Movement Disorders/Failure to Thrive Flashcards
Paulson Lectures
____ tremor (AKA ___ tremor) occurs when the body is supported and at rest, and often improves with movement
Resting / Parkinson’s
____ tremor is seen with the body part held against gravity
postural
____ tremor is seen with voluntary movement of the limb
kinetic
____ tremor is worse during goal-directed movement
intention
____ tremor occurs during muscle contraction against stationary objects
isometric
____ tremor is a postural tremor usually involving writing or drinking from a cup, is exacerbated by emotional stress, and can be improved with alcohol
Essential
___ tremor is manifested as intention tremor and is tested with finger-to-nose test and heel-to-shin test
Cerebellar
___ tremor occurs in the legs/trunk immediately after standing and is often treated with Klonopin
Orthostatic
____ are rapid, involuntary, non-repetitive, dance-like movements involving the face, trunk, and limbs
Chorea
In PD, dopamine is decreased and ____ is increased, causing overstimulation of skeletal muscles.
acetylcholine
___ is used for pts with mild, early Parkinson Disease. Side effect include, skin mottling, orthostatic hypotension, edema, confusion
Amantadine
_______ is only helpful for treating tremors and drooling. The side effects often outweigh the benefits
Anticholinergic medication
Side effects of anticholinergic meds include
- confusion
- vision changes, mydriasis
- flushed skin, hyperthermia
- tachycardia
____ is the most effective medication for PD, but the body gets used to it over time and requires incremental increase in dosage
Levadopa
Side effects of Levadopa include:
- orthostatic hypotension
- dyskinesias
- peripheral edema
- dizziness
- hallucinations, abnormal dreams
- nausea, constipation
Dopamine agonists, such as ___ and ____, directly stimulate dopamine receptors and are an alternative to Levadopa.
- Mirapex
- Requip
Which second generation antipsychotic poses the highest risk of tardive dyskinesia?
… & lowest risk?
- high risk = Risperidone (Risperdal)
- low risk = Clozapine (Clozaril)
Which antiemetics have been found to cause tardive dykinesia if used chronically
Reglan, Compazine, Phenergan
Pt presents with bradykinesia, rigidity, and pill rolling tremor.
…Dx?
Parkinson’s disease
In ALS, lower motor neuron involvement leads to:
- weakness
- atrophy
- fasciculation
In ALS, upper motor neuron involvement leads to:
- hyperreflexia, spasticity
___ is an autoimmune disorder characterized by dysfunction at the neuromuscular joint, causing weakness and fatigability
Myasthenia Gravis
___ is involuntary obscene speech
Coprolalia
___ is repetition of others’ speech
Echolalia
___ is repetition of words of phrases
Palilalia
What is the clinical diagnostic criteria for Tourettes
multiple motor tics and at least 1 phonic tic must be present at some point during illness
Pt presents with uncomfortable urge to move their legs.
What could be a probable cause of this syndrome?
- Iron deficiency anemia
Pt presents with uncomfortable urge to move their legs.
How would you Tx?
- iron replacement in IDA
- avoid sleep deprivation
- avoid antidepressants, sedating antihistamines, antiemetics
- Mirapex / Requip (dopamine agonists)
Pt presents with chorea, psychiatric disturbance, and dementia.
… Tx?
- PT/OT/home care
- ST/dietitian
- Tetrabenzine
- or Zyprexa
___ is a syndrome of weight loss, decreased appetite, and poor nutrition, and inactivity accompanied with dehydration, depression, and impaired immune function
Failure to thrive
Patient is considered frail if they have 3 or more of what symptoms?
- weight loss
- exhaustion
- weakness (decreased grip strength)
- slow walking speed
- decreased physical activity
_____ is a catabolic state often associated with anorexia, weight loss, and insulin resistance
Cachexia
____ is loss of muscle mass that occurs with agiing
Sarcopenia
Tx for frailty
- Exercise
- calorie and protein support
- vit D supplements
- reduce # of meds
In patient with failure to thrive, how would you Tx depression?
Miratazapine (Remeron) - can increase appetite and weight gain
What tests would you do to determine if pt has Myasthenia Gravis?
- Ice bag test (Ptosis improves)
- Edrophonium/Tensilon Test = edrophonium would improve Sx
