Movement Disorders/Failure to Thrive

Question 1

____ tremor (AKA ___ tremor) occurs when the body is supported and at rest, and often improves with movement

Answer 1

Resting / Parkinson’s

Question 2

____ tremor is seen with the body part held against gravity

Answer 2

postural

Question 3

____ tremor is seen with voluntary movement of the limb

Answer 3

kinetic

Question 4

____ tremor is worse during goal-directed movement

Answer 4

intention

Question 5

____ tremor occurs during muscle contraction against stationary objects

Answer 5

isometric

Question 6

____ tremor is a postural tremor usually involving writing or drinking from a cup, is exacerbated by emotional stress, and can be improved with alcohol

Answer 6

Essential

Question 7

___ tremor is manifested as intention tremor and is tested with finger-to-nose test and heel-to-shin test

Answer 7

Cerebellar

Question 8

___ tremor occurs in the legs/trunk immediately after standing and is often treated with Klonopin

Answer 8

Orthostatic

Question 9

____ are rapid, involuntary, non-repetitive, dance-like movements involving the face, trunk, and limbs

Answer 9

Chorea

Question 10

In PD, dopamine is decreased and ____ is increased, causing overstimulation of skeletal muscles.

Answer 10

acetylcholine

Question 11

___ is used for pts with mild, early Parkinson Disease. Side effect include, skin mottling, orthostatic hypotension, edema, confusion

Answer 11

Amantadine

Question 12

_______ is only helpful for treating tremors and drooling. The side effects often outweigh the benefits

Answer 12

Anticholinergic medication

Question 13

Side effects of anticholinergic meds include

Answer 13

• confusion
• vision changes, mydriasis
• flushed skin, hyperthermia
• tachycardia

Question 14

____ is the most effective medication for PD, but the body gets used to it over time and requires incremental increase in dosage

Answer 14

Levadopa

Question 15

Side effects of Levadopa include:

Answer 15

• orthostatic hypotension
• dyskinesias
• peripheral edema
• dizziness
• hallucinations, abnormal dreams
• nausea, constipation

Question 16

Dopamine agonists, such as ___ and ____, directly stimulate dopamine receptors and are an alternative to Levadopa.

Answer 16

• Mirapex

- Requip

Question 17

Which second generation antipsychotic poses the highest risk of tardive dyskinesia?

… & lowest risk?

Answer 17

• high risk = Risperidone (Risperdal)

- low risk = Clozapine (Clozaril)

Question 18

Which antiemetics have been found to cause tardive dykinesia if used chronically

Answer 18

Reglan, Compazine, Phenergan

Question 19

Pt presents with bradykinesia, rigidity, and pill rolling tremor.
…Dx?

Answer 19

Parkinson’s disease

Question 20

In ALS, lower motor neuron involvement leads to:

Answer 20

• weakness
• atrophy
• fasciculation

Question 21

In ALS, upper motor neuron involvement leads to:

Answer 21

• hyperreflexia, spasticity

Question 22

___ is an autoimmune disorder characterized by dysfunction at the neuromuscular joint, causing weakness and fatigability

Answer 22

Myasthenia Gravis

Question 23

___ is involuntary obscene speech

Answer 23

Coprolalia

Question 24

___ is repetition of others’ speech

Answer 24

Echolalia

Question 25

___ is repetition of words of phrases

Answer 25

Palilalia

Question 26

What is the clinical diagnostic criteria for Tourettes

Answer 26

multiple motor tics and at least 1 phonic tic must be present at some point during illness

Question 27

Pt presents with uncomfortable urge to move their legs.

What could be a probable cause of this syndrome?

Answer 27

• Iron deficiency anemia

Question 28

Pt presents with uncomfortable urge to move their legs.

How would you Tx?

Answer 28

• iron replacement in IDA
• avoid sleep deprivation
• avoid antidepressants, sedating antihistamines, antiemetics
• Mirapex / Requip (dopamine agonists)

Question 29

Pt presents with chorea, psychiatric disturbance, and dementia.

… Tx?

Answer 29

• PT/OT/home care
• ST/dietitian
• Tetrabenzine
• or Zyprexa

Question 30

___ is a syndrome of weight loss, decreased appetite, and poor nutrition, and inactivity accompanied with dehydration, depression, and impaired immune function

Answer 30

Failure to thrive

Question 31

Patient is considered frail if they have 3 or more of what symptoms?

Answer 31

• weight loss
• exhaustion
• weakness (decreased grip strength)
• slow walking speed
• decreased physical activity

Question 32

_____ is a catabolic state often associated with anorexia, weight loss, and insulin resistance

Answer 32

Cachexia

Question 33

____ is loss of muscle mass that occurs with agiing

Answer 33

Sarcopenia

Question 34

Tx for frailty

Answer 34

• Exercise
• calorie and protein support
• vit D supplements
• reduce # of meds

Question 35

In patient with failure to thrive, how would you Tx depression?

Answer 35

Miratazapine (Remeron) - can increase appetite and weight gain

Question 36

What tests would you do to determine if pt has Myasthenia Gravis?

Answer 36

• Ice bag test (Ptosis improves)

- Edrophonium/Tensilon Test = edrophonium would improve Sx