Neuro cases 2

Question 1

A ______ is an involuntary, rhythmic, oscillatory movement of a body part and is the most common movement disorder that is seen in a primary care setting

Answer 1

tremor

Question 2

What are some examples of the classifications of tremors

Answer 2

Resting 
Action 
Parkinsonian 
Cerebellar 
Psychogenic

Question 3

A _______ tremor occurs in body part that is relaxed and completely supported against gravity; enhanced by mental stress or movement of another body part; diminished voluntary movement in that part

Answer 3

resting tremor

Question 4

What are the three types of action tremors?

Answer 4

Postural
Isometric
Kinetic

Question 5

A _______ tremor maintains the position against gravity

Answer 5

Postural

Question 6

A _______ tremor is a tremor that occurs with a muscle contraction that is against a rigid stationary object

Answer 6

Isometric

Question 7

________ tremor includes an intention tremor, which is produced with target directed movement

Answer 7

Kinetic

Question 8

What is an enhanced physiologic tremor?

Answer 8

A tremor that everyone has that is low amplitude and high frequency at rest and can be enhanced by stress, anxiety, etc

Question 9

Describe the essential classification of tremors

Answer 9

most common
usually kinetic
hands, LE, voice and is typically bilateral

Can be inherited

Question 10

Describe the parkinsonism tremors

Answer 10

Most patients will exhibit a resting tremor followed by a classic tremor that starts as a pill rolling motion of the fingers

bradykinesia with movements; standing up, reduced arm swing while walking

Question 11

Describe a cerebellar tremor

Answer 11

Low frequency, slow intension postural tremor that is caused by MS, cerebellar plaques, stroke, brainstem tumors

Question 12

A _______ tremor tends to increase with attention and stop with distraction; typically seen in patients employed in allied health professions

Answer 12

Psychogenic

Question 13

If a patient presented to the clinic with a resting tremor, decreased dexterity, soft voice, less arm swinging, sleep disturbances, decreased facial expression, shuffling, etc,

what would you think diagnostically?

Answer 13

Parkinsons

Question 14

Differentiate between the handwriting that is seen with someone with parkinson’s disease versus a patient who has an essential tremor

Answer 14

The patient with PD will have small and illegible handwriting whereas the ET Will have tremulous and large handwriting

Question 15

_______ is the loss of cognitive functioning-thinking, remembering, and reasoning to an extent that it interferes with everyday life and activities

Answer 15

Dementia

Question 16

A ______ _______ ________ is a significant cognitive decline in at least one domain interfering with activities of daily living

Answer 16

Major neurocognitive disorder

Question 17

A _______ _______ _______ is a modest disorder that does not interfere with daily living

Answer 17

minor neurocognitive disorder

Question 18

What is a mini-cog test?

Answer 18

Patient is asked to repeat three unrelated words, perform a clock drawing, then relay the three words

Question 19

How do you score the mini cog test

Answer 19

One point for each word remembered and 2 points for a good clock

3+ usually indicates a lower likelihood of dementia

Question 20

What is the ascertain 8 questionnaire>

Answer 20

Screens for major and minor disorders with yes and no questions

2+ a cognition issue is likely to be present

Question 21

If a cognition test is positive, what are the next steps that should be taken clinically?

Answer 21

Test for the degree of the cognitive decline

Question 22

What are the cognitive tests that are used to test the degree of cognitive decline?

Answer 22

Mini-mental state examination
Montreal cognitive assessment (MOCA)
St Louis University mental status examination

Question 23

What is the most common pathologic tremor?

Answer 23

Essential tremor

Question 24

True or false alcohol can improve the symptoms of an essential tremor

Answer 24

True!

Question 25

—————— includes difficulty rising from a seated position, reduced arm swing while walking, micrographia

Answer 25

Bradykinesia

Question 26

Why is it important to get a family history regarding tremors running in the family?

Answer 26

Because some of them have genetic linkages

Question 27

What disease is micrographia commonly seen in?

Answer 27

Parkinson’s

Micrographia is writing the letters super small

Question 28

What is typically the first sign of a neurodegenerative disease?

Answer 28

A resting tremor is typically what brings people in for further evaluation