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Clin Med II- Neuro > Movement Disorders > Flashcards

Movement Disorders Flashcards

1
Q

Tx for essential tremor

A

proponolol- first line. Primidone.

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2
Q

Differentiate essential tremor from parkinson’s

A

tremor during activity in essential tremor. tremor at rest in parkinson’s.

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3
Q

Diagnostics in parkinson’s

A

check serum urate level for prognosis! if high, means progression of disease is slower

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4
Q

Myerson’s sign

A

In parkinson’s- patient unable to prevent blinking when their glabella is touched

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5
Q

Tx options in parkinson’s

A

Amantadine- if mild sx with no disability. Improves all symptoms. Anticholinergics- help with rigidity and tremor. Levodopa- improves all symptoms. Dopamine agonists can be used in conjuction with levodopa or if levodopa fails, MOAI’s (Rasagiline) and COMT inhibitors. PT, speech therapy, walkers, voice amplifiers. High freq. thalamic stimulation- can help tremor

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6
Q

Diagnosis of huntington’s

A

check family history (autosomal dominant). CT/MRI shows cerebral atrophy and atrophy of caudate nucleus. PET shows reduced metabolic rate of corpus straitum

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7
Q

Childhood case of huntington’s

A

akinesia rather than chorea

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8
Q

Diagnosis of Idiopathic torsion dystonia

A

one of exclusion, so r/o birth trauma, anoxia, kernicterus (bilirubin induced brain issues)

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9
Q

What determines presentation and prognosis of idiopathic torsion dystonia?

A

age of onset. Childhood- dystonia in legs, poor prognosis. Adults- in arms/trunk, usually no severe disability

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10
Q

4 features of parkinson’s

A

tremor at rest, bradykinesia, rigidity, postural instability

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11
Q

Huntington’s main characteristics

A

family history, chorea/dyskinesia, dementia

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12
Q

Focal torsion dystonia features

A

spastic torticolis, blepharospasms, oromandibular dystonia, writer’s cramp

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13
Q

Type of Idiopathic torsion dystonia

A

Focal torsion dystonia- if patient has family history of this, then patient may have this atypical or attentuated form. If no family history, this is focal manifestation of adult onset ITD

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14
Q

Tx of focal torsion dystonia

A

Blepharospasms, writer’s cramp, and spastic torticolis can be injected with botox. but otherwise, medical tx usually does not work

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15
Q

Is there a mental delay with ITD?

A

No- this is how it is differentiated from cerebral palsy

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16
Q

Idiopathic torsion dystonia tx

A

responds poor to treatment. one variant of dominantly inheritied ITD in which kids cannot walk responds well to levodopa

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17
Q

Onset of spastic torticolis in focal torsion dystonia

A

25-50

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18
Q

Generalized myoclonic jerks

A

Myoclonus

19
Q

Other causes of myoclonic jerks

A

myoclonus, idiopathic eplepsy, lipid storage dz, ramsay hunt, cruetzfeld jacob

20
Q

Myoclonus tx

A

valproic acid, benzodiazepines, anoxic brain injury myoclonus- oxitriptam

21
Q

Dx of wilson’s disease

A

serum ceruloplasmin low (less than 5mg/dL) and urine excretion of copper high (more than 40 mcg/24h). LIver biopsy may show cirrhosis or hepatitis

22
Q

Features of wilson’s dz

A

kayser-fleischer ring- pathognomonic. Abnormal movement and posture, psych and neuropsych signs because basal ganglia involved, incoordination, spasticity,

23
Q

Organs that wilson’s dz can affect

A

Liver and brain

24
Q

ddx of wilson’s

A

parkinson’s, ataxia, dystonic syndrome, pdeudosclerosis with tremor

25
Q

tx for wilson’s

A

autosomal recessive. chelating agents, oral zinc acetate or zinc gluconate

26
Q

Drug induced abnormal movements- characteristics

A

similar to parkinsonism- tremor, rigidity, postural instability, bradykinesia. Als, akathesia (motor restlessness), acute dystonia, tardive dyskinesia (lower face abnormal movement), chorea

27
Q

Drugs that can cause drug-induced abnormal movements

A

BAMP- Butyrophenone, aripirazole, metaclopramide, phenothiazines (promethazine)

28
Q

Drugs that can cause chorea

A

AABCPLLO- Amphetamines, anticholinergics, bromocriptine, carbamazepine, phenytoin, lithium, levedopa, OC’s

29
Q

Drugs causing dystonia

A

CBLL’s- carbamazepine, bromocriptine, lithium, levodopa

30
Q

Drugs causing parkinsonism

A

reserpine, tetrabenzine

31
Q

drugs causing postural tremor

A

caffeine, thyroid issues

32
Q

RLS characteristics

A

irresistible urge to move the legs, often family hx,

33
Q

causes of RLS

A

idiopathic, genetic, pregnancy related, iron deficiency anemia, peripheral neuropathy (diabetes)

34
Q

Tx for RLS

A

pramipexole (dopamine agonist), ropinirole, benoz, gabapentin

35
Q

DOC for gilles de la tourette

A

haloperidol

36
Q

characteristics of gilles de la tourette

A

motor and phonic tics (most are motor).

37
Q

onset of gilles de la tourette

A

early- before 21

38
Q

gilles de la tourette a/w what disorder?

A

OCD

39
Q

Dx of gilles de la tourette

A

PE will show no focal neurological deficits other than tics. EEG shows minor non-specific abnormalities. Order labs to r/o wilson’s dz. Do family history (is autosomal DOMINANT)

40
Q

Which med might cause hypertension when combined with tyramine rich foods?

A

MAOI

41
Q

When are anticholinergics contraindicated?

A

prostatic hyperplasia, narrow angle glaucoma, obstructive GI dz

42
Q

when is levodopa contraindicated?

A

narrow angle glaucoma, psychotic illness, concurrent use with MOAI’s

43
Q

What COMT inhibitor can cause fulminant hepatic failure when combined with….

A

tolcapone

44
Q

Which movement disorders are hereditary?

A

essential tremor- AD. WIlson’s- AR. Gilles de la Tourettes- AD with variable penetrance, Huntington’s- AD

Clin Med II- Neuro (10 decks)

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