Lecture 4 - Movement Disorders (also see Pharm deck 8)

Question 1

clinical symptoms in parkinsons don’t appear before at least ____ of neurons are lost. which pathway is most effected?

Answer 1

60%;

nigrostriatal

Question 2

PD: 
tremor is symmetric or asymetric?
\_\_\_\_ (oropharyngeal prob);
\_\_\_\_ sleep disorder;
\_\_\_\_ (psych prob)
\_\_\_\_ (GI)

Answer 2

asymmetric;
sialorrhea (excessive salivation);
REM (ie act out dreams);
depression;
constipation

Question 3

PD:
Deep brain stimulation of ____ can be used to treat advanced parkinson disease. in a DaT scan, radioactive ____ is injected (similar to PET scan)

Answer 3

subthalamic nucleus;

dopamine

Question 4

parkinson plus syndromes:
more or less responsive to L-dopa?
more or less rapidly progressive?

Answer 4

less, more

Question 5

progressive supranuclear palsy:
\_\_\_ \_\_\_\_ is characteristic (early in disease);
\_\_\_\_ rigidity;
\_\_\_\_ palsy, causing dysphagia;
\_\_\_\_ gaze palsy (supranuclear);
\_\_\_\_ difficulty

Answer 5

postural instability;
axial;
pseudobulbar;
vertical;
speech (and memory)

Question 6

multiple system atrophy:
autonomic symptoms such as ____ and _____;
____ hypotension;
____ symptoms and gait ataxia (if in C type);
_____ sign on MRI;
____ signs such as increased reflexes, babinski

Answer 6

urinary incontinence, impotence;
orthostatic;
cerebellar;
"hot cross bun"
pyramidal

Question 7

essential tremor:
intentional or resting tremor?
also postural;
familial or sporadic?

Answer 7

intentional;

familial

Question 8

essential tremor:

2 first line treatments

Answer 8

propanolol, primidone

Question 9

restless leg syndrome:
urge to move legs or legs move on own?
worse with exercise or resting?
worse during day or night?

Answer 9

urge to move;
worse resting;
at night

Question 10

restless leg:
associated with ____ anemia;
treat with ____ agonists

Answer 10

iron deficiency;

dopamine (ie pramipaxole)

Question 11

dystonia:
____, _____ muscle contractions;
3 examples

Answer 11

sustained, involuntary;

blephospasm, torticollis, writer’s cramp

Question 12

dystonia:
improved with ____, worse with ____;
“____ tricks”;
most effective treatment?

Answer 12

sleep, stress;
sensory;
botulinim toxin

Question 13

tourette syndrome:
____ tics. most be present least ____.;
preceeded by ______. associated with what 2 psych disorders?

Answer 13

vocal AND motor (repetitive)
1 year;
urges;
ADHD, OCD

Question 14

tourette syndrome treatment:
_____ (an alpha 2 agonist);
____ (for depression/anxiety);
benzos, antipsychotics

Answer 14

clonidine (or guanfacine);

SSRIs

Question 15

____ = sudden, jerky purposeless movements;

due to lesions in ______; what infectious disease can cause it?

Answer 15

chorea;
basal ganglia;
acute rheumatic fever

Question 16

Normal pressure hydrocephalus:
triad of symptoms;
characteristic ____ gait

Answer 16

urinary incontinence, dementia, ataxia (Wacky, wobbly, wet);

magnetic

Question 17

normal pressure hydrocephalus:
due to stretch of the ____ ____;
_____ characteristically improves symptoms;
treatment is ______

Answer 17

corona radiata;
LP;
ventriculoperitoneal