Clin med 5: Movement Disorders

Question 1

What kind of tremor do patients with Parkinson’s Disease initially present with?

Answer 1

Unilateral resting tremor - “pill-rolling” quality

*TRAPS

T = tremor at rest

R = rigidity

A = akinesia and bradykinesia

P = postural instability

S = shufflng gait

Question 2

Although findings are similar to PD, what distinguishes Progressive Supranuclear Palsy (PSP)?

Answer 2

Loss of voluntary control of eye movements (especially VERTICAL gaze)

Question 3

Although findings are similar to PD, what distinguishes Multiple Systems Atrophy (MSA)?

Answer 3

Pronounced autonomic dysfunction

Question 4

Although findings are similar to PD, what distinguishes Cortical Basal Degeneration (CBD)?

Answer 4

• Cortical and ganglionic dysf.
• May see cortical sensory loss, apraxia, myoclonus or aphasia

Question 5

Sustained muscle contraction that produce twisting and repetitive movements and abnormal postures; often stuck in torticollis, defines what?

Answer 5

Dystonia

Question 6

Chorea vs. Athetosis?

Answer 6

• Chorea = irregular, brief, “dancelike movements;” may be incorporated into puposeful movements
• Athetosis = writhing (snake-like), sinous movements (often occur in combo w/ chorea)

Question 7

Who is most often affected by Sydenham’s Chorea?

Why does it occur?

Characterized by?

Answer 7

• Mainly children/adolescents as complication of previous strep infection
• Unilateral choreiform movements

Question 8

What is the treatment of choice for someone with Focal Torsion Dystonia?

Answer 8

BOTOX

Question 9

Wilson’s disease is a disorder of ________ metabolism that produces ______ and _______ dysfunction

Answer 9

Wilson disease is a disorder of copper metabolism that produces neurologic and HEPATIC dysfunction

Question 10

Who is most often affected by Wilson’s Disease?

Answer 10

Children and young adults

Question 11

Which disease have both bradykinetic and hyperkinetic movements?

Answer 11

Wilson’s Disease

Question 12

What is the clinical presentation of Essential Tremor (aka Benign Familial Tremor)?

How does it progress?

Answer 12

• Postural or kinetic tremor (induced by movement) of both hands and may involve head or voice
• Can begin in early adulthood, and usually progresses slowly over years to decades

Question 13

Drug induced Parkinson’s will present with what kind of finding different from idiopathic?

Answer 13

Bilateral tremor/findings

Question 14

Which movement disorder is characterized by hypophonia (soft voice), masked facies, decreased frequency of eye blink, and a Myerson’s sign?

Answer 14

Idiopathic Parkinson’s Disease (the classic/most common)

Question 15

Which disease is characterized by unexplained periods of markedly increased confusion that last days to week and closely mimic delirium?

Answer 15

Lewy Body Disease