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1. Clin Med III > 4- Movement Disorders > Flashcards

4- Movement Disorders Flashcards

1
Q

What type of movement is described as a state of restlessness?

A

Akathisia

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2
Q

What type of movement is defined as an inability to coordinate movements of the trunk/ limbs?

A

Ataxia

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3
Q

What type of movement is defined as involuntary writhing limb movements?

A

Athetosis

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4
Q

What type of movement is defined as flailing, ballistic, involuntary movements in a limb?

A

Ballism

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5
Q

What type of movement is defined as quick, involuntary, dance-like movements?

A

Chorea

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6
Q

What type of movements are defined as involuntary, chorea-like or tic-like?

A

Dyskinesias

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7
Q

What is defined as abnormal muscle tone with sustained posture?

A

Dystonia

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8
Q

What type of movement is defined as involuntary, spasmodic, jerky?

A

Myoclonus

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9
Q

What type of movement is defined as habitual, semi-voluntary, spasmodic, quick, and brief?

A

Tic

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10
Q

What type of movement is defined as involuntary, rhythmic, and repetitive?

A

Tremor

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11
Q

What is the 2nd most common neurodegenerative disease?

A

Idiopathic PD

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12
Q

What is the disease course of idiopathic PD?

A

Sx free for ~3 yrs after diagnosis

Major complications after ~5-7 yrs

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13
Q

What are the 4 cardinal features of idiopathic PD?

A

Rest tremor- unilateral

Rigidity- sustained through passive ROM

Akinesia-bradykinesia

Postural instability- stooping, retropulsion

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14
Q

Masked fascies, loss of manual dexterity, loss of spontaneous animation, and loss of associated movements are a/w with what feature/ disease?

A

Akinesia-bradykinesia

Idiopathic PD

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15
Q

In addition to the cardinal features of idiopathic PD, what other systems can be affected?

A

Motor, cognitive, psych, autonomic, sensory, sleep

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16
Q

What are the components of the unified PD rating scale (UPDRS)?

A

I- mentation, mood, behavior

II- ADL

III- motor exam

IV- therapy complications

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17
Q

What feature of drug-induced parkinsonism will differentiate it from PD?

A

Symmetric sxs

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18
Q

What feature of vascular disease will differentiate it from PD?

A

Gait disturbance and UMN findings

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19
Q

What feature of normal pressure hydrocephalus (NPH) will differentiate it from PD and what might be seen on MRI brain?

A

Apraxia of gait

Ventricular enlargement disproportionate to cerebral atrophy

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20
Q

What feature of corticobasal degeneration (CBS) will differentiate it from PD?

A

Cognitive disorder

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21
Q

What feature of progressive supranuclear palsy (PSP) will differentiate it from PD and what might be seen on MRI brain?

A

Early falls, poor L-dopa response

Hummingbird sign

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22
Q

What feature of multi-system atrophy (MSA) will differentiate it from PD and what might be seen on MRI brain?

A

Early autonomic features

Hot cross bun sign

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23
Q

What feature of dementia with lewy bodies (DLB) will differentiate it from PD?

A

Hallucinations, cognitive disorder

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24
Q

What is the imaging test of choice if you suspect Parkinsonism?

(gait disorder, falling, cognitive disorders)

A

MRI brain

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25
Q

What condition should be ruled out in any patient < 50 yo with a movement disorder and suspected Parkinsonism?

A

Wilson’s disease

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26
Q

What diagnostic study should be ordered for any patient with a tremor?

A

Thyroid studies

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27
Q

What diagnostic study should be ordered for any patient with cognitive sxs, or functional neuro sxs?

A

Neuropsychometric testing

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28
Q

What diagnostic study should be ordered for any patient with mixed tremor disorders?

A

SPECT (DaTSCAN)

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29
Q

What PD tx is used as a trial for all parkinsonism pts, is 1st line for pts > 70 yo and used as refractory tx in pts < 70 yo?

A

Sinemet (carbidopa, levodopa)

30
Q

What are the SEs and long-term effects of tx with Sinemet (carbidopa/ levodopa)?

A

SE: nausea

Long-term: motor fluctuations

31
Q

What dopamine agonists are used in the tx of PD and when are they indicated?

A

Pramipexole, Ropinirole, Rotigotine

< 70 yo, mild sxs, dyskinesias

32
Q

What are the SEs of dopamine agonists used in the tx of PD?

Pramipexole, Ropinirole, Rotigotine

A

Sleepiness, nausea, orthostatic hypotension, hallucinations

33
Q

How are PD pts started on tx with dopamine agonists?

Pramipexole, Ropinirole, Rotigotine

A

6-8 week titration

34
Q

What are possible tx options for dialorrhea in PD pts?

(dialorrhea: excessive drooling/ salivation)

A

Robinul (caution in elderly- confusion)

Botox

35
Q

What are possible tx options for MCI or dementia in PD pts?

(MCI: mild cognitive impairment)

A

Anticholinesterases

36
Q

What are surgical tx options for PD?

