Which condition presents with pill-rolling tremor, cogwheel rigidity, and bradykinesia?

• A. Acute akathisia
• B. Acute pseudo parkinsonism
• C. Benadryl adverse effects
• D. Cardiovascular effects (Anticholinergics)

Answer: (B)

Parkinsonism is characterized by a resting tremor (often described as pill-rolling), cogwheel rigidity, and bradykinesia. When these signs develop after starting a medication that blocks dopamine in the nigrostriatal pathway, they point to drug-induced parkinsonism, historically called acute pseudo parkinsonism. This pattern is distinct from acute akathisia, which mainly causes inner restlessness and the urge to move rather than a tremor with rigidity; anticholinergic-related effects like Benadryl adverse effects or cardiovascular anticholinergic effects don’t produce the classic Parkinsonian triad. So the combination of pill-rolling tremor, cogwheel rigidity, and bradykinesia is best explained by acute pseudo parkinsonism due to drug-induced dopamine blockade.