Movement/Tic D/Os

Question 1

Parkinson’s disease treated with levodopa develops VHs. Recommendations?

Answer 1

Reduce dose of levodopa

Question 2

What MRI finding would most specifically indicate a diagnosis of Huntington’s disease?

Answer 2

Caudate head atrophy

Question 3

65 y/o with h/o asthma presents tx of essential tremor.

First line tx?

Answer 3

Primidone

Avoid beta blockers

Question 4

42 y/o M with gradually progressive cognitive deficits also develops jerking movements of extremities, head, and trunk.
MRI - atrophy caudate nuclei BL.
Pts father had similar issues that started at 50.
Which test is most likely to confirm dx?

Answer 4

DNA analysis for CAG repeats

Question 5

79 y/o pt with decreasing mental state over 3 weeks has an exaggerated startle response with violent myoclonus (elicited by turning on room lights, speaking loudly, or touching the patient).
Myoclonic jerks occur spontaneously. Ataxia.
EEG - sharp waves.
Dx?

Answer 5

Subacute spongiform encephalopathy

Question 6

Med useful in management of orthostatic hypotension in Parkinson’s?

Answer 6

Fludrocortisone

Question 7

Tx of Huntington’s chorea

Answer 7

Haldol

Question 8

98 y/o M in ER. Unconscious after choking. Had progressive neuro condition presented in early 30’s with involuntary, irregular movements of all extremities and face. After 15 yr course evolved into rigid, akinetic condition with difficulty swallowing and speaking. Progressive dementia and full time care. Postmortem exam showed generalized brain atrophy.
Dx?

Answer 8

Huntington’s

Question 9

Gait consisting of: postural instability, festination (shortening strides and moving feet more quickly to accelerate),and truncal rigidity.
Lewy bodies visualized.
Involuntary acceleration is seen in what condition?

Answer 9

Parkinson’s

Question 10

35 y/o with history of 2 year cognitive deterioration, difficulty at work, and irritability.
Restless with slow, writhing movements in most muscle groups and frequent blinking.
Father and grandpa had similar sxs and died in their 50s.
Dx?

Answer 10

Huntington’s

Question 11

Pt with depression. 3 yr hx of change in personality. Irritability. Impulsive outbursts. Eccentric or inappropriate social interactions. Lost job. Now withdrawn and fidgety.
Increased eye blinking, marked tongue impersistence, mild bradykinesia, akinesia, and mild hyperreflexia w/o clonus.
Pts dad died of severe dementia at 55.
Dx?

Answer 11

Huntington’s

Question 12

Typical of idiopathic Parkinson’s disease, rather than another Parkinsonian syndrome

Answer 12

Aysmmetrical onset and progression of motor symptoms

Question 13

First line tx for restless legs

Answer 13

Pramipexole

Question 14

Multifocal myoclonus in comatose pt indicates

Answer 14

Metabolic encephalopathy

Question 15

Most effective tx for writer’s cramp (focal dystonia associated with writing)?

Answer 15

Botulinium toxin

Question 16

Essential tremor improves with

Answer 16

reaching for objects (action)

Question 17

Most prevalent mvmt d/o in those > 70 y/o?

Answer 17

Essential tremor

Question 18

6 y/o with 4 wks of intense eye-blinking and lip pursing that waxes and wanes, increases
with stress.
Family Hx of tic d/o.
First step?

Answer 18

Explain to family that it may be transient

Question 19

Diagnosis w/ trinucleotide repeat expansion

Answer 19

Huntingtons

Question 20

Treatment for Huntington’s Disease

Answer 20

High potency Antipsychotics

Question 21

25 yo pt w/ several year cognitive decline, dysarthria, dysphagia, and slow mvmts. 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 dx w/ blood
test for?

Answer 21

Ceruloplasmin

Question 22

For which pt would ordering a serum ceruloplasmin be indicated?

Answer 22

Young adult M w/ new onset emotional lability and mvmt d/o

Question 23

Huntington’s disease etiology classified as polymorphism d/t what property?

Answer 23

Region has many alleles differing in # of CAG repeats