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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
Multi system atrophy Parkinsonsim
Falls, axial dystonia, respiratory stridor, akinesia, absence of rest tremor, dysmetria Prominent autonomic features!!! Poor l-dope response
26
Dementia with lewy bodies
HALLUCINATIONS | Cognitive disorder: prominent dream enactment behavior, mild autonomic sxs
27
When to do MRI of the brain
Gait disorder and falling | Cognitive disorder
28
Multisystem atrophy on MRI
Hot cross bun sign
29
Progressive supranuclear palsy on MRI
Hummingbird sign due to midbrain atrophy
30
What to rule out in all pts <50 with movement disorder
Wilson's disease
31
How to rule out Wilson's disease
Urine copper or serum ceruloplasmin | Eye exam for K-F rings
32
What to be done for all pts with cognitive or functional neuro sxs
Neuropyschometric testing
33
What to do for all pts with tremor
Thyroid studies
34
When to give vitamin D supplements
All pts with PD b/c increased risk of falling
35
When to do SPECt (DaTSCAN)
Mixed tremor disorders (rest and postural etc)
36
Types of tx for IPD
``` 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
What is Sinemet?
Carbidopa/levodopa (IRimmedite release empty stomach and CR with meals)
38
Who gets Sinemet?
All pts with IPD over 70 YO | Pts <70 when other rx not working (like DA agonist)
39
Long term use of Sinemet
Motor fluctuations
40
Side effects of Sinemet
Nausea Rare BP changes Impulse control disorders
41
DA agonist options
Pramiprezole, Ropinirole, Rotigotine (titrate 6-8 wk process)
42
Side effects of DA agonists
Sleepiness, nausea, orthostatic hypotension, hallucinations, ICDs
43
Indications to use DA agonists
Patient <70 YO Mild sxs Dyskinesias
44
Tx of MCI or dementia associated with IPD
Anticholinesterases
45
Tx of sialorrhea (drooling) associated with IPD
Robinul (can cause confusion in elderly) or botulinum toxins
46
Types of surgical tx for IPD
Ablative, FUS, stimulation
47
Deep brain stim surgery sites
Vental immediate nucles: ET or tremor predominant Subthalamic nuclues: PD Globus pallidus interna: dystonia or rigidity prominent PD
48
Indications for DBS
Significant disability Motor fluctuations wiht max medications Still levodopa responsive No cognitive impairment
49
How get essential tremor
Autosomal dominant (chromosome 2 or 3)
50
Tremor in essential tremor
4-11 Hz Postural or kinetic, typically UEs May have rest tremor later on May improve with EtOH and worsen with caffeine
51
Tx of essential tremor
Weight weights and weighted utensils Propranolol and primidone are best! Gapapentin, topiramate, diazepam, botulinum (head tremor) DBS of VIM if refractory to meds
52
Criteria for restless legs syndrome
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
Secondary causes of RLS
Neuropathy, Fe deficiency, pregnancy, renal failure
54
Tx for RLS
``` Only at night!!! Fe replacement (ferritin <40) DA agonists, anti-epileptics, benzos, opioids, carbi/levodopa ```
55
What to watch out with tx of RLS
Rebound and augmentation (DA agonists, why take at night)
56
Pathophys of Huntington's
HD gene on chromosome 4 leading to CAG repeats | Autosomal dominant
57
Motor sxs of Huntington's
``` Chorea Motor impersistence (milk maid grasp and fly catcher tongue) ```
58
Tx for Huntingtons (when symptomatic)
Anti-DA drugs Benzos Anti-depressants
59
What are tic disorders?
Semi-voluntary, suppressible Motor or phonic (vocal) Simple-sniff, grunt, blink Complex- words, chewing, scratching
60
Types of tic disorders
Provisional (Transient) Chronic Tourette's Tardive tics (from anti-psychotics)
61
Etiology of tics
Primary/genetic: Tourettes Drug induced: stimulants, steroids, neuroleptics Post-infectious: strep
62
Association of tics
OCD and ADD
63
Tx of tics
Clonidine Neuroleptics benzos
64
Criteria for Tourette's
``` 2 or more motor tics AND 1 or more phonic tics >1 yr No secondary causes Onset before 18 Copralalia (<10%) ```
65
Tx for Tourette's
Meds, botulinum toxin, DBS
66
What is geste antagoniste?
Sensory trick in dystonia (focal) where can touch or do something to make it go away for a little
67
Types of dystonia
Generalize: usually childhood onset and genetic Focal: cervical, blepharospasm, task-specific, lingaul etc
68
Tx of dystonia
``` Dopaminergic Muscle relaxers Benzos Anticholinergics Botulinum toxins (all focal) DBS ```
69
Hemifacial spasm
Involuntary, intermittent spasms of half the face (starts in periorbital muscles)
70
Most common cause of hemifacial spasm
CN VII compression (others like CVA, MS, Post-Bell's palsy)
71
Tx for hemifacial spasm
Botox-A in spots on face
72
What is basically the movement disorder that doesn't fit into any other category?
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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