FTT & Movement Disorders (Exam 2)

Question 1

A syndrome of weight loss, decreased appetite and poor nutrition, and inactivity, often accompanied by dehydration, depressive symptoms, impaired immune function, and low cholesterol

Answer 1

Adult failure to thrive

Question 2

A person must be considered __________ ___________ in order to be diagnosed with Adult Failure to Thrive.

Answer 2

Physically Frail

Question 3

If a pt had malnutrition or weight loss and impaired physical function, how would you describe their condition?

Answer 3

Frailty

Question 4

True or False? Unintentional weight loss is a significant predictor of death in nursing homes

Answer 4

True

Question 5

_______ is a catabolic state often seen in end-stage diseases like cancer, ESRD, lung disease, and heart failure.

Answer 5

Cachexia

Question 6

________ describes a loss of muscle mass that occurs with aging. This condition is associated with functional decline, disability, and falls.

Answer 6

Sarcopenia

Question 7

True or false? If a patient has cachexia- nutrition therapy will not alter the progression.

Answer 7

True. Cachexia is a progressive disorder in which nutrition therapy does not alter the course.

Question 8

True or False? A disability is not an independent risk factor for mortality, hospitalization, and need for long term care.

Answer 8

FALSE.

A disability is an Independent risk factor for mortality, hospitalization, and need for long term care

Question 9

__________ is an acute cognitive decline, different from a patient’s baseline, that results from a number of factors; such as meds, ETOH, hospitalization, etc, and is reversible.

Answer 9

Delirium

Question 10

What should be on your differential Dx of an elderly pt who has unexplained injuries, isnt getting/taking their meds, or whose caregiver has changed behaviors?

Answer 10

Elder abuse and neglect

Question 11

What is a clinical test used to check if a pt is at a greater fall risk?

Answer 11

“get up and go” test
(have pt sit in chair and stand up on their own, then walk 10 ft- should take 8-10 secs, if takes longer they are at a greater risk for a fall)

Question 12

Urine analysis’ are not always needed for elderly pt’s who are “confused”. Why is this true?

Answer 12

Because most elderly pt’s will always have bacteria in urine, due to colonization/age.
Abx not indicated unless pt has urinary s/sx, fever and/or leukocytosis.

Question 13

Which two labs are the most definitive markers of

malnutrition and should be considered when evaluating an elderly patient who is potentially “failure to thrive”?

Answer 13

Albumin and total cholesterol

Question 14

The _____ Criteria is a list of meds that have worse side effects for older adults and can be used in helping you eliminate unnecessary or marginally beneficial drugs from a pt who is failure to thrive.

Answer 14

The BEERS criteria

Question 15

True or False? Tube feeding does not have a survival benefit compared to hand feeding in those with severe cognitive impairment.

Answer 15

TRUE

aspiration is still possible with a feeding tube

Question 16

What 4 interventions have been proven to treat FRAILTY?

Answer 16

• Exercise
• Protein/ Calorie support
• Vitamin D supplementation
• reduce polypharmacy

Question 17

Which medication is frequently used to treat depression in elderly pt’s with failure to thrive, because it also helps increase appetite and promote weight gain?

Answer 17

Mirtazapine (Remeron)

Question 18

A _________ is the most common type of movement disorder and is caused by contractions of antagonistic muscles.

Answer 18

Tremor

Question 19

In a _________ tremor, the body part is supported and relaxed. The tremor can come and go depending on patient’s stress level, if they feel observed. Often better during movement.

Answer 19

Resting tremor

Question 20

A/an __________ tremor occurs during a voluntary movement

Answer 20

Action tremor

Question 21

A ____________tremor occurs when a person maintains a position against gravity, such as holding the arms outstretched

Answer 21

Postural tremor 
(type of action tremor)

Question 22

A ____________ tremor is a type of action tremor associated with any voluntary movement, such as moving the wrists up and down or closing and opening the eyes.

Answer 22

Kinetic

Question 23

A _____________ tremor worsens during goal-directed movement. Pt’s with this tremor would have trouble completing the finger to nose test.

Answer 23

Intention

Question 24

A __________ tremor would occur during muscle contraction against stationary objects, such as holding a heavy book or dumbbell.

Answer 24

Isometric tremor

Question 25

This Movement Disorder/ Tremor disorder is usually a postural-action tremor. Pt might complain of trouble writing or drinking from a cup. It frequently affects the hands, forearms, head, and/or voice. Emotional stress usually exacerbates the tremor. Alcohol provides relief in many and can be diagnostic of this condition.

Answer 25

Benign Essential Tremor (AKA Familial Tremor)

Question 26

Which medication would be used to treat essential tremor causing intermittent disability? What med would be used for essential tremor causing persistent disability?

