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Neurology > Movement Disorders > Flashcards

Movement Disorders Flashcards

1
Q

In general, what 4 classifications do we look at when a patient presents with a tremor?

A

Rest vs. Action Body Part Affected Frequency Amplitude (fine/course)

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2
Q

How do we tell if a patient has a resting tremor?

A

Support the body part against gravity

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3
Q

What can increase or decrease a resting tremor?

A

Movement

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4
Q

If a patient goes to grab something and the shake, what’s it called?

A

Intention tremor

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5
Q

If a patient presents with a tremor that is high-frequency, and low amplitude (fine & fast), what diagnosis?

A

Physiologic tremor

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6
Q

When does someone typically have a physiologic tremor?

A

Hyper-adrenergic states (anxiety, caffeine, or withdrawals of caffeine or alcohol)

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7
Q

If a 65 year old patient presents with a tremor that is in the right arm and has slowly gotten worse over the past couple months, and their neurological exam is normal, what ddx?

A

Benign essential tremor

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8
Q

What are the main things we think of for a benign essential tremor?

A

60+, UE tremor, starts on one side and move to bilateral, SLOW progression

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9
Q

How do we treat a benign essential tremor?

A

Beta blockers, rest/sleep, eat well

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10
Q

A patient presents with a tremor involving the left hand and the first two fingers that’s been there for the past year or so. They have noticed a decrease in their affect, on PE they have no weakness and no changes in DTR’s but they do have cogwheel, what ddx?

A

Parkinson’s

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11
Q

What is decreased in Parkinson’s disease?

A

Dopamine in the substantia nigra

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12
Q

What are the 4 cardinal signs of Parkinson’s disease?

A

Tremor, rigidity, bradykinesia, and postural impairment

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13
Q

What is Bradykinesia?

A

Slowness of movements (gait and speech)

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14
Q

What’s the classic name for a Parkinson’s gait? How do they turn?

A

Festinating gait with Turn “en bloc” (along with freezing)

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15
Q

Although there’s no definitive diagnosis for Parkinson’s what can we look at?

A

Dopamine levels – high suspicion. Refer

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16
Q

What symptoms are NOT Parkinson’s?

A

No response to levodopa, symmetrical, rapid progression, abnormal eye movements (that’s MS)

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17
Q

At what point do we treat Parkinson’s?

A

When functional disabilities begins

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18
Q

How can we treat Parkinson’s?

A

Levodopa (so dopamine can cross the BBB) but it wears off :(

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19
Q

What are some S/E of levodopa?

A

Increase in uncontrolled movement (Dyskinesias)

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20
Q

When Levodopa begins to wear off, what can you add?

A

Entacapone
Dopamine Agonists: Ropinirole
Anticholinergics: Benztropine (Cogentin)
MAO-B inhibitor: Selegiline

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21
Q

What’s the absolute last source of treatment for Parkinson’s?

A

Deep brain stimulation

22
Q

A 40 year old presents with spastic, involuntary movements of the arm, that they don’t seem to notice, ddx?

A

Huntington’s

23
Q

How do you describe the involuntary movements of Huntington’s?

A

Chorea with Hemiballismus

24
Q

What else would you notice about the movements of a person with Huntington’s?

A

Abnormal eye movements

25
Q

What’s often untreated in Huntington’s?

A

Psych = Depression, OCD, Anxiety, Mania

26
Q

What type of disease is Huntington’s?

A

Autosomal Dominant Disease

27
Q

When treating a patient with Huntington’s what do we also need to consider?

A

Nutritional, PT/OT, Neuro, Speech Pathologist, Psych ANNNDD Genetic counseling

28
Q

If a young boy presents with a very fine extra eye movement, such as excessive blinking, and tends to repeat the words of his parents excessively, what diagnosis?

A

Tourette’s

29
Q

How can you actually make the diagnosis of Tourette’s?

A

It’s NOT explained by any other medical condition

It must occur almost every day for >1 year (most often before 18)

30
Q

Where does Tourette’s initially start vs. over time?

A

Initially = head & face

Over Time = Changes with increasing complexity

31
Q

When do tics increase vs. decrease?

A

Increase with stress & decrease with activities

32
Q

How does Tourette’s change over the course of a lifetime?

A

Lifelong symptoms but often decrease in adulthood

33
Q

When would you actually need to treat Tourette’s?

A

If their Tic presents a problem

34
Q

What are some pharm & non-pharm treatments for Tourette’s?

A 
Pharm = SSRI’s & Antianxiety
Non-Pham = Habit reversal training, biofeedback, botox injections
35
Q

What do many Tourette’s patients also have?

A

ADD, anxiety, OCD

36
Q

What movement disorder involves intermittent or sustained muscle contractions causing twisting and repetitive movements?

A

Cerebral Palsy

37
Q

If we see a child in the ER with CP, what do we always need to consider?

A

Non-traumatic fractures!

38
Q

If a patient has a burning pain, often in the LE, what classification is this diagnosis?

A

Neuropathy

39
Q

If a patient has a neuropathy what are the hypersensitive to?

A

Light touch

40
Q

If a person show’s up with foot drop and after the excellent HPI you discover they were out drinking heavily last night and were fine when they went to bed, what diagnosis?

A

Saturday Night Palsy

41
Q

If a swimmer presents with numbness and shooting pain through the upper extremity, what ddx? What special test to you do to confirm?

A

Thoracic Outlet Syndrome Adson’s sign!

42
Q

If a patient is a long time ___ they can also get neuropathies

A

Alcoholic

43
Q

If what levels in a diabetic are not well controlled they can develop diabetic neuropathies in the feet?

A

A1c’s

44
Q

What medications can cause neuropathies?

A

Chemotherapies, phenytoin, metronidazole

45
Q

If a patient has intermittent, lancing, facial pain what ddx?

A

Trigeminal Neuralgia

46
Q

How old are patient’s with trigeminal neuralgia? What if they are younger?

A

Older than 50. If younger, think MS

47
Q

What type of pressure hurts vs. doesn’t hurt a patient with trigeminal neuralgia?

A

Hurts = Breeze, kiss, shave, chewing

Doesn’t hurt = Deep/Firm pressure

48
Q

What would you see on PE in a patient with trigeminal neuralgia?

A

Normal except for pain with soft touch

49
Q

If a patient allodynia (pain from a non-painful stimulus) in a dermatomal pattern, what ddx?

A

Zoster

50
Q

How do we treat Zoster and WHY?

A

Acyclovir

Treat to PREVENT post herpetic neuralgia

51
Q

What must we always do during PE before giving the Dx of Zoster?

A

Florescence dye exam of the eye

Neurology (11 decks)

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