Neurology

Question 1

Upper motor neuron damage

Answer 1

1. Spasticity
2. Weakness
3. Brisk reflexes
4. Babinski sign

Question 2

Lower Motor Neuron damage

Answer 2

1. Atrophy
2. Fasciculations
3. Weakness
4. Loss of deep tendon reflexes

Question 3

Akinetic rigid syndromes (movement disorder)

Answer 3

1. Idiopathic Parkinson’s
2. Secondary Parkinson’s
3. Parkinson’s plus syndromes
   (PSP, multiple system atrophy, corticobasal degeneration)

Question 4

Idiopathic Parkinson’s disease

Answer 4

Degenerative disease of the basal ganglia affecting middle to late life people
Onset 55-60 y/o

Cause unknown
Suspected combo of genetics & enviro factors
Very few cases familial
Insidious onset (slow)
Unilateral onset (UL)
Stiffness, clumsiness and slowness of movement

Question 5

Idiopathic Parkinson’s Disease

Answer 5

1. Tremor- unilateral UL pill rolling at rest (NB if this diagnosis)
2. Bradykinesia (slow movements)
3. Rigidity (increased muscle tone, using passive movements, forment’s sign)
4. Disturbance in posture/equilibrium (stooped posture, decreased arm swing, shuffling gait)
5. Freezing episodes (inability to initiate walking - late phase)
6. Non-motor symptoms: mood swings, fatigue, constipation, cognitive and dementia (late)

Question 6

Parkinson’s (2nd causes)

Answer 6

1. Drugs
2. Toxins (manganese, carbon monoxide, cyanide)
3. Head trauma

Tremor not present

Question 7

Parkinson’s plus syndromes

Answer 7

1. Absent tremor
2. Axial rigidity
3. Young pt
4. Symmetrical onset
5. Other systems involved (automatic, cerebellar etc.)
6. No response L DOPA treatment

Question 8

Excessive involuntary movements
(Movement disorders)