Mr. Shah is a 70-year-old male, retired schoolteacher.

He presents with 2-
months history of “weird movements” in his right hand. He also reports a
change in his handwriting starting 6 months ago and the banks not
accepting his checks as his signature looks different.

1: If you were to elicit a ten-minute focused history from this patient, what other
information would you want to gather?

2: Video 1-Patient interview-History taking:

a. What were the salient points in the history you just observed in the video?

b. What other information would you specifically ask in the history based on the
mnemonic, “‘OLD CARTS”?
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3: Video 2 A & 2 B Physical examination including gait

a. What were the salient points in the physical examination you observed in the video?

b. What is your most likely diagnosis? What is your differential?

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4: Pharmacological treatment
How would you treat this patient?

5: Video 3 (Treatment outcome-1) This patient has been on treatment for 6-months
Note down the observations in the patient. Does his condition appear better following the
treatment?

6: Video 4 (Long-term treatment outcome-2) Patient has continued with the medication with
a stepped up dosage for an extended period when he visited England.
a. The patient has been on long-term treatment. What are your salient observations?

b. How do you manage the condition?

c. Discuss the pathological findings to confirm the diagnosis of the disorder.

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