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Neurology 1 > Neurology - Parkinson's Disease and other Hyperkinetic Movement Disorders > Flashcards

Neurology - Parkinson's Disease and other Hyperkinetic Movement Disorders Flashcards

1
Q

patient with tremor, slow movement, postural instability and rigidity

a.parkinsons
b.huntingtons
c.guillian barre
d.stroke
e.brown sequard

A

a.parkinsons

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2
Q

tremor differentials

A

parkinsonism
tremor disorders - essential tremor, dystonic tremor

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3
Q

for a diagnosis of parkinsonian syndrome what is required alone with one of muscular rigidity, 4-6 hz rest tremor and postural instability

a.hyperreflexia
b. sensory disturbances
c.intention tremor
d.bradykinesia

A
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4
Q

for a diagnosis of parkinsonian syndrome what is required alone with one of muscular rigidity, 4-6 hz rest tremor and postural instability

a.hyperreflexia
b. sensory disturbances
c.intention tremor
d.bradykinesia

A

d.bradykinesia

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5
Q

for a diagnosis of parkinsonian syndrome bradykinesia and 1 other of rigidity , 4-6hz rest tremor and what else is required

a. postural instability
b.hyperreflexia
c.postural hypotension
d. babinski sign

A

a. postural instability

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6
Q

signs for diagnosis of parkinsonian syndrome

A

slow
stiff
shaky
stability

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7
Q

what is the core feature of parkinsonism

a.bradykinesia
b. postural instability
c.intention tremor
d.resting tremor
e.muscular rigidity

A

a.bradykinesia

slowness of initiation of voluntary movement with progressive reduction in speed and amplitude of repetitive movements

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8
Q

bradykinesia in parkinsonism

A

manual dexterity problems eg buttons and zips

slowing down

difficulty with repetitive movements

loss of arm swing

dragging leg

micrographia

reduced facial expression

drooling overnight

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9
Q

patient has hand tremor that is symmetrical in both hands and present with hands on lap no bradykinesia and normal gait . voice tremor on speaking what is the most likely diagnosis

a.parkinsons
b.huntingtons
c.guillian barre
d.stroke
e.essential tremor
f.dystonic tremor

A

e.essential tremor

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10
Q

what is a true rest tremor

a.present when hands on lap prone
b.present when walking
c.present when completing tasks only
d.present when arms raised

A

b.present when walking

or arms supine

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11
Q

rigidity (increased resistance to passive movement) occurs at which joints in parkinsonism

a.knees and ankles
b.hips and knees
c.wrist and elbow
d.elbow and shoulder

A

c.wrist and elbow

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12
Q

FROMENTS

A
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13
Q

what type of rigidity is seen in parkinsons

a.clasp knife
b.lead pipe
c.cogwheel

A

b.lead pipe
c.cogwheel

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14
Q

the rigidity in parkinsons is usually …

a.symmetrical
b.asymmetrical

A

b.asymmetrical

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15
Q

stooped posture with shuffling, arms flexed and one arm reduced swing with tremor in the stationary arm , loss of fluency when turning indicate what

a.parkinsons
b.huntingtons
c.guillian barre
d.stroke
e.essential tremor
f.dystonic tremor

A

a.parkinsons

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16
Q

MSA BROAD BASED?

A
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17
Q

the loss of arm swing in the parkinsonian gait is usually …

a.asymmetrical with tremor in stationary arm

b.asymmetrical with tremor in swinging arm

c.symmetrical with no tremor

d.symmetrical with tremor

A

a.asymmetrical with tremor in stationary arm

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18
Q

what test is done to assess for postural instability in suspected parkinsonism

a.push test
b.pull test
c.froments
d. tinnels
e.phalens

A

b.pull test

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19
Q

steps of parkinson diagnosis

A

1.parkinsonism syndrome
2.exclude other causes
3.supportive criteria

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20
Q

features of non degenerative / secondary causes of parkinsonism

A

repeated strokes/head injury
history of encephalitis
neuroepileptic drug exposure - metoclopramide, prochlorperazine, lithium, ccb, valporate

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21
Q

which of these drugs is NOT a secondary cause of parkinsonism

a.metoclopramide
b.prochloroperazine
c.ccb
d.lithium
e.valproate
f. carbimazole

A

f. carbimazole

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22
Q

patient with repeated strokes / head injury and history of encephalitis presenting with parkinsonism which type most likely

a.degenerative
b.non degenerative

A

b.non degenerative

secndary cause = non degenerative

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23
Q

neuroepilpetic drugs may..

