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🧠📖💯 > Movement > Flashcards

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
Q

Inability to sustain the fingers and toes, tongue, or any other part of the body in one position

A

Athetosis

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26
Q

Uncontrollable, large amplitude, poorly patterned flinging movement of an entire limb

A

Ballismus

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27
Q

Usual cause of bilateral ballismus

A

Nonketotic hyperosmolar coma

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28
Q

Treatment of ballismus

A

Haloperidol

Phenothiazine

29
Q

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.

A

Dystonia

30
Q

What is Segawa Disease?

A

Idiopathic dystonia that responds to extremely small doses of L-dopa.

31
Q

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

A

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
Q

Retrocollis, back arching, internal rotation of the arms, extension of the elbows and wrists (simulating opisthotonos) are characteristic of what etiology of dystonia?

A

Drug-induced

Tx: diphenhydramine, benztropine

33
Q

DBS to address dystonia focuses on which region?

A

Globus pallidus, bilateral posteroventral

34
Q

What is paroxysmal kinesigenic choreoathetosis?

A

Brief attacks of dystonia/choreoathetosis
Trigger: sudden movement, startle, HV

AD, adolescent males
PRRT2 mutation

Tx: Phenytoin, CBZ

35
Q

Persistent dystonic spasms
Precipitated by alcohol, coffee, or fatigue

Tx: Clonazepam

A

Mount and Reback type

Nonkinesigenic choreoathetosis

36
Q

Involuntary rhythmic oscillatory movement produced by alternating or irregularly synchronous contractions of reciprocally innervated muscles.

A

Tremor

37
Q

Frequency (Hz) of the following tremors?

Palatal 
Cerebellar (rubral, ataxic, intention)
Parkinson (rest)
Essential (senile, familial)
Postural/action
Physiologic (enhanced)
A 
Palatal - 1-2
Cerebellar - 2-4
Parkinson - 3-5
Essential 4-8
Postural/action - 5-8
Physiologic - 8-13
38
Q

Which tremors are attenuated by alcohol?

A

Physiologic (enhanced)
Essential (familial, senile)
Alternate beat

39
Q

Pathologic tremors in general have been linked to cellular activity where?

A

Thalamus, Nucleus intermedius ventralis

40
Q

Which AED is known to cause tremor?

A

Valproate

41
Q

What is the most common type of tremor?

A

Essential (familial) Tremor

42
Q

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

A

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
Q

Which of the following is NOT effective in treating essential tremor?

A) Alcohol
B) Propranolol
C) Primidone
D) Benzodiazepines
E) Amantadine
A

D) Benzodiazepines

44
Q

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

A

D) Abates upon walking

Tremor continues and may worsen while walking
unlike essential tremor

45
Q

In PD, the cogwheel effect is called what sign?

A

Negro sign

not specific for Parkinson

46
Q

Cogwheeling brought out by having the patient engage the opposite limb

A

Froment sign

*initially described in essential tremor

47
Q

Treatment for Parkinsonian Tremor

A

Anticholinergics:
Benztropine, Trihexyphenidyl

L-dopa

48
Q

What is MPTP (1-methyl-4-phenyl-1,2,3,6,-tetrahydropyridine)?

A

Meperidine analogue

Destroys neurons of SNpr

49
Q

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.

A

Intention (ataxic, cerebellar, goal-directed) tremor

50
Q

In “loading the limb”, all tremors are reduced except these two

A

Tremors 2/2 polyneuropathy

Psychogenic tremor

51
Q

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

A

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
Q

Contraction of the masseters occurring concurrently with pendular ocular convergence is found in what disease? What is this phenomenon called?

A

Whipple Disease

Oculomasticatory myorhythmia

53
Q

With unilateral palatal tremor, what structure is involved?

A

Contralateral olive

Interruption in the triangle of Guillain-Mollaret

54
Q

What is the triangle of guillain-mollaret?

A

Dentate -> B. conjunctivum -> red nucleus -> CTT -> Olivary n. -> dentate

RID nucleus

Red Nucleus - Inferior Olive - Dentate nucleus

55
Q

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.

A

Asterixis

56
Q

Very rapid, shock-like contractions of a group of muscles, irregular in rhythm and amplitude, and, with few exceptions, asynchronous and asymmetrical in distribution.

A

Myoclonus

57
Q

Most common mutation associated with startle syndromes?

A

GLRA1

58
Q

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.

A

Vigevano maneuver

59
Q

Most common type of focal dystonia

A

Torticollis

60
Q

What is Meige Syndrome?

A

Lingual, Facial, Oromandibular spasms

61
Q

Most common form of task-specific dystonia

A

Writer’s cramp

62
Q

Blockade and subsequent unmasking of which dopamine receptor has been linked to the development of tardive dyskinesias?

A

D2

63
Q

Treatment of Tardive Dyskinesias

A

Dopamine and noradrenergic-depleting drugs:
Tetrabenazine > reserpine

Anticholinergic drugs
Trihexyphenidyl

64
Q

What are the two main identifying features of tics and habit spasms?

A

Stereotypy

Irresistability

65
Q

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

A

True: D) Associated w/ streptococcal infections

  • Begins in childhood
  • Boys more affected than girls
  • Associated with ADHD and w/ OC traits
66
Q

Treatment of Gilles de la Tourette Syndrome?

A

Haloperidol

67
Q

What are the conditions hypothesized to have a modest association between each other in PANDAS?

A

Streptococcal infection
Tic disorder
Obsessive-compulsive disorder

68
Q

Inner feeling of restlessness, an inability to sit still, and a compulsion to move about.

A

Akathisia

69
Q

Which PD medication causes pathologic gambling addiction?

A

Dopamine agonists can cause impulsivity

Pramipexole, ropinirole, rotigatine

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