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Movement Flashcards

1
Q

In the basal ganglia, where is Glutamate found?

A

1) Cortex -> Striatum

2) STN

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2
Q

In the basal ganglia, where is GABA found?

A

1) Striatal
2) Pallidal
3) SNpr

(projection neurons)

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3
Q

Where are the dopamine receptors found?

D1-D5

A

D1, D2: Striatum

D3: Nucleus accumbens

D4: Frontal cortex

D5: Hippocampus, limbic system

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4
Q

A) Tardive dyskinesias and drug-induced parkinsonian syndromes occur when drugs competitively bind to which dopamine receptor?

B) The newer antipsychosis drugs, which produce fewer of these effects, have a stronger affinity for which receptor?

A

A) D2

B) D4

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5
Q

Dopadecarboxylase inhibitor:

A

Carbidopa

Benserazide

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6
Q

MOA of Entacapone?

A

Catechol-O-methyltransferase (COMT) inhibitor

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7
Q

Where are D1 receptors predominant?

A

Small spiny putaminal neurons

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8
Q

In the BG, where is Acetylcholine synthesized?

A

Large nonspiny striatal neurons (Golgi type 2)

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9
Q

State the principal location of morbid anatomy for this symptom:

Unilateral hemiballismus and hemichorea

A

C/l Subthalamic nucleus of Luys / Luysial-pallidal connections

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10
Q

Chronic chorea of Huntington type

A

Caudate nucleus and putamen

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11
Q

Decerebrate rigidity

A

Bilateral tegmental upper brainstem

Level of RED NUCLEUS or between red and vestibular nuclei

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12
Q

Palatal and facial myoclonus (rhythmic)

A

Ipsilateral central tegmental tract

  • w/ denervation of ION and N. ambiguus
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13
Q

Fill in the blank:

Causes of bradykinesia:
Parkinson - reduced dopa from SN to striatum

Neuroleptic drugs: dopa receptor blockade

Huntington: degeneration of striatal neurons

Wilson: _____

A

Destruction of medial pallidum

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14
Q

Persistent voluntary contraction of hand muscles may fail to be inhibited, so that there is interference with the next willed movement. What is this phenomenon called?

A

Tonic innervation

Blocking

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15
Q

Tendency for the voluntary movement to adopt the frequency of a coexistent tremor

A

Entrainment

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16
Q

When the limb muscles are passively stretched, the patient appears to actively resist the movement

A

Gegenhalten
Paratonia
Oppositional resistance

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17
Q

All active movement phenomena that are a consequence of disease of the basal ganglia

A

Dyskinesia

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18
Q

Involuntary arrhythmic movements of a forcible, rapid, jerky type

A

Chorea

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19
Q

Inherited disorders associated with Chorea (5)

A 
Huntington
Wilson Disease
DRPLA
Neuroacanthocytosis
Benign hereditary chorea
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20
Q

Drugs that can cause chorea (5)

A

Coke P(enny)OND

Cocaine
Phenytoin
OCPs
Neuroleptics
Dopa agonist (overdose)
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21
Q

Systemic diseases associated with Chorea

A

Pcv THT

Polycythemia vera
Thyrotoxicosis
Hyperosmolar nonketotic hyperglycemia
Toxoplasmosis

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22
Q

Immune mediated chorea (5)

A

CLAPS

Chorea gravidarum
Lupus
APAS
Paraneoplastic
Sydenham chorea***
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23
Q

Paraneoplastic chorea is associated with which antibodies (2)?

