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MS3 Neurology > Case Files > Flashcards

Case Files Flashcards

1
Q

What is the next diagnostic step when essential tremor is suspected?

A

MRI of brain and spine

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2
Q

What are the suggested therapies for essential tremor?

A

Primidone, Propranolol

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3
Q

What part of the brain shows increased activity on PET scan in people with essential tremor?

A

The thalamus

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4
Q

The tremors of what condition can be mistaken for essential tremor?

A

Hyperthyroidism

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5
Q

When are botox injections indicated in the treatment of essential tremor?

A

Tremors of the head and voice

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6
Q

What is the next diagnostic step when Huntington’s is suspected?

A

Genetic counseling for HD;
ANA, electrolytes, r/o illicit drugs or poisoning, glucose level, creatnine level, HIV test, RPR, TSH level, B12 level;
MRI scan

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7
Q

What is the pathology behind HD?

A

Trinucleotide CAG repeats in huntingtin gene, chromosome 4;
>40 - always HD
26-39 - sometimes HD

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8
Q

What is athetosis?

A

Twisting and writhing movements associated with chorea

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9
Q

What is dystonia?

A

Sustained muscle contractions cause twisting and repetitive movements or abnormal postures

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10
Q

What is tardive dyskinesia?

A

Neurologic disorder caused by the long term and/or high dose use of dopamine antagonists, usually antipsychotics and among them, especially the classic antipsychotics

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11
Q

What other signs and symptoms are associated with HD?

A

Depression, anxiety, executive function impairment, subcortical dementia, behavioral disinhibition

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12
Q

How does HD present in children?

A

The Westphal variant, about 5% of HD, presents in children with Parkinsonian like movements, ie bradykinesia and rigidity

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13
Q

HD involves degeneration of what parts of the brain?

A

Head of the caudate nucleus and putamen

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14
Q

When generalized dystonia is suspected, what is the next diagnostic step?

A

MRI of the brain

Therapy is deep brain stimulation of the globus pallidus and pars interna

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15
Q

What is dystonia?

A

Sustained muscle contractions that cause twisting and repetitive movements or abnormal postures

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16
Q

What is myoclonus?

A

Sudden, involuntary jerking of a muscle or group of muscles

17
Q

What IS opisthotonos?

A

Great rigid spasm of the body with the back fully arched and heels and head bent back

18
Q

Generalized dystonia tends to begin when?

A

In childhood;
DYT-1;
Large phenotypic variability

19
Q

What is the pharmacologic therapy for dystonia?

A

levodopa;
central antimuscarinic agents ie trihexyphenidryl;
baclofen;
benzodiazepines

20
Q

What can be administered to combat an acute dystonic reaction caused by haloperidol?

A

Diphenhydramine (25-50 mg IV)

21
Q

What is the inheritance pattern of DYT-1?

A

AD

22
Q

What is the next diagnostic step when Parkinson’s is suspected?

A

MRI to r/o other causes of asymmetric tremor etc.

23
Q

What are the main symptoms of PD?

A

Tremor at rest;
Hypokinesia;
Rigidity;
Postural instability

24
Q

What are the signs of PD on pathology?

A

Loss of pigment in the substantia nigra;

Eosiniphilic inclusion bodies (Lewy bodies) in substantia nigra

25
Q

What cerebellar disorder mimics PD?

A

Multiple system atrophy, MSA - less tremor, symmetric

26
Q

What cerebellar disorder mimics PD?

A

Multiple system atrophy, MSA - less tremor, symmetric

27
Q

Name the dx:

Unilateral coarse tremor, rigidity, increased reflexes, limb apraxia, limb dystonia, alien limb phenomenon

A

Corticobasal ganglionic degeneration;

can mimic PD

28
Q

Name the dx:

Early frequent falls, upward posture, inability to look down (suprenuclear downgaze palsy)

A

Progressive supranuclear palsy

29
Q

When are entacapone and tolcapone used?

A

COMT inhibitors - prevent peripheral degradation of levodopa

30
Q

When are pramipexole, ropinirole and bromocriptine used?

A

D2 agonists used in the tx of PD;
cross BBB;
act primarily as D2-like receptors

31
Q

When are MAO-B inhibitors such as selegiline and rasagiline used?

A

Can be used as monotherapy in mild PD;

Can be added to a regimen for patients already on levodopa therapy

32
Q

What medications are used to combat tremor in PD?

A

Anticholinergics such as diphenhydramine and trihexyphenidyl

33
Q

How does amantadine work?

A

NMDA receptor blocker;
tx for levodopa-induced dyskinesia;
mild attenuation of the cardinal symptoms of resting tremor and dystonia

34
Q

What is the recommended treatment for dyskinesia seen in PD, especially with younger patients who will be on pharmacotherapy for a long time?

A

DBS

35
Q

What medications can cause drug-induced PD?

A

Antiemetics - dopamine receptor blockers - prochlorperazine, metoclopramide;
Dopamine-depleting agents - tetrabenazine, reserpine;
atypical antipsychotic agents

MS3 Neurology (9 decks)

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