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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
What condition should be ruled out in any patient \< 50 yo with a movement disorder and suspected Parkinsonism?
Wilson's disease
26
What diagnostic study should be ordered for any patient with a tremor?
Thyroid studies
27
What diagnostic study should be ordered for any patient with cognitive sxs, or functional neuro sxs?
Neuropsychometric testing
28
What diagnostic study should be ordered for any patient with mixed tremor disorders?
SPECT (DaTSCAN)
29
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**?
Sinemet (carbidopa, levodopa)
30
What are the SEs and long-term effects of tx with Sinemet (carbidopa/ levodopa)?
SE: nausea Long-term: motor fluctuations
31
What dopamine agonists are used in the tx of PD and when are they indicated?
Pramipexole, Ropinirole, Rotigotine \< 70 yo, mild sxs, dyskinesias
32
What are the SEs of dopamine agonists used in the tx of PD? Pramipexole, Ropinirole, Rotigotine
Sleepiness, nausea, orthostatic hypotension, hallucinations
33
How are PD pts started on tx with dopamine agonists? Pramipexole, Ropinirole, Rotigotine
6-8 week titration
34
What are possible tx options for dialorrhea in PD pts? (dialorrhea: excessive drooling/ salivation)
Robinul (caution in elderly- confusion) Botox
35
What are possible tx options for MCI or dementia in PD pts? (MCI: mild cognitive impairment)
Anticholinesterases
36
What are surgical tx options for PD?
Ablative MRgFUS (MRI guided focus US) Deep brain stimulation (bilateral)
37
What is the location for deep brain stimulation (DBS) if ET or tremor predominant PD?
Vim
38
What is the location for deep brain stimulation (DBS) if PD? (non-specific)
STN
39
What is the location for deep brain stimulation (DBS) if dystonia or rigidity prominent PD?
GPi
40
What are the indications for DBS surgery? (4)
Significant disability Motor fluctuations w/ max meds L-dopa responsive No cognitive impairment
41
How does the frequency of an essential tremor (ET) compare to a PD tremor?
ET: 4-11 Hz (higher frequency) PD: 4-7 Hz
42
What are the characteristics of an ET?
Bilateral UE's Rest tremor may develop later on May improve with EtOH/ worsen with caffeine
43
What is the non-pharmacologic tx for ET?
Wrist weights, weighted utensils
44
What meds are used for 1st and 2nd line tx of ET?
1st line: Propranolol, Primidone, Gabapentin 2nd line: Topiramate
45
What meds can be used as adjunct tx of ET?
Diazepam, Clonazepam Botox (head tremor)
46
What is the tx for a med refractory ET?
DBS of Vim
47
Restless leg syndrome (RLS) is defined as abnormal sensations with urge to the move the legs. When are sxs alleviated/ worse?
Alleviated by movement (occurs at rest) Worse at night
48
Neuropathy, Fe deficiency, pregnancy, and renal failure can be secondary causes of what condition?
RLS
49
How are pharmacologic tx options used for RLS?
Only at night in the beginning of disease course
50
What drug classes can be used in the tx of RLS?
**Dopamine agonists** Anti-epileptics Benzos- sleep Opioids
51
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)?
Carbidopa/ L-dopa
52
What etiologies should be ruled out for chorea?
Hereditary Metabolic Drug-induced Systemic disorders Infectious/ post-infectious Age-related
53
"Butterfly ventricles" noted on brain imaging/ eval is concerning for what condition?
Huntington's Disease (HD)
54
What is the classic triad a/w HD?
Motor (chorea) Cognitive Psychiatric (most disabling)
55
What is used for symptomatic tx of HD?
Anti-dopaminergic drugs (chorea) Benzodiazepines Anti-depressants
56
What type of disorder is semi-voluntary, suppressible, can be motor or phonic, and simple vs complex?
Tic disorder (simple- sniff, grunt, blink, complex- words, chewing, scratching)
57
What time frame is defined as a provisional vs chronic tic disorder?
Provisional: \< 1 yr then goes away Chronic: \> 1 yr
58
What type of tic disorder occurs after exposure to dopamine blocking agents?
Tardive tic
59
What conditions might be a/w a tic?
OCD, ADD
60
What is the tx for tics?
Clonidine Neuroleptics Benzos
61
Tourette's syndrome is a primary/ genetic cause of a tic. What is the DSM-5 criteria?
2+ motor tics AND 1+ phonic tics for \> 1 yr No secondary causes Onset before 18 yo Copralalia (\< 10%)
62
What is the tx for Tourette's syndrome?
Meds, botox, DBS (if severe, disabling)
63
How do you distinguish between primary generalized and primary focal dystonia?
Primary generalized- childhood onset Primary focal- adult onset
64
What is tx for dystonia?
**Botox** (no systemic sxs) DBS (if severe) (others: dopaminergic, muscle relaxers, benzos, anticholinergics)
65
Geste antagoniste (sensory trick) is most commonly a/w what type of dystonia?
Cervical focal
66
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?
Hemifacial spasm (HFS) Caused by CN VII compression
67
Bright light, wind, fatigue, stress, smiling, or speaking can be triggers for what condition?
Hemifacial spasm (HFS)
68
How is hemifacial spasm (HFS) diagnosed and what is the tx?
Dx w/ clinical and MRI Tx with Botox-A
69
Pt presenting with bizarre movements, exaggerated efforts, and distraction/ inconsistent movements is concerning for what?
Functional/ psychogenic movement disorder
70
What is the tx for functional/ psychogenic movement disorders?
Multidisciplinary approach

1. Clin Med III (29 decks)

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