A

anti-CRMP

anti-Hu

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24
Q

Most common cause of a choreiform dyskinesia in neurologic practice

A

Excess dopamine administration in advanced PD

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25
Inability to sustain the fingers and toes, tongue, or any other part of the body in one position
Athetosis
26
Uncontrollable, large amplitude, poorly patterned flinging movement of an entire limb
Ballismus
27
Usual cause of bilateral ballismus
Nonketotic hyperosmolar coma
28
Treatment of ballismus
Haloperidol | Phenothiazine
29
Unnatural spasmodic movement or posture that puts the limb in a twisted position. Patterned, repetitive, or tremulous and can be initiated or worsened by attempted movement.
Dystonia
30
What is Segawa Disease?
Idiopathic dystonia that responds to extremely small doses of L-dopa.
31
Which of the following is TRUE of Segawa disease? A) Autosomal recessive B) Not responsive to L-dopa C) Worse upon waking up D) None of the above
D) None of the above Autosomal DOMINANT Very RESPONSIVE to L-dopa Diurnal fluctuation is characteristic. Worsens as the day wears on, improves with sleep.
32
Retrocollis, back arching, internal rotation of the arms, extension of the elbows and wrists (simulating opisthotonos) are characteristic of what etiology of dystonia?
Drug-induced Tx: diphenhydramine, benztropine
33
DBS to address dystonia focuses on which region?
Globus pallidus, bilateral posteroventral
34
What is paroxysmal kinesigenic choreoathetosis?
Brief attacks of dystonia/choreoathetosis Trigger: sudden movement, startle, HV AD, adolescent males PRRT2 mutation Tx: Phenytoin, CBZ
35
Persistent dystonic spasms Precipitated by alcohol, coffee, or fatigue Tx: Clonazepam
Mount and Reback type | Nonkinesigenic choreoathetosis
36
Involuntary rhythmic oscillatory movement produced by alternating or irregularly synchronous contractions of reciprocally innervated muscles.
Tremor
37
Frequency (Hz) of the following tremors? ``` Palatal Cerebellar (rubral, ataxic, intention) Parkinson (rest) Essential (senile, familial) Postural/action Physiologic (enhanced) ```
``` Palatal - 1-2 Cerebellar - 2-4 Parkinson - 3-5 Essential 4-8 Postural/action - 5-8 Physiologic - 8-13 ```
38
Which tremors are attenuated by alcohol?
Physiologic (enhanced) Essential (familial, senile) Alternate beat
39
Pathologic tremors in general have been linked to cellular activity where?
Thalamus, Nucleus intermedius ventralis
40
Which AED is known to cause tremor?
Valproate
41
What is the most common type of tremor?
Essential (familial) Tremor
42
Which of the following is TRUE of essential (familial) tremor? A) Appears upon rest B) Peaks at 60 years of age C) 8-13Hz D) Autosomal dominant with high penetrance
True: D) Autosomal dominant with high penetrance Appears w/ attempts to maintain static limb posture / produce smooth trajectory of movement Peaks at a) second decade; b) >35 yo 4-8 Hz
43
Which of the following is NOT effective in treating essential tremor? ``` A) Alcohol B) Propranolol C) Primidone D) Benzodiazepines E) Amantadine ```
D) Benzodiazepines
44
Which is NOT true of Parkinsonian tremor? A) 3-5Hz B) If the tremulous hand is completely relaxed (not just in repose), the tremor usually disappears C) Alternating tremor D) Abates upon walking E) Interferes little with voluntary movement
D) Abates upon walking | Tremor continues and may worsen while walking unlike essential tremor
45
In PD, the cogwheel effect is called what sign?
Negro sign not specific for Parkinson
46
Cogwheeling brought out by having the patient engage the opposite limb
Froment sign *initially described in essential tremor
47
Treatment for Parkinsonian Tremor
Anticholinergics: Benztropine, Trihexyphenidyl L-dopa
48
What is MPTP (1-methyl-4-phenyl-1,2,3,6,-tetrahydropyridine)?
Meperidine analogue | Destroys neurons of SNpr
49
This tremor requires for its full expression the performance of an exacting, precise, projected movement. Absent when limbs are inactive and during the first part of a voluntary movement.
Intention (ataxic, cerebellar, goal-directed) tremor
50
In "loading the limb", all tremors are reduced except these two
Tremors 2/2 polyneuropathy | Psychogenic tremor
51
Which is TRUE regarding comparisons between essential and symptomatic palatal tremor? A) Essential palatal tremor is more common B) An audible click is heard in symptomatic palatal tremor C) Essential palatal tremor persists during sleep D) Symptomatic palatal tremor is associated with pendular nystagmus synchronized with palatal movements
True: D) Symptomatic palatal tremor is associated with pendular nystagmus synchronized with palatal movements * Essential tremor - no pathologic basis - (+) audible click - ceases during sleep * Symptomatic palatal tremor - CTT lesion - persists during sleep - (+) pendular nystagmus
52
Contraction of the masseters occurring concurrently with pendular ocular convergence is found in what disease? What is this phenomenon called?
Whipple Disease Oculomasticatory myorhythmia
53
With unilateral palatal tremor, what structure is involved?
Contralateral olive Interruption in the triangle of Guillain-Mollaret
54
What is the triangle of guillain-mollaret?
Dentate -> B. conjunctivum -> red nucleus -> CTT -> Olivary n. -> dentate RID nucleus Red Nucleus - Inferior Olive - Dentate nucleus
55
Arrhythmic lapses of sustained posture that allow gravity or the inherent elasticity of muscles to produce a sudden movement, which the patient then corrects, sometimes with overshoot.
Asterixis
56
Very rapid, shock-like contractions of a group of muscles, irregular in rhythm and amplitude, and, with few exceptions, asynchronous and asymmetrical in distribution.
Myoclonus
57
Most common mutation associated with startle syndromes?
GLRA1
58
This maneuver consists of flexing the neck and bringing the arms closer to the torso, which may reduce the intensity of an attack. Used in startle syndromes.
Vigevano maneuver
59
Most common type of focal dystonia
Torticollis
60
What is Meige Syndrome?
Lingual, Facial, Oromandibular spasms
61
Most common form of task-specific dystonia
Writer's cramp
62
Blockade and subsequent unmasking of which dopamine receptor has been linked to the development of tardive dyskinesias?
D2
63
Treatment of Tardive Dyskinesias
Dopamine and noradrenergic-depleting drugs: Tetrabenazine > reserpine Anticholinergic drugs Trihexyphenidyl
64
What are the two main identifying features of tics and habit spasms?
Stereotypy | Irresistability
65
Which is TRUE of Gilles de la Tourette Syndrome? A) Begins in adolescence B) Girls more affected than boys C) Associated with bipolar disorder D) Associated w/ streptococcal infections
True: D) Associated w/ streptococcal infections * Begins in childhood * Boys more affected than girls * Associated with ADHD and w/ OC traits
66
Treatment of Gilles de la Tourette Syndrome?
Haloperidol
67
What are the conditions hypothesized to have a modest association between each other in PANDAS?
Streptococcal infection Tic disorder Obsessive-compulsive disorder
68
Inner feeling of restlessness, an inability to sit still, and a compulsion to move about.
Akathisia
69
Which PD medication causes pathologic gambling addiction?
Dopamine agonists can cause impulsivity Pramipexole, ropinirole, rotigatine

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