A

unmask pre clinical PD or be a secondary cause of parkinsonism

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24
Q

red flags for degenerative atypical parkinsonian disorders

A

poor levodopa response
early recurrent falls
prominent early speech/swallowing difficulty
early cognitive decline
cerebellar , pyrimidal, dyspraxia signs
supranuclear gaze palsy
prominent early autonomic dysfunction
absence of rest tremor/ dyskinesia

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25
Q

APPLAUSE SIGN

A
26
Q

SUPRANUCLEAR GAZE

A
27
Q

a high pitched quivering dysarthria is characteristic of what

a.Multiple system atrophy (MSA)
b.Progressive supranuclear palsy (PSP)

A

a.Multiple system atrophy (MSA)

28
Q

a low pitched growl dysarthria is characteristic of what

a.Multiple system atrophy (MSA)
b.Progressive supranuclear palsy (PSP)

A

b.Progressive supranuclear palsy (PSP)

29
Q

what scan shows integrity of dopaminergic nigrostriatal pathways

a.CT
b.CAT
c.DAT
d.MRI
e.EEG

A

c.DAT

30
Q

how will an essential tremor appear on a DAT scan

a. normal
b.abnormal

A

a. normal

31
Q

how will an drug induced parkinsonsim on a DAT scan

a. normal
b.abnormal

A

a. normal

32
Q

how will a dystonic tremor appear on a DAT scan

a. normal
b.abnormal

A

a. normal

33
Q

how will a vascular parkinsonism appear on a DAT scan

a. normal
b.abnormal

A

a. normal

except if basal ganglia infarct - moth eaten appearance

34
Q

how will dopa responsive dystonia appear on a DAT scan

a. normal
b.abnormal

A

a. normal

35
Q

how will alzheimers appear on a DAT scan

a. normal
b.abnormal

A

a. normal

36
Q

how will FXTAS appear on a DAT scan

a. normal
b.abnormal

A

a. normal

37
Q

how will parkinsons disease appear on a DAT scan

a. normal
b.abnormal

A

b.abnormal

38
Q

how will MSA appear on a DAT scan

a. normal
b.abnormal

A

b.abnormal

39
Q

how will PSP appear on a DAT scan

a. normal
b.abnormal

A

b.abnormal

40
Q

how will dementia with lewy bodies appear on a DAT scan

a. normal
b.abnormal

A

b.abnormal

41
Q

how will Corticobasal degeneration appear on a DAT scan

a. normal
b.abnormal

A

b.abnormal

42
Q

how will wilsons appear on a DAT scan

a. normal
b.abnormal

A

b.abnormal

43
Q

how will spinocerebellar ataxia 2, 3 appear on a DAT scan

a. normal
b.abnormal

A

b.abnormal

44
Q

supportive criteria for parkinsons

A

unilateral onset
persistent asymmetry
rest tremor
progressive
excellent levodopa response
visual hallucinations
clinical course more than 10 yrs

45
Q

types of parkinsons drugs

A

dopaminergic medications
-levodopa
- dopamine agonists

dopamine degradation inhibitors
-MAO b inhibitors
–COMT inhibitors

46
Q

which drugs are most effective at alleviating parkinsonism

a.levodopa
b.dopamine agonists
c. MAO b inhibitors
d. COMT inhibitors

A

a.levodopa

47
Q

which drugs are useful for overnight/ early morning symptoms

a.levodopa
b.dopamine agonists
c. MAO b inhibitors
d. COMT inhibitors

A

b.dopamine agonists

48
Q

which drugs are least likely to cause psychotic symtpoms

a.levodopa
b.dopamine agonists
c. MAO b inhibitors
d. COMT inhibitors

A

b.dopamine agonists

49
Q

impusle control??

A
50
Q

first line drug for parkinsons

A

no universal 1 line

take into account clinical and lifestyle characteristics
patient preference and expectations

51
Q

which parkinsons drug has a short half life and competes for absorption with other amino acids with delayed gastric emptying as a side effect

a.levodopa
b.dopamine agonists
c. MAO b inhibitors
d. COMT inhibitors

A

a.levodopa

can also cause psychosis

52
Q

non oral treatments

A

deep brain stimulation

duodopa

apomorphine sc

53
Q

gambling, shopping, binge eating and hypersexuality are all….

A

impulse control disorders

54
Q

young males with a history or family history of substance abuse, prominent dyskinesia and bipolar are most at risk of whoich dose related effect of dopaminergic antagonists

a. delayed gastric emptying
b.psychosis
c.impulse control disorders

A

c.impulse control disorders

55
Q

dopamine disregulation syndrome is a side effect usually seen with which parkinsons drug

a.levodopa
b.dopamine agonists
c. MAO b inhibitors
d. COMT inhibitors

A

a.levodopa

56
Q

impulse control disorders are mostly associated with which parkinsons drug

a.levodopa
b.dopamine agonists
c. MAO b inhibitors
d. COMT inhibitors

A

b.dopamine agonists

57
Q

non motor PD symptoms

A

depression
REM sleep behaviour disorder
constipation
olfactory disturbance

58
Q

swallowing difficulties are more common and a more significant problem in ..

a.parkinsons
b.msa and psp

A

b.msa and psp

59
Q

swallowing difficulties are……….. to dopaminergic medications

a.responsive
b.irresponsive

A

b.irresponsive

60
Q

inability to swallow PD medication is ..

A

A MEDICAL EMERGENCY

61
Q

what happens with abrupt withdrawal of PD medication

A

life threatening syndrome similar to neuroleptic malignant syndrome

62
Q

if patient has sawllowing difficulties and cannot swallow PD medication what should be done

A

nasogastric tube
nil by mouth
admitted to hospital
liase with consultant

Neurology 1 (44 decks)

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