Obj 5: Movement disorders - aa

Question 1

Mr. Lawson has hand tremor that worsens with emotional stress and improves with alcohol. No other symptoms or findings. His father had the same tremor.
What is it?

Answer 1

benign essential tremor

Question 2

Ms. Collins is complaining of a “weird” feeling in her limbs at night when she is laying in bed. When she moves them, she feels better. What is it?

Answer 2

restless leg syndrome

Question 3

What is the usual initial manifestation of Tourette syndrome, and at what age does it show up?

Answer 3

~80% of the time motor tics are the initial manifestation
~20% of the time it’s phonic tics first
~(both develop eventually)
~First shows up between the ages of 2 and 15

Question 4

Name 3 treatment options for Tourette.
~one thing to take PO
~one thing to inject
~one thing to do

Answer 4

~clonidine, haloperidol
~botox at site of most distressing tics
~cognitive behavioral therapy

Question 5

Baby M experienced a hypoxic cerebral injury during a difficult vaginal delivery. 3 years later, she comes back to your office with a diagnosis of cerebral palsy from another clinic.
What symptoms do you expect to see?
Will it get worse?
What is the treatment?
What do you tell her parents about life expectancy?

Answer 5

~spasticity (75% of patients)
~mild or moderate mental retardation (53%)
~seizures (50%)
~cerebral palsy by definition is nonprogressive
~if mild, may resolve by age 7; PT, OT, manage symptoms
~LIFE EXPECTANCY MAY BE NORMAL, if symptoms are managed well

Question 6

What are the four cardinal signs of parkinsonism?

Answer 6

1. resting tremor
2. rigidity
3. bradykinesia
4. progressive postural instability

Question 7

Parkinson disease is strongly hereditary.

T/F

Answer 7

FALSE
Usually idiopathic (rarely, some familial basis)

Question 8

What is the parkinsonism facies?

Answer 8

~Fixed facial expression
~Infrequent blinking
~Widened palpebral fissures

Question 9

Resting tremor of parkinsonism is often confined to one side for years.
T/F

Answer 9

TRUE

Question 10

What is the Myerson sign?

Answer 10

~repetitive tapping over the bridge of the nose
~positive: sustained blink response
~negative (normal): blink response extinguishes with repeated tapping

Question 11

What is the walk of parkinsonism?

Answer 11

~small, shuffling steps
~hunched posture
~difficulty turning (takes multiple maneuvers)

Question 12

Name 3 types of drugs for parkinson disease.

Answer 12

~amantadine: helps all clinical features
~anticholinergics: helps tremor and rigidity
~dopamine, dopamine agonists, anything that keeps dopamine around longer

Question 13

There are no drugs that help stop the progression of parkinson.
T/F

Answer 13

TRUE
Treatments are symptomatic only.
Destruction of substantia nigra is progressive.

Question 14

Longer CAG trinucleotide repeats mean what for a patient?

Answer 14

EARLIER age of onset of Huntington and FASTER disease progression.

Question 15

Huntington disease is inherited in what fashion?

Answer 15

Autosomal dominant.

Question 16

Huntington is gradual onset and unstoppable progression of ____ and ____.

Answer 16

CHOREA

DEMENTIA

Question 17

Name a drug given for chorea in Huntington.

Answer 17

amantadine

Question 18

Name two drugs given for dyskinesia in Huntington disease.

Answer 18

~tetrabenzine

~haloperidol

Question 19

Name two drugs given for the behavioral disturbances of Huntington disease.

Answer 19

~haloperidol

~clozapine