movement/tic Flashcards
42 y/o M with a gradually progressive cognitive deficit also develops jerking movements of the extremities, head, and trunk. Imaging shows atrophy of the caudate nuclei bilaterally. Pt’s father had a similar illness that started at age 50. Which of the following tests is most likely to confirm the diagnosis? (6x)
DNA ANALYSIS FOR CAG REPEATS
79 y/o pt w/ decreasing mental state over 3 weeks has an exaggerated startle response with violent myoclonus that is elicited by turning on the room lights, speaking loudly, or touching the patient. Myoclonic jerks occur spontaneously, ataxia, EEG: sharp waves. Dx: (5x)
SUBACUTE SPONGIFORM ENCEPHALOPATHY
Parkinson’s Disease treated w/ levodopa. Visual hallucinations. Recommendations? (5x)
REDUCE DOSE OF LEVODOPA
What MRI finding would most specifically indicate a diagnosis of Huntington’s Disease? (5x)
CAUDATE HEAD ATROPHY
65y/o w/ h/o asthma presents for treatment of essential tremor. Which for first-line? (4x)
PRIMIDONE
Medication useful in management of orthostatic hypotension in Parkinson’s (4x)
FLUDROCORTISONE
98 y/o M in ER, unconscious after choking, had progressive neuro condition presented in his early 30’s w involuntary irregular movements of all extremities & face but after 15 yr course evolved into rigid, akinetic condition w diff swallowing, speaking. Also progressive dementia & full time care. After obstruction was relieved pt remained unconscious, had cardiac arrest & died. PM exam showed generalized brain atrophy. (Pathology picture showing brain atrophy). Dx: (3x)
HUNTINGTON’S DISEASE
Treatment of Huntington’s chorea (3x)
HALOPERIDOL
Gait consisting of: postural instability, festination, & truncal rigidity. Lewy bodies visualized. Also with involuntary acceleration is seen in what condition? (3x)
PARKINSON’S DISEASE
35 y/o pt w/ 2 yr hx of cognitive deterioration, difficulty at work, and irritability. Exam: restless w/ slow, writhing movements in most muscle groups and frequent blinking. Pt’s father and paternal grandpa had similar sx and died in their 50s. Dx: (2x)
HUNTINGTON’S DISEASE
Pt w/ depression, 3 yr hx of change in personality, irritability, impulsive outbursts, & eccentric or inappropriate social interactions. He subsequently lost his job & is now withdrawn & fidgety. Pt has increased eye blinking, marked tongue impersistence, mild bradykinesia, akinesia & mild hyperreflexia w/o clonus. The pt’s dad died of severe dementia at 55. Dx? (2x)
HUNTINGTON’S DISEASE
Typical of Idiopathic Parkinson’s disease, rather than another Parkinsonian syndrome: (2x)
ASYMMETRICAL ONSET AND PROGRESSION OF MOTOR SYMPTOMS.
Typical of Idiopathic Parkinson’s disease, rather than another Parkinsonian syndrome: (2x)
ASYMMETRICAL ONSET AND PROGRESSION OF MOTOR SYMPTOMS.
First-line treatment for restless leg syndrome (2x)
PRAMIPEXOLE
Multifocal myoclonus in a comatose patient indicates: (2x)
METABOLIC ENCEPHALOPATHY
Most effective tx for “writer’s cramp” (focal dystonia assoc w/ writing) (2x)
BOTULINUM TOXIN
Essential tremor improves with
REACHING FOR OBJECTS
Most prevalent movement d/o in those over 70 y/o?
ESSENTIAL TREMOR
6 y/o w/ 4 wk intense eye-blinking and lip pursing. Wax and wane, increase with stress. Family Hx of tic d/o. First step:
EXPLAIN TO FAMILY MAY BE TRANSIENT
Dz w/ trinucleotide repeat expansion
HUNTINGTON’S
Treatment for Huntington’s disease:
HIGH POTENCY ANTIPSYCHOTICS
25 yo pt w several year cognitive decline, dysarthria, dysphagia, and slow movements. Has hand tremor which increases in amplitude on arm extension. Also has hepatic disease of unknown etiology. Ocular exam reveals golden brown ring around cornea. Can confirm diagnosis w blood test for?
CERULOPLASMIN
For which patient would ordering a serum ceruloplasmin be indicated?
