Movement disorders

Question 1

Tx of anti-DA induced akathisia?

Answer 1

BB (Propranolol)

Question 2

Tx of anti-DA induced dystonia?

Answer 2

decr antipsychotic
amantadine
Benadryl
Benztropine

Question 3

AEs of anti-histamine/adrenergic/muscarinic’s?

Answer 3

• Wt gain
• incr AST/ALT/jaundice
• Rash
• Photosensitivity

Question 4

What is Withdrawal Dyskinesia?

Answer 4

symptoms will increase initially when antipsych drug is stopped

Question 5

Predisposed to neuroleptic malig syndrome?

Answer 5

genetic mutation @ chr 19

Question 6

What is an Acute Dystonic Reaction?

Answer 6

Unwanted, continuous contraction of a group of muscles

can be caused by anti-psychotics or metaclopromide

Question 7

S/s of Acute Dystonic Reaction?

Answer 7

tongue hanging out + eye looking upward (typically young men)

Question 8

Tx of Acute Dystonic Reaction?

Answer 8

Benadryl 50 mg IV once to tx acute dystonia, can also give a small dose of Atropine

Question 9

Etiology of cervical dystonia in peds?

Answer 9

hemivertebral vs. TB vs. self-correction for diplopia

Question 10

Spared in myasthenia gravis?

Answer 10

pupils

Question 11

More likely to be seronegative myasthenia gravis?

Answer 11

Purely ocular

Question 12

Pathophys of myasthenia gravis

Answer 12

Abs link to receptors and cause endocytosis and complement mediated damage to membrane

*Fewer folds and widened synaptic cleft

Question 13

Antibodies and proteins associated with myasthenia gravis?

Answer 13

1. muscle specific kinase
2. muscle protein titin
3. ryanodine in pts with thymoma
4. anti-nAch receptor

Question 14

70% of pts with myasthenia gravis have…

Answer 14

lymphofollicular hyperplasia

Question 15

Myasthenic Crisis =

Answer 15

diaphragmatic and intercostal weakness causes respiratory complications + bulbar symptoms

• intubate, d/c anti-cholinesterase and corticosteroids, treat with plasmaphoresis/IVIgG

Question 16

When should a pt with MG be intubated?

Answer 16

FVC if <1.2 L

*Atropine to minimize secretions, B2 agonists to minimize bronchospasms

Question 17

OPTIC NEURITIS: S/s?

Answer 17

• Pain around one eye (particularly on movement)
• Blurred vision (may proceed complete monocular blindness by days or weeks)
• Loss of color vision (red desaturation)

Question 18

OPTIC NEURITIS: Exam?

Answer 18

• Impaired visual acuity
• Pink/swollen optic disc w pale optic n
• Visual field defect
• Relative afferent pupil defect (affected eye may respond directly to light, but not as well as the other side)

Question 19

only field defect in papilledema is:

Answer 19

incr physiologic blind spot

Question 20

Tx for Acute MS Related Optic Neuritis:

Answer 20

**GIVE IV Metyhlprednisolone (solu-medrol); do NOT give oral prednisone, makes it worse!

Question 21

Causes of non-compressive CN III palsy?

Answer 21

MG (Diurnal Variation) & DM

Question 22

What should you order for CN III palsy?

Answer 22

1. CT w/o contrast (or w/?)
2. If blood then load with NS (for hemodilution, need to counteract the contrast and help decr BP)
3. treat for hypervolemia, hemodilution, htn

Question 23

Dx of giant cell arteritis?

Answer 23

ESR
normocytic normochromic anemia
incr LFTs
Biopsy (skip lesions)

Question 24

Tx of giant cell arteritis?

Answer 24

1. IV hydrocortisone (after ESR taken)

2. 40-60mg prednisolone req initially (responds well w/in 1-2 days)–continue for 18-24mo

Question 25

Associated with giant cell arteritis?

Answer 25

Polymyalgia Rheumatica: girdle pains + morning stiffness w/ some constitutional sx **NO cranial symptoms like GCA

Question 26

How does hyperthyroidism --> stroke?

Answer 26

Hyperthyroid => Afib can cause embolic stroke + recurrent TIAs (will show perfect vessels, etc) ** just as big a risk as someone with constant afib

Question 27

Conditions associated with hyperthyroidism?

Answer 27

1. myasthenia gravis | 2. pseudotumor cerebri

Question 28

pseudotumor cerebri: chronic complications? seen on exam?

Answer 28

Chronic: optic nerve can be affected --> acetazolamide (Surgical drainage or fenestration of CN 2 may be req) exam: bil papilledema, 6th nerve palsy

Question 29

Stroke in a paired venous sinus is likely due to: Stroke in an unpaired venous sinus is likely due to:

Answer 29

Paired sinus: likely infection Single sinus: likely hypercoag state

Question 30

Thrombosis of entire sup. venous sinus: symptoms/presentation?

Answer 30

``` Overlies para-sagittal areas => Sz Paraplegia incr ICP Papilledema ``` P/w: HA + Papilloedema and other ICP features; Seizures + Bilateral signs of neurological deficit (progressive w/ impaired consciousness)

Question 31

Thrombosis of entire sup. venous sinus: Predispositions?

Answer 31

- pregnancy/labor/OCPs - Dehydration and Cachexia - Cancer and anti-cancer meds (tamoxifen, hydroxyurea) - Sickle cell + protein C/S coagulopathy

Question 32

LATERAL SINUS THROMBOSIS: | signs/symptoms?

Answer 32

- infection in mastoid/inner ear - incr ICP - Seizures - Drowsiness

Question 33

CAVERNOUS SINUS THROMBOSIS: signs/symptoms?

Answer 33

- Red swollen eyelid and conjunctiva - III, IV, Va/ Vb , VI palsies - Papilledema

Question 34

Cause of lateral and cavernous sinus thrombosis? Treatment?

Answer 34

spread of infection (face and Orbit --> Cavernous --> Ear --> Lateral) Heparin + Abx

Question 35

CEREBELLO-PONTINE ANGLE TUMORS: Involves what CN's? Symptoms? MC type?

Answer 35

5 + 7 + 8 sensorineural hearing loss (weber to healthy ear) acoustic neuroma

Question 36

Origin of acoustic neuroma? Presentation? Dx?

Answer 36

- sheath of Schwann cells of CN VIII - unilateral progressive SN hearing loss + tinnitus - CN VII palsy and facial drooping - MRI of internal auditory canals with and without contrast

Question 37

HSV ENCEPHALITIS: EEG? Dx?

Answer 37

EEG: severe slowing on temporal lobes (triphasic waves, unilateral) - MRI of brain lit up on temporal lobes - Positive PCR (temporal lobes + broca's)

Question 38

HSV ENCEPHALITIS: | Signs/symptoms?

Answer 38

``` Sz AMS peech output bad x5 days fever obtunded ```

Question 39

HSV ENCEPHALITIS: | ER management?

Answer 39

1. ABC's 2. CT w/o contrast to r/o stroke --> assume inf 3. tx with broad specrum abx 4. MRI head (temporal lobe*)

Question 40

HSV ENCEPHALITIS: | Tx?

Answer 40

ICP management, fluids, ACV therapy, do NOT use steroids, seizure control