Q75: Neurology: PLAB 1 /UK(MLA)/AKT Exam style question

UKMLA Exam Style Question 2026

Aug 18

Today we will discuss another Q75 Neurology PLAB 1/ UKMLA exam style question.

A 54-year-old woman visits her GP, complaining of increased difficulty with balance and coordination. Over the past year, she has noticed progressive clumsiness, including frequent trips and falls. Her husband reports that she has been increasingly slow in her movements and has developed a tremor in both hands. She's also been experiencing episodes of lightheadedness upon standing, along with urinary incontinence. She's been having difficulty swallowing recently, with an episode of choking on her food. On examination, she walks with a stooped posture and has impaired finger-nose coordination. She has soft, low-volume speech and exhibits a lack of facial expressions. What is the most likely diagnosis?

A. Huntington's disease

B. Cerebral palsy

C. Spinocerebellar ataxia

D. Multiple system atrophy

E. Alzheimer's disease

The answer is given below

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Explanation:

The correct answer is D

Multiple system atrophy (MSA) is a rare, adult-onset neurodegenerative disorder characterised by a combination of autonomic dysfunction, parkinsonism, and cerebellar ataxia. The autonomic dysfunction manifests as postural (orthostatic) hypotension and urinary incontinence, as seen in this patient. Parkinsonism presents with bradykinesia (slowness of movement), rigidity, tremor, and a stooped posture. The cerebellar ataxia is characterised by gait and limb ataxia, leading to impaired balance and coordination and dysarthria (difficulty articulating words due to problems with the muscles involved in speech). These combined features make MSA the most likely diagnosis in this case.

Huntington's disease typically presents with chorea (involuntary, jerky movements), psychiatric symptoms, and cognitive decline.

Cerebral palsy is a group of disorders affecting movement and muscle tone or posture caused by damage to the immature brain as it develops, most often before birth.

Spinocerebellar ataxia usually presents with coordination problems but lacks the autonomic dysfunction and parkinsonism seen in MSA.

Alzheimer's disease primarily affects memory, thinking, and behaviour and would not explain this patient's motor and autonomic symptoms

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References

Multiple system atrophy | Practical Neurology: This is a review article that provides a practical guide to diagnosing and managing multiple system atrophy (MSA). It explains the diagnostic criteria, the clinical features, the differential diagnosis, and the symptom management of MSA.
Multiple system atrophy (MSA) - Symptoms and causes: This is a Mayo Clinic webpage that describes the symptoms and causes of MSA. It also explains the types of MSA, the risk factors, the complications, and the diagnosis and treatment options.
Multiple System Atrophy - Physiopedia: This is a Physiopedia webpage that provides an overview of MSA. It covers the definition, epidemiology, etiology, pathophysiology, clinical presentation, diagnosis, outcome measures, management, differential diagnosis, and prognosis of MSA.

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