A

Ablative

MRgFUS (MRI guided focus US)

Deep brain stimulation (bilateral)

37
Q

What is the location for deep brain stimulation (DBS) if ET or tremor predominant PD?

A

Vim

38
Q

What is the location for deep brain stimulation (DBS) if PD?

(non-specific)

A

STN

39
Q

What is the location for deep brain stimulation (DBS) if dystonia or rigidity prominent PD?

A

GPi

40
Q

What are the indications for DBS surgery? (4)

A

Significant disability

Motor fluctuations w/ max meds

L-dopa responsive

No cognitive impairment

41
Q

How does the frequency of an essential tremor (ET) compare to a PD tremor?

A

ET: 4-11 Hz (higher frequency)

PD: 4-7 Hz

42
Q

What are the characteristics of an ET?

A

Bilateral UE’s

Rest tremor may develop later on

May improve with EtOH/ worsen with caffeine

43
Q

What is the non-pharmacologic tx for ET?

A

Wrist weights, weighted utensils

44
Q

What meds are used for 1st and 2nd line tx of ET?

A

1st line: Propranolol, Primidone, Gabapentin

2nd line: Topiramate

45
Q

What meds can be used as adjunct tx of ET?

A

Diazepam, Clonazepam

Botox (head tremor)

46
Q

What is the tx for a med refractory ET?

A

DBS of Vim

47
Q

Restless leg syndrome (RLS) is defined as abnormal sensations with urge to the move the legs. When are sxs alleviated/ worse?

A

Alleviated by movement (occurs at rest)

Worse at night

48
Q

Neuropathy, Fe deficiency, pregnancy, and renal failure can be secondary causes of what condition?

A

RLS

49
Q

How are pharmacologic tx options used for RLS?

A

Only at night in the beginning of disease course

50
Q

What drug classes can be used in the tx of RLS?

A

Dopamine agonists

Anti-epileptics

Benzos- sleep

Opioids

51
Q

What drugs should be avoided in the tx of RLS due to potential for rebound and augmentation (sxs earlier in day, pts awoken early in a.m. or sxs in arm)?

A

Carbidopa/ L-dopa

52
Q

What etiologies should be ruled out for chorea?

A

Hereditary

Metabolic

Drug-induced

Systemic disorders

Infectious/ post-infectious

Age-related

53
Q

“Butterfly ventricles” noted on brain imaging/ eval is concerning for what condition?

A

Huntington’s Disease (HD)

54
Q

What is the classic triad a/w HD?

A

Motor (chorea)

Cognitive

Psychiatric (most disabling)

55
Q

What is used for symptomatic tx of HD?

A

Anti-dopaminergic drugs (chorea)

Benzodiazepines

Anti-depressants

56
Q

What type of disorder is semi-voluntary, suppressible, can be motor or phonic, and simple vs complex?

A

Tic disorder

(simple- sniff, grunt, blink, complex- words, chewing, scratching)

57
Q

What time frame is defined as a provisional vs chronic tic disorder?

A

Provisional: < 1 yr then goes away

Chronic: > 1 yr

58
Q

What type of tic disorder occurs after exposure to dopamine blocking agents?

A

Tardive tic

59
Q

What conditions might be a/w a tic?

A

OCD, ADD

60
Q

What is the tx for tics?

A

Clonidine

Neuroleptics

Benzos

61
Q

Tourette’s syndrome is a primary/ genetic cause of a tic. What is the DSM-5 criteria?

A

2+ motor tics AND 1+ phonic tics for > 1 yr

No secondary causes

Onset before 18 yo

Copralalia (< 10%)

62
Q

What is the tx for Tourette’s syndrome?

A

Meds, botox, DBS (if severe, disabling)

63
Q

How do you distinguish between primary generalized and primary focal dystonia?

A

Primary generalized- childhood onset

Primary focal- adult onset

64
Q

What is tx for dystonia?

A

Botox (no systemic sxs)

DBS (if severe)

(others: dopaminergic, muscle relaxers, benzos, anticholinergics)

65
Q

Geste antagoniste (sensory trick) is most commonly a/w what type of dystonia?

A

Cervical focal

66
Q

What is defined as involuntary, intermittent spasm of half the face and begins initially in the periorbital muscles, and what are the majority of cases caused by?

A

Hemifacial spasm (HFS)

Caused by CN VII compression

67
Q

Bright light, wind, fatigue, stress, smiling, or speaking can be triggers for what condition?

A

Hemifacial spasm (HFS)

68
Q

How is hemifacial spasm (HFS) diagnosed and what is the tx?

A

Dx w/ clinical and MRI

Tx with Botox-A

69
Q

Pt presenting with bizarre movements, exaggerated efforts, and distraction/ inconsistent movements is concerning for what?

A

Functional/ psychogenic movement disorder

70
Q

What is the tx for functional/ psychogenic movement disorders?

A

Multidisciplinary approach

1. Clin Med III (29 decks)

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