in the limbs, and recurrent falls occurring over the past 3 months. Physical examination reveals asymmetric cogwheel rigidity, masked facies, hypophonia, and an impaired postural pull test.
• SCENARIO 2: A 71-year-old woman is brought to the medical outpatient clinic by her family due to a 2-year history of progressive memory loss, spatial disorientation, difficulty managing finances, and episodes of nocturnal wandering. Baseline Mini-Mental State Examination score is 18/30.
• SCENARIO 3: A 58-year-old teacher presents with progressive weakness and muscle wasting in the right upper limb, spreading to the left arm over 8 months, accompanied by visible muscle twitching, swallowing difficulties, and emotional lability. Sensation is entirely intact.
• SCENARIO 4: A 24-year-old university student is referred with progressive dysarthria, abnormal posture of the left hand, behavioral changes, emotional blunting, and declining academic performance. Routine liver function tests reveal mildly elevated transaminases.
• SCENARIO 5: A 68-year-old hypertensive patient presents with acute-onset involuntary, large-amplitude, violent flinging movements of the right upper and lower limbs. Brain neuroimaging demonstrates an acute lacunar infarction.