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Phase 3a - Neurology > Movement Disorders > Flashcards

Movement Disorders Flashcards

Essential tremor Cerebellar Disease Ménière’s disease

1
Q

What is Essential Tremor?

A

A common, progressive neurological disorder that causes involuntary rhythmic shaking, typically affecting the hands, head, or voice.

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2
Q

True or False: Essential Tremor typically worsens with movement or posture and is usually symmetrical.

A

true

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3
Q

Essential Tremor is primarily ________ in nature, although environmental factors may contribute.

A

Genetic

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4
Q

How can Essential Tremor be differentiated from Parkinson’s Disease?

A

In Essential Tremor, tremor usually occurs during voluntary movement or posture (postural tremor), while in Parkinson’s Disease, tremor occurs at rest (resting tremor).

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5
Q

Which of the following is commonly used to manage Essential Tremor?
A. Levodopa
B. Beta-blockers
C. Benzodiazepines
D. Dopamine agonists

A

B. Beta-blockers

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6
Q

What investigations should be conducted for a patient with suspected Essential Tremor?

A

Diagnosis is clinical, but imaging (e.g., MRI) may be used to exclude other causes, especially if atypical features are present.

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7
Q

True or False: Essential Tremor is typically associated with other neurological symptoms such as rigidity or bradykinesia.

A

False

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8
Q

What is the first-line treatment for Essential Tremor?

A

Beta-blockers (e.g., propranolol) are often the first-line treatment.

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9
Q

In severe cases of Essential Tremor that do not respond to medication, a procedure called ________ may be considered.

A

Deep brain stimulation

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10
Q

What is the prognosis of Essential Tremor?

A

While Essential Tremor is not life-threatening, it can worsen over time and affect quality of life due to functional impairments.

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11
Q

True or False: Essential tremor is usually a progressive condition

A

True. Essential tremor tends to worsen over time, but the progression rate varies among individuals.

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12
Q

What is the typical presentation of essential tremor?

A

The tremor is usually bilateral (affecting both sides of the body) and most prominent when the affected body part is in motion, such as when writing or holding an object. It may improve with alcohol consumption in some cases.

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13
Q

Essential tremor is most commonly seen in ________ (age group)

A

Older adults (typically over the age of 40).

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14
Q

What factors can exacerbate essential tremor?

A

Stress, fatigue, and stimulants such as caffeine can worsen essential tremor.

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15
Q

True or False: Essential tremor is associated with other neurological symptoms such as bradykinesia or rigidity

A

False. Essential tremor is primarily a motor symptom and does not include features like bradykinesia or rigidity, which are seen in conditions like Parkinson’s Disease.

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16
Q

What is the first-line treatment for essential tremor?

A

Beta-blockers (e.g., propranolol) are commonly used as the first-line treatment for essential tremor. If beta-blockers are ineffective, other medications like primidone may be considered.

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17
Q

True or False: Essential tremor is only hereditary.

A

False. Although essential tremor often has a familial component, it can also occur sporadically without a clear hereditary link.

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18
Q

What role do anticonvulsants play in managing essential tremor?

A

Anticonvulsants such as primidone may be used if beta-blockers are ineffective. They help reduce the tremor by modulating neuronal activity.

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19
Q

What is cerebellar disease?

A

Cerebellar disease refers to any condition that affects the cerebellum, which is responsible for coordination, balance, and fine motor control.

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20
Q

What are common signs of cerebellar disease?

A

Signs include ataxia (lack of muscle coordination), dysmetria (over- or under-shooting a target), dysdiadochokinesia (inability to perform rapid alternating movements), intention tremor, and nystagmus.

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21
Q

True or False: Dysmetria is characterized by the ability to accurately reach and touch a target.

A

False. Dysmetria refers to overshooting or undershooting a target.

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22
Q

Nystagmus is a type of _______ that can occur in cerebellar disease.

A

Nystagmus is a type of involuntary eye movement that can occur in cerebellar disease.

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23
Q

What type of reflexes are seen in cerebellar disease?

A

Reflexes in cerebellar disease can be described as “pendular,” meaning they are less brisk and slower in their rise and fall.

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24
Q

True or False: Pendular reflexes are associated with hyperreflexia in cerebellar disease

A

False. Pendular reflexes are slower and less brisk, not hyperreflexive.

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25
Q

What types of ataxia are observed in cerebellar disease?

