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X Clin Med III Final Exam > Movement Disorders > Flashcards

Movement Disorders Flashcards

1
Q

What is akathisia?

A

State of restlessness (can’t sit still)

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2
Q

What is ataxia?

A

Inability to coordinate movements of the trunk or limbs

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3
Q

What is athetosis?

A

Involuntary writhing limb movements

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4
Q

What is ballism?

A

Flailing, ballistic, involuntary movements in a limb

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5
Q

What is chorea?

A

Quick involuntary, dance-like movements

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6
Q

What are dyskinesias?

A

Involuntary movements, chorea-like or tic-like

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7
Q

What is dystonia?

A

Abnormal muscle tone with sustained posture

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8
Q

What is myoclonus?

A

Involuntary spasmodic jerky movements

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9
Q

What are tics?

A

Habitual, semi-voluntary, spasmodi, quick, brief movements

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10
Q

What PE to do for a movement disorder

A 
MSE
Handwriting sample
Cranial nerves
Motor (rest, posture and kinetic movements, rapid alternating movements)
Reflexes
Sensory
Coordination
Station/stance and pull-testing
Gait
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11
Q

Types of Parkinsonisms

A 
Idiopathic Parkinson's Disease
Drug-induced parkinsonism
Vascular parkinsonism
Normal pressure hydrocephalus
Progressive supranuclear palsy
Multiple system atrophy
Corticobasal degeneration
Dementia with lewy bodies
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12
Q

Disease course of Idiopathic Parkinson’s

A

Symptom free honeymoon about 3 yrs after diagnosis
Motor complications at about 5-7 yrs
Onset to death about 20 years

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13
Q

Pathophysiology of Parkinsons

A

Degeneration of DA neurons in substantia nigra pars compacta

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14
Q

Cardinal features of Idiopathic Parkinson’s

A

Rest tremor
Rigidity
Akinesia-bradykinesia
Postural instability

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15
Q

Rest tremor of Idiopathic Parkinson’s

A

Unilateral

4-7 Hz and can be pill rolling (slow and at rest)

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16
Q

Rigidity of Idiopathic Parkinson’s

A

Sustained resistance through passive range of motion
Lead pipe or cog wheeling
Muscle stretch receptors are normal

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17
Q

Akinesia-bradykinesia of Idiopathic Parkinson’s

A

Masked facies, loss of manual dexterity, getting out of chairs, loss of spontaneous animation, loss of associated movements

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18
Q

Postural instability of Idiopathic Parkinson’s

A

Stooping and retropulsion
Falls with turning (center of gravity)
*should be the last of the 4 to be seen in PD

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19
Q

Rating scales for Idiopathic Parkinson’s

A

-Unified Parkinson’s Disease Rating scale (UPDRS):
I is mentation, mood and behavior
II is activities of daily living
III is motor exam
IV is complications of therapy
-Modifies Hoehn and Yahr staging (stages 0-5)

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20
Q

Drug-induced Parkinsonism

A

Find the offending drug (anti-nausea, anti-psychotic basically anything anti-dopamines)
Absence of rest tremor
Associated akathisia
SYMMETRIC sxs

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21
Q

Vascular Parkinsonsim

A

GAIT DISTURBANCE
Spasticity and hyperreflexia
Pseuchobulbar affect

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22
Q

Normal Pressure Hydrocephalus

A 
APRAXIA OF GAIT
Rigidity
Cognitive impairment
Urinary incontinence
(wet, wacky and wobbly)
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23
Q

Corticobasal degeneration Parkinsonism

A

COGNITIVE DISORDER
Limb apraxia
Unilateral limb rigidity
Dystonia or myclonus

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24
Q

Progressive supranuclear palsy related Parkinsonism

A

Psuedobulbar affect
SUPRANUCLEAR GAZE PALSY (vertical gaze, down > up gaze)
Falls!!
Slowed saccades, axial rigidity, absence of tremor, spastic-ataxic dysarthria, poor L-dope response

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25
Q

Multi system atrophy Parkinsonsim

A

Falls, axial dystonia, respiratory stridor, akinesia, absence of rest tremor, dysmetria
Prominent autonomic features!!!
Poor l-dope response

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26
Q

Dementia with lewy bodies

A

HALLUCINATIONS

Cognitive disorder: prominent dream enactment behavior, mild autonomic sxs

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27
Q

When to do MRI of the brain

A

Gait disorder and falling

Cognitive disorder

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28
Q

Multisystem atrophy on MRI

A

Hot cross bun sign

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29
Q

Progressive supranuclear palsy on MRI

A

Hummingbird sign due to midbrain atrophy

30
Q

What to rule out in all pts <50 with movement disorder

A

Wilson’s disease

31
Q

How to rule out Wilson’s disease

A

Urine copper or serum ceruloplasmin

Eye exam for K-F rings

32
Q

What to be done for all pts with cognitive or functional neuro sxs

A

Neuropyschometric testing

33
Q

What to do for all pts with tremor

A

Thyroid studies

34
Q

When to give vitamin D supplements

A

All pts with PD b/c increased risk of falling

35
Q

When to do SPECt (DaTSCAN)

A

Mixed tremor disorders (rest and postural etc)

36
Q

Types of tx for IPD

A 
Carbidopa/levidopa
DA agonists
MAO-B inhibitors
COMT inhibitors
Anti-cholinergics
MAO-B inhibitor/DA reuptake inhibitor
NMDA antagonist/DA reuptake inhibitor
Surgery
Anti-psychotics
37
Q

What is Sinemet?