Answer 26

Intermittent: Propranolol or Alcohol Persistent: Propranolol or Primidone

Question 27

Does an essential tremor cause a decline in the patient's overall survival rate?

Answer 27

No

Question 28

A _________ tremor occurs in all people and is not caused by any neurologic disease. This tremor can be heightened by anxiety, exhaustion, hypoglycemia, caffeine,etc.

Answer 28

Physiologic tremor

Question 29

A ___________ tremor is a low-frequency, intention tremor that can be unilateral or bilateral. This type of tremor is typically not a benign situation and should be investigated with neural imaging.

Answer 29

Cerebellar tremor

Question 30

A/an __________ tremor occurs in the legs and/or trunk immediately after standing. It is typically not visible, but causes the pt to feel unsteady.

Answer 30

Orthostatic tremor

Question 31

An orthostatic tremor usually responds to what med?

Answer 31

clonazepam

Question 32

A ___________ tremor is a variable tremor that can look like any type of tremor movement. Tremor might stop if pt given a task or distraction. Commonly seen with psychiatric disorders.

Answer 32

Psychogenic tremor (AKA Functional Tremor)

Question 33

A _________ __________ Tremor is a type of Action tremor that occurs only while writing and is limited to the hand

Answer 33

Primary Writing tremor

Question 34

This is a common movement disorder in which patients have an uncomfortable urge to move their legs, especially when relaxed. These pt's may also have involuntary movements of their limbs while sleeping.

Answer 34

Restless leg syndrome (AKA Willis-Ekbom Disease/WED)

Question 35

______ _________ _______ is the most common treatable cause for restless leg syndrome.

Answer 35

Iron deficiency anemia

Question 36

What 2 medications could be considered to treat restless leg syndrome if non-pharmacological methods and iron trial failed?

Answer 36

Mirapex and Requip

Question 37

Which 2 meds could be considered to treat CHRONIC/PERSISTENT restless leg syndrome?

Answer 37

Gabapentin or Lyrica

Question 38

__________ ________ is an inherited, fatal, progressive neurodegenerative disorder characterized by chorea, psychiatric disturbances and dementia

Answer 38

Huntington's Disease

Question 39

True or False. 80% of people who inherit the gene that causes Huntington's Disease will develop the disease.

Answer 39

False- 100% of those who inherit the gene will develop the disease.

Question 40

________ is the word used to describe rapid, involuntary, nonrepetitive dance-like movements involving the face, trunk, and limbs. It is a hallmark sign of Huntington's Disease.

Answer 40

Chorea

Question 41

____________ ________ is a Progressive neurodegenerative disorder characterized by bradykinesia, tremor, rigidity, & postural instability.

Answer 41

Parkinsons Disease

Question 42

All of the following are risk factors for Parkinsons Dz except: a. Depression b. Fever c. Constipation d. Exposure to pesticide

Answer 42

b. fever

Question 43

Parkinsons Disease is caused by degeneration of __________ neurons in the substantia nigra, which leads to an imbalance of __________ and __________.

Answer 43

Dopaminergic | Dopamine and Ach

Question 44

Name the 3 essential features/ hallmark signs of Parkinsons Dz

Answer 44

Resting tremor bradykinesia rigidity

Question 45

___________ is a specific type of resting tremor that is commonly seen in PD.

Answer 45

Pill rolling tremor

Question 46

__________ is a common characteristic of pt's with PD in which they have reduced blinking & masked facies

Answer 46

hypomimia

Question 47

_________ ___________ is seen in later stages of PD, in which the pt has a feeling of imbalance and a tendency to fall

Answer 47

Postural instability

Question 48

``` The following are motor symptoms that might be seen in a pt with what disease? • Dysarthria • Dysphagia • Sialorrhea • Blurred vision • Micrographia • Freezing gait ```

Answer 48

Parkinsons Disease

Question 49

What are some dz's that might be on your Ddx for a pt who possibly has Parkinsons Disease?

Answer 49

* Essential tremor * Lewy Body Dementia * Multiple System Atrophy * Secondary parkinsonism * Corticobasal degeneration * Progressive supranuclear palsy

Question 50

``` The following are NON-motor symptoms that might be seen in a pt with what neuro-dengenerative disease? • Depression** • Anxiety • Cognitive dysfunction • Dementia • Sleep disturbance • Autonomic dysfunction • Constipation • Olfactory dysfunction ```

Answer 50

Parkinson's Disease

Question 51

A patient MUST have what two s/sx's in order to be diagnosed with PD?

Answer 51

1. Bradykinesia | 2. Tremor or Rigidity

Question 52

TRUE OR FALSE? If you put a pt who you suspect to have PD on a dopaminergic med and they do not respond, it is highly unlikely that they have PD.