A

Cerebellar ataxia, sensory ataxia, and vestibular ataxia.

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26
Q

What are common causes of cerebellar disease?

A

Causes include stroke, multiple sclerosis, brain tumors, alcohol-related cerebellar degeneration, and hereditary disorders like Friedreich’s ataxia.

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27
Q

True or False: A common cause of cerebellar disease is acute viral infections like chickenpox.

A

False. Acute viral infections are not a common cause of cerebellar disease.

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28
Q

What is the management approach for cerebellar disease?

A

Management focuses on treating the underlying cause, improving symptoms with physical therapy, and possibly using medications for associated symptoms like tremors or spasticity.

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29
Q

_______ therapy can help improve coordination in patients with cerebellar disease.

A

Physical therapy can help improve coordination in patients with cerebellar disease.

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30
Q

What types of tremor are associated with cerebellar disease?

A

Intention tremor, which worsens as the individual approaches a target.

31
Q

True or False: Intention tremors are present at rest and worsen with voluntary movement.

A

True. Intention tremor worsens as the individual attempts to complete a voluntary movement.

32
Q

What is a common gait abnormality in cerebellar disease?

A

Ataxic gait, characterized by uncoordinated and broad-based steps.

33
Q

___ gait is commonly seen in cerebellar disease, characterized by uncoordinated and broad-based steps.

A

Ataxic gait.

34
Q

What conditions must be considered in the differential diagnosis of cerebellar disease?

A

Stroke, multiple sclerosis, brain tumors, alcohol-related cerebellar degeneration, hereditary ataxias, and vitamin deficiencies.

35
Q

True or False: Alcohol-related cerebellar degeneration is one of the common causes of cerebellar disease.

A

True..

36
Q

What investigations are used to diagnose cerebellar disease?

A

MRI brain, blood tests (e.g., for vitamin deficiencies or autoimmune markers), and genetic testing for hereditary ataxias.

37
Q

________ imaging is commonly used to assess the cerebellum in suspected cerebellar disease.

A

MRI imaging.

38
Q

What are common associated conditions with cerebellar disease?

A

Cognitive dysfunction, spasticity, dysarthria (speech difficulties), and visual disturbances.

39
Q

True or False: Visual disturbances like nystagmus are common in cerebellar disease.

A

True

40
Q

What is Ménière’s disease?

A

Ménière’s disease is a disorder of the inner ear that causes episodes of vertigo, tinnitus, hearing loss, and a feeling of fullness in the ear.

41
Q

What are the classic symptoms of Ménière’s disease?

A

The classic symptoms include recurrent vertigo, tinnitus, sensorineural hearing loss, and ear fullness.

42
Q

True or False: Ménière’s disease is characterized by a progressive hearing loss.

A

True. Over time, hearing loss can become permanent in some patients.

43
Q

What is the typical age of onset for Ménière’s disease?

A

The typical age of onset is between 20 and 50 years old.

44
Q

Ménière’s disease is thought to result from an abnormal accumulation of _______ in the inner ear.

A

Endolymph.

45
Q

Which investigations are commonly used to diagnose Ménière’s disease?

A

Audiometry, MRI, electronystagmography, and caloric testing.

46
Q

True or False: Ménière’s disease is often associated with a family history of hearing loss.

A

True. There may be a genetic predisposition in some cases.

47
Q

What are some treatment options for managing Ménière’s disease?

A

Treatment options include dietary changes (low salt), diuretics, anti-vertigo medications (e.g., betahistine), and in severe cases, surgery.

48
Q

What lifestyle modification can help manage symptoms of Ménière’s disease?

A

Reducing salt intake and managing stress can help control fluid retention in the inner ear.

49
Q

One common drug used in the management of Ménière’s disease to reduce vertigo is _______.

A

Betahistine.

50
Q

What are the main causes of Ménière’s disease?

A

The exact cause is unknown, but it may involve a combination of genetic and environmental factors, including viral infections and immune responses.

51
Q

What is the typical duration of a vertigo attack in Ménière’s disease?

A

A vertigo attack can last anywhere from 20 minutes to several hours.

52
Q

True or False: Ménière’s disease can lead to permanent hearing loss.

A

True. Chronic and untreated disease can cause permanent sensorineural hearing loss.

53
Q

What initial investigations should be performed in cases of essential tremor?

