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IM19.1-8 | Movement Disorders — Assignment
CLINICAL SCENARIO
This assignment requires you to produce a structured neurological assessment report for a patient presenting with a movement disorder, based on a real or simulated clinical encounter during your General Medicine posting. You will document a systematic history and examination, construct a differential diagnosis with an anatomical formulation, select and justify appropriate investigations, and outline a pharmacological management plan aligned to the patient's most likely diagnosis. The report should demonstrate your ability to translate the movement disorder classification framework into actionable clinical reasoning.
Instructions
Write a structured clinical report in the five sections below. Use professional clinical language and name all neurological signs correctly. Do not copy SDL text verbatim — demonstrate your clinical reasoning by integrating history, examination, and pathophysiology. Support each differential with specific evidence from your assessment, not generic descriptions. Your pharmacological plan should reference a drug by its specific name (not just drug class) and include mechanism and adverse effects specific to its use in movement disorders. Word limit: 1,100–1,500 words.
Length: 1,100–1,500 words across all sections
What to Submit
Section 1: Phenomenological Classification of the Movement Disorder
Guidance: Identify the phenomenological category of your patient's primary movement abnormality using the classification framework from the Movement Disorder Foundations SDL. State: (a) the activation condition (rest, posture, action, intention); (b) whether the movement is rhythmic or arrhythmic; (c) whether it is repetitive/stereotyped or random; (d) whether it is suppressible; and (e) which phenomenological class it belongs to (tremor subtype, chorea, dystonia, myoclonus, tics, bradykinesia/hypokinesia). Explain in 2–3 sentences which component of the motor circuit is most likely disrupted and why. Approximately 150 words.
Section 2: Structured History and Neurological Examination
Guidance: Document a structured history using the six-component framework: (1) onset and mode of progression (insidious/subacute/acute), (2) precipitating, aggravating, and relieving factors including rest vs action and medication timing, (3) the activation condition of the movement (what makes it appear and what suppresses it), (4) drug history (specifically dopamine-blocking or prokinetic drugs, antipsychotics, antiemetics, levodopa), (5) family history, and (6) functional impact on daily activities. Then describe your neurological examination findings, naming at least four specific signs using correct clinical terminology (e.g., cogwheel rigidity, festination, geste antagoniste, pill-rolling tremor, hypomimia). If applicable, name the rating scale most appropriate to quantify severity for your patient's condition. Approximately 350 words.
Section 3: Differential Diagnosis and Anatomical Formulation
Guidance: Construct a ranked differential diagnosis of at least THREE conditions. For each: (a) state its name, (b) list the features in your patient that SUPPORT this diagnosis, and (c) list any features that argue AGAINST it. Conclude this section with a concise anatomical formulation: state the anatomical location of the dysfunction (e.g., basal ganglia nigrostriatal pathway; cerebellum; upper motor neuron), the nature of the lesion (degenerative, structural, drug-induced, immune-mediated, metabolic), and the pathophysiological mechanism linking the lesion to the clinical phenotype. Approximately 250 words.
Section 4: Investigations and Pharmacological Management Plan
Guidance: Select the TWO MOST IMPORTANT investigations for your patient's leading differential diagnosis. For each: (a) name the investigation, (b) explain precisely what you expect it to show in your leading diagnosis versus the main alternative, and (c) state how the result would change your management. Then outline a pharmacological management plan for your leading diagnosis: name the drug class and a specific drug, state its mechanism of action in 1–2 sentences, identify two important adverse effects or drug interactions that are specific to that drug in your patient's context (e.g., wearing off and dyskinesias for levodopa; serotonin syndrome risk for MAO-B inhibitors with serotonergic drugs; copper chelation monitoring for D-penicillamine in Wilson's). Approximately 300 words.
Section 5: Critical Reflection on the Clinical Assessment
Guidance: Identify ONE specific clinical finding from your examination (a named sign) that most influenced your differential diagnosis — explain how and why it shifted your thinking. Then identify ONE investigation result that, if it returned differently from what you expect, would most change your management plan — and explain what the alternative result would be and how you would respond. Keep this section concise and specific; avoid generic statements like 'it was a good learning experience.' Approximately 150 words.
Grading Rubric — Movement Disorder Structured Assessment Report Rubric
| Criterion | Points | Full-marks descriptor |
|---|---|---|
| Phenomenological Classification (Section 1): Correctly identifies the phenomenological category of the movement disorder (hypokinetic vs hyperkinetic; rest/postural/kinetic/intention tremor; chorea/dystonia/myoclonus/tics) using standard criteria and explains the neuroanatomical basis of the classification. | 15 pts | Phenomenological category named precisely with all defining features stated (activation condition, rhythm, repetition, suppressibility, direction); correct neuroanatomical circuit assigned with clear mechanistic explanation. |
| Structured History and Examination (Section 2): Documents a systematic history using the six-component framework (onset/progression, precipitating/aggravating/relieving factors, activation condition of movement, drug history, family history, functional impact) AND a structured neurological examination with at least four specific findings relevant to the movement disorder using named rating scale where applicable. | 25 pts | All six history components documented with specific entries; at least four examination findings named using correct clinical terminology; appropriate rating scale cited (UPDRS/MDS-UPDRS for PD, Unified Dystonia Rating Scale, YGTSS for tics, SARA for ataxia). |
| Differential Diagnosis and Anatomical Formulation (Section 3): Constructs a ranked differential diagnosis with at least three conditions; for each, states the supporting and refuting features from the history and examination; provides a concise anatomical formulation naming the anatomical location of dysfunction and the nature of the lesion. | 20 pts | Three differential diagnoses ranked with supporting AND refuting features for each; anatomical formulation names location (basal ganglia, cerebellum, UMN, etc.), nature (degenerative, inflammatory, drug-induced, structural), and mechanism; demonstrates genuine clinical reasoning. |
| Investigations and Management Plan (Section 4): Selects and justifies investigations appropriate to the leading differential (including correct imaging modality with rationale); outlines a pharmacological management plan with drug name, dose class, mechanism, and at least two side effects or interactions specific to that drug class. | 25 pts | Investigation justified by clinical question (e.g., DAT-SPECT for PD vs ET, MRI brain for secondary cause, serum ceruloplasmin for young patient); pharmacological plan names at least one drug with mechanism, dose class, and at least two specific adverse effects or drug interactions (e.g., levodopa dyskinesias and wearing off; MAO-B inhibitor interaction with linezolid). |
| Reflection on Clinical Evaluation (Section 5): Demonstrates genuine critical reflection on the diagnostic process — identifying one specific clinical finding that most influenced the differential diagnosis and one investigation result that would change the management plan, with clear reasoning. | 15 pts | Specific clinical finding named with precise explanation of its diagnostic influence; investigation result and management change explained with mechanistic reasoning; reflection is personal and credible, not generic. |
PEER REVIEW
Review your peer's movement disorder assessment report using the rubric. For each section, assign a score and write one specific comment explaining your assessment — do not copy the rubric descriptor verbatim. For Section 1 (Phenomenological Classification): verify that the activation condition is correctly named (rest vs postural/kinetic vs intention) and that the circuit assignment is mechanistically sound. For Section 3 (Differential Diagnosis): check that each differential has both supporting AND refuting features — a differential with only supporting features does not demonstrate clinical reasoning. For Section 4 (Investigations): verify that the investigation chosen is appropriate to distinguish between the top differentials (e.g., DAT-SPECT for PD vs ET, not generic MRI). Submit your peer review within 72 hours.