A YOUNG ADULT MALE WITH NEW ONSET EMOTIONAL LABILITY AND MOVEMENT DISORDER
Huntington’s disease etiology is classified as a polymorphism due to what property?
THE REGION HAS MANY ALLELES DIFFERING IN THE NUMBER OF GAC REPEATS
68 y/o pt w/ hx of schizophrenia since early adulthood and maintained for yrs on thioridazine. On exam: pt’s tongue frequently retracts on its longitudinal axis and moves in lateral directions. No other findings. When tongue movements are pointed out, pt reports being unaware of making them. What recommendation for best Tx:
GRADUALLY D/C THIORIDAZINE AND START LOW DOSE RISPERIDONE
What is the treatment of acute dystonia?
BENZTROPINE
What symptoms are most commonly associated with Tourette’s syndrome?
OBSESSIONS AND COMPULSIONS
Pathologic findings in brain of Tourette’s?
NO ABNORMALITY
One of the earliest sx of Tourette’s:
EYE-BLINKING AND HEAD JERKING
Tic severity begins to decrease during which age period?
ADOLESCENCE
Common cause of acute cerebellar ataxia in adults:
INTOXICATION WITH ANTIEPILEPTICS
Initial approach for child with new-onset tic disorder
CLINICAL MONITORING
Comorbid condition w/ Tourette’s in kids:
ADHD
Motor dysfunction in Parkinson’s associated with:
INCREASED ACTIVITY IN SUBTHALAMIC NUCLEUS AND PARS INTERNA OF GLOBUS PALLIDUS
Characteristics of Parkinson’s tremor
BEING INHIBITED WITH VOLITIONAL MOVEMENT
80 yo male evaluated for gait imbalance and falls. wife explains that he kicks and screams while sleeping, he reports dreams of being chased. Pt likely has/will develop?
PARKINSON’S DISEASE
67 y/o recently retired pt with Parkinsons, no other psych hx, has taken Pramipexole for several years without cognitive decline. Pt has since started gambling excessively. Pt does not drink or use illicit substances. What is the most likely cause?
USE OF DOPAMINERGIC AGENTS
Most appropriate initial tx for idiopathic Parkinson dz in an 81 y/o pt
CARBIDOPA/LEVODOPA
66 y/o c/o frequent falls, mild axial and L UE rigidity, mild slowness of finger tapping, hand opening, and wrist opposition (all worse on left), normal posture, slow gait with short steps, does not swing left arm, slow rising from chair. What is the dx?
PARKINSON’S DISEASE
Picture showing substantia nigra changes, what neurological disease would be expected?
PARKINSON’S DISEASE
Clinical syndrome that is most commonly comorbid with Parkinson’s disease:
DEPRESSION
Pt w/ Parkinson’s disease experiences visual hallucinations on levodopa/carbidopa therapy. Which med would be the most appropriate intervention:
QUETIAPINE
Pt has severe postural tremor of upper extremities and dystonic posturing of the hands. Pt voice is mildly dysarthric. Eyes have a golden brown limbic ring. Deep tendon reflexes are markedly increased. Elevated LFT’s. Dx?
WILSON’S DISEASE
t c/o inability to sit still and describes feeling an inner tension. Exam notes pt is constantly shifting body and legs. Paced hall continuously. Received a course of neuroleptics until recently. Dx?
AKATHISIA
The single most consistently documented and significant risk factor in the epidemiology of tardive dyskinesia is?
ADVANCED AGE
Risk factor for TD
PRESENCE OF MOOD DISORDER
TD in 63 y/o w/ end stage renal failure. Culprit:
METOCLOPRAMIDE
Which gender has a higher risk for tardive dyskinesia (TD)?
FEMALE
75 y/o with hx of extensive tobacco smoking presents with subacute progressive ataxic d/o over several months. MRI brain is unremarkable. CSF shows mild pleocytosis. Found positive for anti-Yo antibody. What test should be ordered next?
CT CHEST
Adult onset opsoclonus-myoclonus-ataxia is associated with which form of cancer?
BREAST CARCINOMA
Next test to order after anti-Yo antibody found in serum in 72 year old patient with subacute onset of progressive ataxia of gait and limbs
CT of chest (also CT of abdomen and pelvis)
