movement disorders

Question 1

Name the most common movement disorder.

Answer 1

tremor

Question 2

Name the 3 types of action tremors

Answer 2

kinetic, postural, isometric

Question 3

Which tremor can be detected by the finger nose test?

Answer 3

intention tremor; which is a subset of kinetic tremors

Question 4

Which tremor can be detected by having the patient squeeze your finger?

Answer 4

isometric - occurs during muscle contractions against stationary objects

Question 5

Which tremor is observed when a patient holds out their arms for example?

Answer 5

postural - holding body parts against gravity

Question 6

Which type of tremor can come and go, gets worse when the person is under stress and is often better during movement?

Answer 6

resting tremor

Question 7

what is a lab you might consider running in a patient with an essential tremor?

Answer 7

TSH- hyperthyroidism may increase heart rate, resulting in a tremor

Question 8

what are some of the side effects associated with Propranolol 60-320 mg/day?

Answer 8

hypotension, light headedness, decreased heart rate

Question 9

what kind of tremor occurs in all people, is most of the time not visible to the eye and is heightened by fear/anxiety, hypoglycemia, exhaustion, hyperthyroidism, caffeine etc ?

Answer 9

physiologic tremor

Question 10

a tremor that could be caused by MS, CVA or brain tumor, which manifests as an intension tremor and would get worse as a patient approached target during finger-to-nose test and heel to shin test

Answer 10

cerebellar tremor

Question 11

tremor that occurs in the legs/and or trunk immediately after standing, often responds to clonazepam (Klonopin)

Answer 11

orthostatic tremor

Question 12

action tremor that occurs only while writing, limited to the hand, low frequency large amplitude

Answer 12

primary writing tremor

Question 13

Name some characteristics of a psychogenic tremor.

Answer 13

often sudden onset, not present if patient not aware of being observed, changeable features, extinction with distraction, wont respond to medications, increased when patient is under stress

Question 14

trinucleotide mutation on the short arm of chromosome 4 can cause what disease?

Answer 14

Huntington’s disease

Question 15

what are the 3 hallmark features of Parkinson’s disease?

Answer 15

resting tremor, bradykinesia, rigidity

Question 16

what is the usual presenting complaint in a patient with PD?

Answer 16

tremor

Question 17

what is a common side effect to the majority of PD medications?

Answer 17

orthostatic hypotension

Question 18

what type of medication could you give to a PD patient to treat their tremors and drooling?

Answer 18

anticholinergic medications; ex. benztropine (Cogentin), trihexyphenidyl

Question 19

name the side effects of anticholinergic medications.

Answer 19

mydriasis, urinary retention, hyperthermia, confusion, tachycardia, flushed skin, shaking, absent bowel sounds

Question 20

which is THE most effective drug to treat PD?

Answer 20

Levadopa; especially good for treating symptoms of bradykinesia

Question 21

name 2 most common causes of death in patients with Huntington’s.

Answer 21

aspiration pneumonia

Question 22

which medication is used to treat chorea in patients with Huntington’s?

Answer 22

Tetrabenazine (xenazine)

Question 23

What medication might you give to a patient who has early onset PD, patients <65-70 and symptoms aren’t life threatening?

Answer 23

dopamine agonist:
bromocriptine (cyclist)
pramipexole (Mirapex)
Ropinirole (Requip)
Rotigotine (Neupro)
Apomorphine (Apokyn)

Question 24

What other medication must you combine with Levadopa?

Answer 24

carbidopa- peripheral dopa decarboxylase inhibitor

Question 25

Why must patients with PD take Carbidopa/Levadopa (Sinemet) 25/100 mg PO TID at the same time every day?

Answer 25

their body starts to depend on it

Question 26

Name some of the most common side effects of Sinemet.

Answer 26

orthostatic hypotension, dyskinesias, hallucinations, abnormal dreams

Question 27

which PD med is not effective when given alone, but prolongs the levodopa effect when given with a dose of levodopa?

Answer 27

COMT inhibitors - ex. Tolcapone (Tasmar) & entacapone (Comtan)

Question 28

which medication would a PD be taking if they excreted orange urine?

Answer 28

COMT inhibitors

Question 29

which PD med blocks central dopamine metabolism and increases concentrations at the synapse, and can also benefit as a monotherapy early in the disease?

Answer 29

Mao B inhibitors such as selegiline (Zelpar) and Rasagiline (Azilect)

Question 30

prolonged use of dopamine receptor blocking agents, mainly antipsychotics (aka neuroleptics) and antiemetics can cause a hyperkinetic movement disorder called ?

Answer 30

tardive dyskinesia (TD)

Question 31

which second generation antipsychotic has the highest risk of developing TD?

Answer 31

Risperidone (Risperdal)

Question 32

first generation antipsychotics have a higher incidence of TD than second generation. T or F?

Answer 32

True