A

Carbidopa/levodopa (IRimmedite release empty stomach and CR with meals)

38
Q

Who gets Sinemet?

A

All pts with IPD over 70 YO

Pts <70 when other rx not working (like DA agonist)

39
Q

Long term use of Sinemet

A

Motor fluctuations

40
Q

Side effects of Sinemet

A

Nausea
Rare BP changes
Impulse control disorders

41
Q

DA agonist options

A

Pramiprezole, Ropinirole, Rotigotine (titrate 6-8 wk process)

42
Q

Side effects of DA agonists

A

Sleepiness, nausea, orthostatic hypotension, hallucinations, ICDs

43
Q

Indications to use DA agonists

A

Patient <70 YO
Mild sxs
Dyskinesias

44
Q

Tx of MCI or dementia associated with IPD

A

Anticholinesterases

45
Q

Tx of sialorrhea (drooling) associated with IPD

A

Robinul (can cause confusion in elderly) or botulinum toxins

46
Q

Types of surgical tx for IPD

A

Ablative, FUS, stimulation

47
Q

Deep brain stim surgery sites

A

Vental immediate nucles: ET or tremor predominant
Subthalamic nuclues: PD
Globus pallidus interna: dystonia or rigidity prominent PD

48
Q

Indications for DBS

A

Significant disability
Motor fluctuations wiht max medications
Still levodopa responsive
No cognitive impairment

49
Q

How get essential tremor

A

Autosomal dominant (chromosome 2 or 3)

50
Q

Tremor in essential tremor

A

4-11 Hz
Postural or kinetic, typically UEs
May have rest tremor later on
May improve with EtOH and worsen with caffeine

51
Q

Tx of essential tremor

A

Weight weights and weighted utensils
Propranolol and primidone are best!
Gapapentin, topiramate, diazepam, botulinum (head tremor)
DBS of VIM if refractory to meds

52
Q

Criteria for restless legs syndrome

A

Abnormal sensations with urge to move legs
Occurs at rest
Alleviated by movement
Sxs worse at night
(associated with periodic limb movements, can be seen in arms and torso too)

53
Q

Secondary causes of RLS

A

Neuropathy, Fe deficiency, pregnancy, renal failure

54
Q

Tx for RLS

A 
Only at night!!!
Fe replacement (ferritin <40)
DA agonists, anti-epileptics, benzos, opioids, carbi/levodopa
55
Q

What to watch out with tx of RLS

A

Rebound and augmentation (DA agonists, why take at night)

56
Q

Pathophys of Huntington’s

A

HD gene on chromosome 4 leading to CAG repeats

Autosomal dominant

57
Q

Motor sxs of Huntington’s

A 
Chorea
Motor impersistence (milk maid grasp and fly catcher tongue)
58
Q

Tx for Huntingtons (when symptomatic)

A

Anti-DA drugs
Benzos
Anti-depressants

59
Q

What are tic disorders?

A

Semi-voluntary, suppressible
Motor or phonic (vocal)
Simple-sniff, grunt, blink
Complex- words, chewing, scratching

60
Q

Types of tic disorders

A

Provisional (Transient)
Chronic
Tourette’s
Tardive tics (from anti-psychotics)

61
Q

Etiology of tics

A

Primary/genetic: Tourettes
Drug induced: stimulants, steroids, neuroleptics
Post-infectious: strep

62
Q

Association of tics

A

OCD and ADD

63
Q

Tx of tics

A

Clonidine
Neuroleptics
benzos

64
Q

Criteria for Tourette’s

A 
2 or more motor tics AND
1 or more phonic tics >1 yr
No secondary causes
Onset before 18
Copralalia (<10%)
65
Q

Tx for Tourette’s

A

Meds, botulinum toxin, DBS

66
Q

What is geste antagoniste?

A

Sensory trick in dystonia (focal) where can touch or do something to make it go away for a little

67
Q

Types of dystonia

A

Generalize: usually childhood onset and genetic
Focal: cervical, blepharospasm, task-specific, lingaul etc

68
Q

Tx of dystonia

A 
Dopaminergic
Muscle relaxers
Benzos
Anticholinergics
Botulinum toxins (all focal)
DBS
69
Q

Hemifacial spasm

A

Involuntary, intermittent spasms of half the face (starts in periorbital muscles)

70
Q

Most common cause of hemifacial spasm

A

CN VII compression (others like CVA, MS, Post-Bell’s palsy)

71
Q

Tx for hemifacial spasm

A

Botox-A in spots on face

72
Q

What is basically the movement disorder that doesn’t fit into any other category?

A

Functional/psychogenic (usually abrupt onset or triggered by minor trauma
Lots of characteristic features

X Clin Med III Final Exam (6 decks)

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