Movement disorders

Question 1

what are the 4 things to look for in tremors

Answer 1

frequency
amplitude
exacerbating factors

Question 2

defining feature of resting tremor

Answer 2

worse at rest

abolished with movement

Question 3

condition with resting tremor

Answer 3

parkinsons

Question 4

defining features of intention tremor

Answer 4

large amplitude

worse at end of purposeful acts (e.g. finger pointing)

Question 5

defining features of postural tremor

Answer 5

absent at rest
presents on maintained posture (hands outstretched)
may persist on movement

Question 6

causes of postural tremor

Answer 6

benign - autosomal dominant (essential tremor)
thyrotoxicosis
B agonists
anxiety

Question 7

what helps benign postural tremor

Answer 7

propranolol (treatment)

alcohol

Question 8

defining feature of re-emergent tremor

Answer 8

postural tremor developing after a delay of approximately 10 seconds

Question 9

3 features of parkinsonian syndrome

Answer 9

bradykinesia
resting tremor
muscle rigidity

Question 10

what is parkinsons disease

Answer 10

progressive neurodegenerative disorder due to loss of dopaminergic neurons from mitochondrial dysfunction

Question 11

where does neuronal loss occur in parkinsons

Answer 11

substantia nigra

Question 12

what pigment makes substantia nigra black normally

Answer 12

neuromelanin

Question 13

what is the other pathological feature of parkinsons

Answer 13

lewy bodies

Question 14

what are lewy bodies

Answer 14

atypically folded alpha synuclein forming eosinophilic intracellular inclusions

Question 15

how is parkinsons diagnosed

Answer 15

onset of motor symptoms

exclusion of other causes - anaemia, hypothyroid

Question 16

describe the ‘rolling pill’ tremor

Answer 16

thumb moves backwards and forwards on palm of hand

Question 17

signs of increased rigidity and tone

Answer 17

flexed, hunched posture

cogwheeling

Question 18

what is bradykinesia

Answer 18

slow to initiate movements

slow and low aplitude of repetitive movements

Question 19

signs of bradykinesia

Answer 19

‘mask like’ expressionless face
dysphagia
slow blink rate
slow, shuffling gait (decreased arm swinging, freeze at doors)

Question 20

what are some non-motor symptoms of parkinsons

Answer 20

depression and hallucinations
dementia
decreased sense of smell
REM sleep disorder 
autonomic features - postural hypotension, constipation

Question 21

tremor dominant/non-tremor dominant parkinsons has the fastest progression

Answer 21

non-tremor dominant

Question 22

why might non-motor symptoms of parkinsons be present first

Answer 22

presence of lewy bodies in PNS and other areas of CNS

Question 23

parkinsons is typically bilateral/unilateral

Answer 23

unilateral

Question 24

what are atypical features of parkinsons

Answer 24

early dementia
imbalance
autonomic

Question 25

first line treatment in parkinsons

Answer 25

levodopa

Question 26

what does levodopa do and what symptoms does it help

Answer 26

increases intracerebral dopamine (dopamine precursor) | particularly helps rigidity and bradykinesia

Question 27

what should be given alongside levodopa and why

Answer 27

decarboxylase inhibitor: madopar, sinemet prevents peripheral breakdown of drug in liver reduces peripheral side effects

Question 28

what are side effects of levodopa

Answer 28

``` nausea/vomiting hypotension psychosis/hallucinations daytime solomnence dyskinesia (long term use) ```

Question 29

what can decrease the efficacy of levodopa

Answer 29

protein

Question 30

what helps tremor in parkinsons

Answer 30

anticholinergics | clozapine

Question 31

what could be added if levodopa resistant disease

Answer 31

dopamine agonists

Question 32

SE of dopamine agonists

Answer 32

compulsive behaviours fibrosis hallucinations + psychosis erythromyalgia

Question 33

what anti-emetic should be used in Parkinsons

Answer 33

domperidone

Question 34

what drug should be used in parkinsons if hypotensive

Answer 34

mineralcorticoid - fludrocorticone acetate

Question 35

what medications should be used for depression in parkinsons

Answer 35

tricyclics (desipramine) | SSRI (citalopram)

Question 36

what medication should be used for psychosis in parkinsons

Answer 36

clozapine

Question 37

what genetic mutations cause young-onset parkinsons

Answer 37

synuclein parkin LRRK2

Question 38

what can cause secondary parkinsonianism

Answer 38

``` drug induced (anti-psychotics/anti-emetics) post traumatic vascular disease infection (prion disease, HIV) hydrocephalus parathyroid paraneoplastic ```

Question 39

clinical features of vascular parkinsons

Answer 39

predominantly affects lower limbs | tremor uncommon

Question 40

clinical features of drug induced parkinsons

Answer 40

bilateral | coarse postural tremor

Question 41

what conditions may mimic parkinsons

Answer 41

multiple system atrophy progressive supranuclear palsy dementia with lewy bodies

Question 42

what is chorea

Answer 42

involuntary, irregular jerking movements affecting limbs and axial muscle groups suppressed with difficulty - often incorporated into voluntary gestures (facial grimacing, raising shoulders, flexing extending fingers)

Question 43

what is Sydenham's chorea

Answer 43

complication of a strep pneumoniae infection develops weeks-months after primary infection due to necrotising arteritis in striatum and thalamus

Question 44

what is dystonia

Answer 44

prolonged muscle contractions causing abnormal posture or repetitive movements (sustained head retraction, sustained inversion of foot)

Question 45

what mutation causes idiopathic generalized dystonia

Answer 45

DYT1 - autosomal dominant (reduced penetrance)

Question 46

what group are susceptible to idiopathic generalized dystonia

Answer 46

Ashkenazi Jews

Question 47

clinical features of idiopathic generalised dystonia

Answer 47

starts in leg affecting gait | spreads to whole body in 5-10 years