Week 5 SBL Learning Issues (Stacked)

Question 1

Hand shakiness DDxs

Answer 1

• Essential tremor
• Parkinson’s
• Drug Induced (antidepressants, asthma drugs)
• Hypo/hyperthyroidism
• Anxiety/stress

Question 2

Patient presents with hand shakiness. What are we asking in the history, and why?

Answer 2

• How long has this been happening? (essential tremor/Parkinson’s worsen w time)
• Is it worse at rest or during movement? (Parkinson’s worse at rest, ET during movement)
• Has anybody in your family had this? (ET is hereditary)
• Are you on any medications (SSRIs, SABA/LABAs, amiodarone)

Question 3

What is tremor?

Answer 3

Involuntary, rhythmic movement of a part (or parts) of the body

Question 4

What are Parkinson’s plus syndromes? What are 3 examples?

Answer 4

• Syndromes that produce similar symptoms, but don’t respond to L-dopa
• Three examples are multi systems atrophy, Dementia with Lewy bodies, and progressive supranuclear palsy

Question 5

Outline multiple systems atrophy

Answer 5

• Degenerative autonomic condition
• Presents with Parkinsonian symptoms (e.g. rigidity, bradykinesia, tremors)
• Primary sign is autonomic dysfunction (e.g. constipation, sexual dysfunction, loss of bladder control, REM sleep disorder, orthostatic hypotension)

Question 6

What is meant by “Parkinsonism”?

Answer 6

Any conditions with bradykinesia, rigidity, and tremors

Question 7

What is the defining feature of dementia with lewy bodies (compared to Parkinson’s)?

Answer 7

Hallucinations

Question 8

What are the two types of Lewy Body Dementia?

Answer 8

• Dementia with Lewy Bodies
• Parkinson’s Disease Dementia

Question 9

The pathology of progressive supranulear palsy is characterized by widespread neurodegeneration associated with ____ ____ deposition in subcortical regions.

Answer 9

Tau protein

Question 10

True or false: like Parkinson’s patient, Progressive Supranuclear Palsy patients tend to lean backward and extend their neck

Answer 10

• False
• This is true of PSP patients, but not of Parkinson’s patients

Question 11

How do beta blockers help essential tremor?

Answer 11

• Block to B2 receptors on muscle spindles, blocking input

Question 12

List six kinds of tremor

Answer 12

• Dystonic
• Essential
• Cerebellar
• Postural
• Physiologic
• Parkinson’s

Question 13

Describe how deep brain stimulation works

Answer 13

• Neurosurgically implant electrodes in brain (e.g. GPi, thalamus, STN etc)
• Impulse generator implanted in skin of chest
• Generator sends continuous stimulations to the electrode, blocking tremor-causing impulses

Question 14

Is dystonic tremor symmetrical or asymmetrical?

Answer 14

Asymmetrical

Question 15

Is essential tremor usually symmetrical?

Answer 15

Yes

Question 16

Is Parkinson’s tremor usually symmetrical?

Answer 16

No

Question 17

Is cerebellar tremor usually bilateral or unilateral?

Answer 17

Unilateral (ipsilateral to lesion)

Question 18

Dystonic tremor age of onset

Answer 18

40s and 50s

Question 19

Common age of essential tremor onset

Answer 19

40+

Question 20

Common causes of postural tremor

Answer 20

• Normal (physiological) tremor
• Essential tremor

Question 21

Parkinson’s tremor avg age of onset

Answer 21

~60

Question 22

Non-motor symptom of dystonic tremor

Answer 22

Pain