Chapter 24. Movement Disorders: Diagnosis and Assessment Flashcards
Question 24-1:
Which of the following is not a typical clinical feature of tardive dyskinesia?
A. Repetitive stereotypic movements of the mouth
B. Inability to voluntarily suppress the movements
C. Facial movements are mainly of the lower face
D. Gait is usually normal
Answer 24-1: B.
Tardive dyskinesia is under voluntary control
in that it can be suppressed temporarily. When
the patient loses concentration the suppression
is lost. Repetitive stereotypic movements of
the mouth are expected, and the facial
movements involve mainly the lower face.
Gait is usually normal, though gait difficulty
can be seen
Question 24-2:
Which of the following features are true of primary writing tremor?
A. Action tremor particularly exacerbated by writing
B. Tremor with writing associated with dystonic posturing
C Tremor which affects only writing and not other tasks and movements
D. Unusually loose grip on a pen
Answer 24-2: C.
Primary writing tremor is associated with
tremor while writing in the absence of other
signs of movement disorder such as dystonia
or tremor with other tasks. Patients often grip
the pen excessively tightly to dampen the
tremor, however, this is not a dystonia -
dystonic writer cramp is a separate disorder.
Question 24-3: A patient reports tremor when eating and writing, but has no tremor at rest. Muscle tone is not increased, and there is no alteration in station or gait. Which is the most likely diagnosis? A. Essential tremor B. Parkinson's disease C. Orthostatic tremor D. Tardive dyskinesia
Answer 24-3: A.
Essential tremor is the most common tremor
and of higher incidence than tremor from
Parkinson’s disease: The tremor is not present
at rest, rather is present with fine activities
such as writing or eating. Parkinson’s tremor
is typically seen at rest, and abates with
activity of the hand. Orthostatic tremor is a
tremor of the legs upon standing. Tardive
dyskinesia is stereotypic movement which can
be inhibited with effort
Question 24-4: Which of the following is not a feature of early Parkinsonism? A. Rigidity B. Bradykinesia C. Resting tremor D. Motor fluctuations
Answer 24-4: D.
Motor fluctuations are seen more in patients
with long-standing parkinsonism rather than
early in the disease. Early on. rigidity,
bradykinesia and resting tremor are conunon,
although not all are present and the symptoms
are commonly markedly asymmetric
Question 24-5:
Which of the following best described the speech difficulty in patients with Parkinson’s disease?
A. Palilalia
B. Slurred speech with decreased volume
C Stuttering speech with defective prosody and inappropriate pauses
D. Fluent sounding speech devoid of content
Answer 24-5: B.
Patients with Parkinson’s disease typically
have slurred speech with loss of volume.
Palilalia can be seen in PD, but this is
uncommon and when present early in the
disease suggests alteinative diagnosis
including PSP or MSA. Defective prosody
and inappropriate pauses suggest a cerebellar
lesion. Fluent speech devoid of content is
typical of Wernicke’s aphasia
Question 24-6: A young adult patient presents with dystonia and is found on examination to have supranuclear ophthalmoplegia. Laboratory studies indicate a lactic acidosis, Which is the most iikely diagnosis? A. Leigh's disease B. SCA C Lesch-Nyhan syndrome D. Ataxia telangiectasia
Answer 24-6: A.
Leigh’s disease is a disorder of mitochondrial
metabolism which can be characterized by
dystonia, ocular motor defects including
nuclear and supranuclear abnormalities,
retinal disease, and lactic acidosis. The other
listed conditions can produce dystonia, but
they are less likely to produce the other
fmdings, especially the lactic acidosis
Question 24-7:
Which of the following statements about Parkinson’s disease are true?
1. Observation of Keyser-Fleischer rings on the cornea confirm the diagnosis
2. Handwriting becomes smaller and slower
3. Marked voice changes are common early in the course
4.Motor findings are commonly asymmetric early in the course
Select A= 1,2.3. B = 1.3. C=2.4. D = 4 only. E= All
Answer 24-7: C.
Patients with Parkinson’s disease have
handwriting which becomes slower, smaller,
and more effortful. Whereas these writing
changes are common early, prominent voice
changes are a later occurrence, and when
present nearly suggest consideration of
alternative diagnoses. Motor findings are
commonly asymmetric early in the course,
which often prompts search for a structural
lesion. Keyser-Fleischer rings are seen in
Wilson’s disease rather than Parkinson’s
disease.
Question 24-8:
Which of the following features would be expected in patients with progressive suprauuclear palsy?
1. Lewy bodies
2. Motor neuron degeneration
3. Prominent tremor
4. Eyelid apraxia
Select : A = 1.2.3. B = 1.3. C = 2.4. D = 4 only. E = All
Answer 24-8: D.
PSP is characterized by rigidity and
bradykinesia which suggests parkinsonism,
but there is typically no tremor, and eyelid
apraxia is observed. Dementia is common.
The movement disorder does not respond to
L-dopa as does PD. lewy bodies are seen in
PD and dementia with lewy bodies and
variably in patients with other disorders,
though they are not seen in patients with PSP.
Question 24-9:
Which of the following helps to differentiate corticobasal degeneration from other causes of rigidity and bradykinesia?
1. Alien limb syndrome
2. Motor neuron degeneration
3. Limb apraxia
4. Absence of ataxia
Select: A = 1.2.3. B = 1. 3. C = 2. 4. D = 4 only. E = All
Answer 24-9: B.
CBD is characterized by rigidity and.
bradykinesia along with gait ataxia. Dystonia
and myoclonus are common. Differentiating
features include the alien limb syndrome,
where the limb seems to have its own
intention, and limb apraxia which is not
typical of any of the other Parkinsonism-plus
syndromes
Question 24-10:
Which of the following conditions shows Lewy bodies on pathological examination?
1. Dementia with Lewy bodies
2. Parkinson’s disease
3. Shy-Drager syndrome
4. Olivopontocerebellar degeneration
Select: A = 1. 2. 3. B = 1, 3. C = 2, 4. D = 4 only. E = All
Answer 24-10: E.
All of these conditions can show Lewy bodies
on pathological examination. PD and DlB are
the classically-described conditions, but the
others can as well, in addition to CBD and
striatonigral degeneration
