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clin med III final > movement disorders > Flashcards

movement disorders Flashcards

1
Q

a state of restlessness, can’t sit still

A
  • akathisia
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2
Q

inability to coordinate movements of the limbs or trunk

A

ataxia

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3
Q

involuntary writhing limb movements

A
  • athetosis
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4
Q

cause of idiopathic parkinson’s disease

A
  • destruction of Dopamine in the substantia nigra pars compacta
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5
Q

four cardinal features of idiopathic parkinson’s disease

A
  1. rest tremor
  2. rigidity
  3. akinesia-bradykinesia
  4. postural instability
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6
Q

describe rest tremor in idiopathic parkinson’s disease

A
  • unilatearl
  • can be pill-rolling
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7
Q

explain rigitidy of idiopathic parkinson’s disease

A
  • sustained resistance through passive range of motion
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8
Q

describe akinesia-bradykinesia associated with idiopathic parkinson’s disease

A
  • loss of manual dexterity
  • reduced facial expression (masked facies)
  • slowing of movement
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9
Q

describe postural instability associated with idiopathic parkinson’s disease

A
  • stooping
  • retropulsion: tendency to walk backwards
  • falls with turning
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10
Q

what are the autonomic features associated with idiopathic parkinson’s disease

A
  • sweating abnormalities
  • orthostatis hyoptension
  • impotence
  • constipation
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11
Q

two common rating scales for idiopathic partkinson’s disease

A
  • unified parkinson’s disease rating scale
  • modified hoehn and yahr staging
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12
Q

how does drug induced parkinsonism differ from idiopathic parkinson’s disease

A
  • offending drug (phenergan, anti-psychotic)
  • absence of rest tremor
  • symmetric symtpoms
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13
Q

how does vascular disease differ from idiopathic parkinson’s disease

A
  • gait disturbance
  • spasticity
  • hyper-reflexia
  • pseudobulbar affect: inappropriate involuntary laughing/crying
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14
Q

how does normal pressure hydrocephalus differ from idiopathic parkinson’s disease

A
  • apraxia of gait (feet stuck to ground, magnetic gait)
  • cognitive impairment
  • urinary incontinence
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15
Q

how does corticobasal degeration differ from idiopathic parkinson’s disease

A
  • cognitive disorder
  • limb apraxia
  • unilateral limb rigidity
  • myoclonus or dystonia
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16
Q

describe Progressive Supranuclear palsy

A
  • pseudobulbar affect
  • supranuclear gaze palsy (vertical gaze, down>up gaze)
  • early falls
  • absence of tremor
  • poor L-dopa response
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17
Q

describe multi-system atrophy

A
  • prominent autonomic features early on
    • severe constipation, orhostatic BP changes
  • falls
  • axial dystonia
  • no rest tremor
  • poor L-dopa response
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18
Q

describe dementia with lewy bodies

A
  • cognitive disorder
  • hallucination
  • prominent dream enactment behavior
  • mild autonomic symptoms
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19
Q

multi-system atrophy (MSA) has what sign on MRI

A
  • hot cross bun
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20
Q

progressive supranuclear palsy has what sign on MRI

A

hummingbird sign

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21
Q

diagnostic workup if you suspect parkinsonism

A

MRI brain

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22
Q

normal pressure hydrocephalus has what sign on MRI

A

massively enlarged ventricles

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23
Q

any patient < 50 yo who presents with a movement disorder, you need to rule out

A
  • wilson’s disease
    • serum ceruloplasmin
    • K-F rings
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24
Q

any patient who presents with a tremor, check these labs

A

thyroid studies

25
all patients who you follow with Parkinsons disease, check this lab
vitamin D
26
how should sinemet immediate release and continued release be taken
* IR: empty stomach * CR: with meals
27
all parkinsonism patients get put on a trial of
* Sinemet (carbidopa/levodopa)
28
Sinemet (carbidopa/levodopa) is given to what patients with IPD
* all patients with IPD \> 70 * IPD pts \< 70 if other Rx not working
29
long term use with Sinemet (carbidopa/levodopa) causes
* motor fluctuations
30
side effects of Sinemet (carbidopa/levodopa)
* nausea * rare drop in BP * impulse control disorders
31
List the Dopamine agonists used for IPD
* Pramipexole * Ropinirole * Rotigotine (patch)
32
side effects of Dopamine agonists
* **sleepiness** * nausea * orthostatic hypotension
33
indication for use of Dopamine agonists in tx of IPD
* patient \< 70 * mild symptoms * **dyskinesias**
34
what medication can be given in IPD patients for drooling
* Robinul - anticholinergic * botulinum toxins
35
indications for DBS surgery
* significant disability * motor fluctuations with maximized medications * **still levodopa responsive** * **no cognitive impairment**
36
essential tremor is caused by
* autosomal dominant inheritane with variable penetrance * FET1/ETM1 * FET2/ETM2
37
features of essential tremor
* postural or kinetic, typically **bilateral upper extremities (hands)** * rest tremor may develop later on * may improve with ETOH * may have head, chin or voice tremor
38
DOC treatment options for essential tremor
* wrist weights * **propranolol**
39
treatment of head tremor associated with essential tremor
botulinum toxin
40
list the 4 criteria for diagnosis of restless leg syndrome
1. abnormal sensations with urge to move legs 2. occurs at rest 3. alleviated by movement 4. symptoms worse at night
41
restless leg syndrome is associated with what movements
PLM: periodic limb movement
42
secondary causes of RLS
* neuropathy * Fe deficiency * pregnancy * renal failure
43
treatment of Restless leg syndrome
* Dopamine Agonists (pramipexole, ropinirole, rotigotine) * only use at night * helps both RLS and PLM
44
what can happen in RLS if patient is taking dopamine agonists TID
* rebound and augmentation * symtpoms spread from legs to arms and occurs all day long and becomes very hard to treat
45
cause of huntington's disease
* autosomal dominant with high penetrance * CAG repeat
46
treatment of symptomatic huntington's disease
* **anti-dopaminergic drugs** - typically antipsychotic * benzodiazepines * anti-depressants
47
huntington's disease presents with what deficits
* motor * wide based gait, chorea * cognitive * executive function, visual-spatial abilities * psychiatric * depression, psychosis
48
differentiate between transient and chronic tic disorders
* transient \< 6 months
49
Tics are associated with what conditions
* OCD * ADD
50
what are some drug classes that induce Tics
* stimulants * steroids * neuroleptics
51
treatment of Tics
* **Clonidine** * neuroleptics (halidol) * Benzodiazepines
52
diagnostic criteria for Tourettes syndrome
* motor tics and phonic tics for \> 1 yr * no secondary causes * onset before 18 yo
53
generalized Dystonia
* idiopathic torsion dystonia * **childhood** onset
54
focal dystonia comes in what categories
* cervical * blepharospasm (excessive blinking or squinting) * task-specific * lingual * laryngeal
55
focal dystonia seen in what patient population
adults
56
treatment of Dystonia
botulinum toxins
57
what are hemifacial spasms? where do they begin
* involuntary, intermittent spasms of half of the face * perioribital muscles
58
causes of hemifacial spams
* **CN VII compression**: most common * CVA, MS, post bell's palsy
59
tx of hemifacial spams
* BTX-A

clin med III final (7 decks)

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