A 58 year old male is brought to the hospital by his wife because in the last 3 days he is having fever, chills and cough. The wife states that in the last 5 years the patient has been taking a medication for "tremors". Over these years he has developed difficulty in getting up from chairs and difficulty in initiating walking. She describes his gait as rigid, with small steps, the shoulders bent forward, the head flexed over the chest, and the arms hanging immobile at the sides. Lately he also has been very depessed and has difficulty swallowing food. The physical examination reveals: blood pressure 100/60, body temperature 104 F, heart rate 104 and respiratory rate 22. The physician also notes lack of facial expression, and very low and monotonous speech. The patient is hospitalized and the laboratory tests reveal:

Hgb 14 gm/l Hct 42.3% WBC 15.800 with 73% neutrophils, 21% lymphocytes and 4% monocytes, platelets 325.000

Glucose 82 mg/dl

Blood culture shows Streptococcus pneumoniae

The patient remains in the hospital for 3 days but he deteriorates and dies. At autopsy there is bronchopneumonia and the brain examination shows:

1- The cause of the tremors in this patient is:

A-Fever

B-Epilepsy

C-Depression

D-Parkinson’s disease

E-Anxiety

2- The medication this patient has been taking to treat the tremors is:

A-Lithium

B-Imipramine

C-Levodopa

D-Carbamazepine

E-None of the above

3-The symptoms of this disease include:

A-Rigidity

B-Tremors

C-Bradykinesis

D-Impaired postural reflexes

E-All of the above

4-The signs and symptoms in this disease are due to:

A-Increased Dopamine

B-Decreased Dopamine

C-Increased GABA

D-Decreased GABA

E-None of the above

5-The following may be a complication of this disease:

A-Orthostatic hypotension

B-Dysphagia

C-Depression

D-Dementia

E-All of the above

6-The cause of death in this patient is:

A-Parkinson’s disease

B-Bronchopneumonia

C-Acute myeloid leukemia

D-Chronic anemia

E-None of the above

7-The gross pathologic examination of this patient’s brain will show:

A-Shrunken and yellow mammillary bodies

B-Depigmentation of the substantia nigra and locus ceruleus

C-Hemorrhagic and necrotic mammillary bodies

D-Hyperpigmentation of the meninges

E-None of the above