movement disorders

Question 1

what is the most common cause of a resting tremor

Answer 1

parkinsons disease

Question 2

what is a cause of a postural tremor

Answer 2

essential tremor

Question 3

what is the general cause of a kinetic tremor

Answer 3

cerebellar disorder

Question 4

what is a kinetic tremor

Answer 4

occurs during movement towards a target and becomes more pronounced as the person reaches the endpoint of the movement

Question 5

what is another name for a kinetic tremor

Answer 5

intention tremor

Question 6

what is parkinsons disease

Answer 6

a progressive neurodegenerative movement disorder

Question 7

what is the biggest risk factor for parkinsons

Answer 7

advancing age

Question 8

what is the median age of onset for parkinsons

Answer 8

60

Question 9

who is more likely to be affected by parkinsons

Answer 9

men

Question 10

name 2 genes that have been linked to parkinsons

Answer 10

LRRK2
PARKIN

Question 11

disease onset - death for parkinsons

Answer 11

15 years

Question 12

what causes parkinsons (3)

Answer 12

degeneration of neurons in the pars compacta region of the substantia nigra
decrease in dopamine in the basal ganglia
causes greater inhibition of the motor system

Question 13

neuro-histological hallmark of parkinsons

Answer 13

lewy bodies

Question 14

classic triad of features in parkinsons

Answer 14

resting tremor
rigidity
bradykinesia

Question 15

what is bradykinesia

Answer 15

slowness of movement with progressive loss of amplitude or speed

Question 16

how is tremor in parkinsons often described

Answer 16

pill-rolling

Question 17

how is rigidity in parkinsons often described and why

Answer 17

lead pipe - present throughout the range of movement and isn’t dependent on speed of movement
or cogwheel

Question 18

describe gait in parkinsons

Answer 18

shuffling (festinating), stooped posture

Question 19

name some other features of parkinsons

Answer 19

handwriting gets smaller, reduced facial movements and expressions
depression, sleep disturbance, anosmia
issues with speech and swallowing

Question 20

what is anosmia

Answer 20

loss of sense of smell

Question 21

what is a common terminal event in parkinsons

Answer 21

swallowing difficulty leading to aspiration pneumonia

Question 22

what features are needed for a diagnosis of parkinsons

Answer 22

bradykinesia +1 of the following
- resting tremor
- rigidity
- postural instability

Question 23

what scan is not necessary, but can be helpful when diagnosing parkinsons

Answer 23

DaTSCAN

Question 24

what confirms a diagnosis of parkinsons

Answer 24

dopamine responsiveness

Question 25

main drug used for symptom management of parkinsons

Answer 25

levodopa

Question 26

what is a parkinson-plus syndrome

Answer 26

syndromes that present as parkinsonism + additional clinical features

Question 27

what are the 4 parkinson-plus syndromes

Answer 27

progressive supranuclear palsy multiple system atrophy cortico-basal syndrome lewy body dementia

Question 28

what are the symptoms of progressive supranuclear palsy

Answer 28

parkinsonism + early instability and frequent falls impairment of vertical gaze stiff, broad-based gate

Question 29

characteristic MRI finding of progressive supranuclear palsy and what it is

Answer 29

hummingbird sign - shape of midbrain atrophy

Question 30

what triad of symptoms is usually associated with multiple system atrophy

Answer 30

dysautonomia, cerebellar features and parkinsonism

Question 31

name some cerebellar features of multiple system atrophy

Answer 31

incoordination wide-based gait action tremors unusual eye movements

Question 32

what causes a parkinsons presentation in multiple system atrophy

Answer 32

degeneration of the basal ganglia

Question 33

characteristic MRI finding of multiple system atrophy and what it is

Answer 33

hot cross bun sign - cerebellar and pontine atrophy

Question 34

what are common features of lewy body dementia

Answer 34

parkinsonism - early changes in attention and executive function - visual hallucinations - less involvement with memory

Question 35

what is the proposed pathophysiology of lewy body dementia

Answer 35

early death of dopaminergic neurons in the cerebrum, which extends to the basal ganglia (leading to motor symptoms)

Question 36

motor symptoms associated with cortico-basal syndrome

Answer 36

asymmetric rigidity, akinesia and dystonia cortical sensory loss, apraxia

Question 37

what phenomena is associated with cortico-basal syndrome and what is it

Answer 37

alien limb limb behaves as if it has a will of its own

Question 38

what is akinesia

Answer 38

lack of movement

Question 39

what is cortical sensory loss

Answer 39

patients cannot recognise objects by touch despite normal sensory input

Question 40

what is apraxia

Answer 40

difficulty with purposeful movement despite intact motor function

Question 41

name 3 other conditions that mimic parkinsonism

Answer 41

vascular parkinsonism wilson's disease drug-induced parkinsonism

Question 42

what is affected in vascular parkinsonism

Answer 42

the lower limbs - rigidity and bradykinesia

Question 43

what is another name for dementia pugilistica

Answer 43

chronic traumatic encephalopathy

Question 44

who usually presents with dementia pugilistica

Answer 44

boxers - repetitive head trauma

Question 45

who do we need to consider drug-induced parkinsonism in

Answer 45

patients on antipsychotics (haloperidol, risperidone), metoclopramide and prochlorperazine

Question 46

presentation of drug-induced parkinsonism

Answer 46

rapid and bilateral coarse postural tremor

Question 47

what is a complication of drug induced parkinsonism

Answer 47

neuroleptic malignant syndrome

Question 48

management of drug induced parkinsonism

Answer 48

STOP DRUG procyclidine

Question 49

what is wilsons disease

Answer 49

disorder of copper metabolism, where it is deposited in the basal ganglia, cornea and liver

Question 50

inheritance seen in wilsons disease

Answer 50

autosomal recessive

Question 51

ocular signs of wilsons disease

Answer 51

kayser-fleischer rings and sunflower cateracts

Question 52

neurological symptoms of wilsons disease

Answer 52

akinetic-rigid syndrome pseudosclerosis dominated by tremor (coarse and flapping) ataxia dystonia

Question 53

who should we consider wilsons disease in

Answer 53

patients below 50 who present with a hyperkinetic movement disorder or liver cirrhosis

Question 54

hepatic signs of wilsons disease

Answer 54

liver failure coomb's negative haemolytic anaemia jaundice