A

Check U&Es, LFTs, TFTs, and calcium levels.

54
Q

What medications are used to treat essential tremor?

A

Propranolol, Primidone, Pregabalin, Gabapentin, Clonazepam.

55
Q

When should tremors be referred to a specialist?

A

All new tremors not diagnosed as essential tremor.

Diagnostic uncertainty.

Essential tremor requiring further management.

Tremor with other neurological symptoms (e.g., ataxia, cerebellar signs, parkinsonism).

56
Q

What are the core motor symptoms of Parkinson’s Disease?

A

Bradykinesia, rigidity, tremor, postural instability.

57
Q

What are some additional motor presentations in Parkinson’s Disease?

A

Physical slowing, reduced dexterity, micrographia, cramping, gait disturbance.

58
Q

What are common non-motor symptoms of Parkinson’s Disease?

A

Mood disorders (e.g., depression, anxiety).

Sleep disturbances.

Cognitive impairment.

Impulse control disorders.

Autonomic dysfunction (e.g., orthostatic hypotension, hypersalivation, urinary symptoms).

59
Q

What are presymptomatic non-motor symptoms?

A

Anosmia, sleep disturbances, depression, pain.

60
Q

Describe the three main stages of Parkinson’s Disease progression

A

Early (Honeymoon Period): Good response to treatment.

Middle Period: Wearing-off symptoms.

Late Period: Dyskinesias, motor fluctuations, cognitive impairment.

61
Q

What are the primary medications used in Parkinson’s Disease?

A

Levodopa: Most effective for motor symptoms.

Dopamine Agonists: Ropinirole, Pramipexole, Rotigotine.

Monoamine Oxidase Inhibitors (MAOIs): Selegiline, Rasagiline.

62
Q

What are the advantages and disadvantages of dopamine agonists compared to levodopa?

A

Advantages: Less dyskinesia, longer acting.

Disadvantages: Hallucinations, compulsive behavior, postural hypotension, daytime sleepiness.

63
Q

What is entacapone and how does it work?

A

Entacapone is a COMT inhibitor that prevents the breakdown of levodopa in the brain and periphery.

64
Q

How are medications chosen at the time of diagnosis in Parkinson’s Disease?

A

Levodopa: Best for significant motor impairment.

Dopamine Agonists: Moderate motor improvement.

MAOIs: Mild motor improvement.

65
Q

What are the options for managing motor fluctuations?

A

Adjust levodopa dosing, add COMT inhibitors, MAOIs, or dopamine agonists.

66
Q

What are the common sleep problems in Parkinson’s Disease?

A

Insomnia, daytime sleepiness, REM sleep behavior disorder.

67
Q

How is REM sleep behavior disorder treated?

A

Clonazepam or melatonin.

68
Q

How are cognitive disorders in Parkinson’s Disease managed?

A

Review triggering factors and medications.

Refer to neurology for cholinesterase inhibitors (e.g., donepezil) or memantine.

69
Q

How should psychosis in Parkinson’s Disease be managed?

A

Assess for provoking factors (e.g., infection, metabolic issues).

Discontinue offending drugs (e.g., anticholinergics, amantadine).

Consider quetiapine or clozapine under specialist guidance.

70
Q

When should deep brain stimulation be considered?

A

In late-stage Parkinson’s Disease when symptoms are not controlled by best medical therapy.

71
Q

What aspects of palliative care should be considered in Parkinson’s Disease?

A

End-of-life planning, symptom management, and referral to specialist palliative care teams.

72
Q

What are the key NICE recommendations for Parkinson’s Disease management?

A

Patient-centered care with written and oral communication.

Regular reviews every 6-12 months.

Access to physiotherapy, occupational therapy (OT), speech and language therapy (SALT), and dieticians.

Discuss risks of impulse control disorders and hallucinations.

Consider DAT-SPECT for atypical tremors.

73
Q

What are the autonomic symptoms associated with Parkinson’s Disease?

A

Orthostatic hypotension, constipation, urinary frequency/urgency, hypersalivation, sweating abnormalities, sexual dysfunction.

74
Q

How are autonomic symptoms treated?

A

Orthostatic hypotension: Midodrine, fludrocortisone.

Constipation: Laxatives.

Hypersalivation: Glycopyrrolate, botulinum toxin, hyoscine.

Phase 3a - Neurology (24 decks)

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