Answer 52

TRUE

Question 53

What are some factors that would influence your decision to intiate tx for a pt with PD?

Answer 53

degree of functional impairment, patient | values & preferences, amount of interference with work, ADLs, social, or leisure function, and more

Question 54

_________ is an Antiviral medication that has mild antiparkinsonian activity. It is Best as short-term monotherapy in those with mild, early disease

Answer 54

Amantadine

Question 55

__________ is the Most effective drug for symptomatic treatment of PD. It is Especially good for symptoms of bradykinesia. In the US, this med is combined with Carbidopa to decrease the negative side effects. The name of the combined med is _________.

Answer 55

Levodopa | Sinemet

Question 56

This class of meds is also a good choice in treatment of PD, except for pts who did not respond to Levodopa. These meds are Associated with fewer motor fluctuations & dyskinesia's than levodopa.

Answer 56

Dopamine Agonists

Question 57

Name two dopamine agonists commonly used in tx of PD. These two meds are also used in tx of restless leg syndrome.

Answer 57

Mirapex | Requip

Question 58

_______ inhibitors are a type of med used as early monotherapy for PD, but are not as effective as other common classes of meds.

Answer 58

MAO B

Question 59

___________is a class of meds that reduces the metabolism of levodopa. It is Not effective if given alone, but prolong the levodopa effect when given with a dose of levodopa.

Answer 59

COMT Inhibitors | [Tolcapone (Tasmar) & entacapone (Comtan)]

Question 60

Hyperkinetic movement disorder with a delayed onset that appears after prolonged use of dopamine receptor blocking agents, mainly antipsychotics (aka neuroleptics) and antiemetics

Answer 60

Tardive dyskinesia

Question 61

TRUE OR FALSE? Tardive dyskinesia is mainly caused by second generation antipsychotics

Answer 61

False, it is primarily caused by 1st gen antipsychotic meds

Question 62

If a patient presented with any of the following s/sx's and has had a recent change in their psych med, you should consider what dz? • Protruding, twisting movements of the tongue • Smacking of the lips • Retraction of the corners of the mouth • Puffing out of the cheeks • Chewing movements • Puckering the lips

Answer 62

Tardive dyskinesia

Question 63

What dz/ disorders might be on your Ddx for a pt who potentially has TD?

Answer 63

* Tourette syndrome * Schizophrenia, autism, severe mental retardation * Huntington disease (especially early-stage) * Wilson disease * Tremor * Levodopa-induced dyskinesia * Hyperthyroidism * Improperly fitted dentures

Question 64

Progressive neurodegenerative disorder of motor neurons at all levels of the CNS, that causes muscle weakness, disability, and death.

Answer 64

Amyotrophic Lateral Sclerosis (ALS) | aka Lou Gehrigs dz or motor neuron dz

Question 65

What dz's/disorders might be on your Ddx when you are considering ALS as a dx?

Answer 65

* Post-polio syndrome * Benign fasiculations * Multifocal motor neuropathy * Cervical radiculomyelopathy * Inflammatory myopathy

Question 66

_______________ is the only FDA-approved medication known to extend tracheostomy-free survival in pt's with ALS. This med can prolong survival for ______ months.

Answer 66

Riluzole (Rilutek) | 2-3

Question 67

______________ __________ is a common symptom of ALS, in which the pt might have uncontrollable crying or laughing. It can be treated with ___________.

Answer 67

Pseudobulbar affect | Nuedexta

Question 68

The average survival period for a pt diagnosed with ALS is _____ years

Answer 68

3-5 years

Question 69

Relatively uncommon autoimmune disorder characterized by dysfunction at the neuromuscular junction, causing weakness and fatigability of skeletal muscles

Answer 69

Myasthenia Gravis

Question 70

In myasthenia gravis, Autoantibodies act against ___________ Receptors in the postsynaptic neuromuscular junction

Answer 70

Acetylcholine

Question 71

Majority of patients with Myasthenia Gravis have _________ abnormalities

Answer 71

Thymic

Question 72

True or false? Ptosis and/or diplopia are common clinical findings in pts with myasthenia gravis

Answer 72

Most present with ocular symptoms (>50%) Weakness of eyelid leads to ptosis Extraocular muscles produce diplopia Pupils are always spared

Question 73

What is the Ice Pack Test and which dz is it used to test for?

Answer 73

Ice pack placed on pts affected eyelid (with ptosis) for 2 mins, remove, eyelid will improve. Tests for Myasthenia Gravis

Question 74

________________________ is the most sensitive test for Myasthenia Gravis

Answer 74

Single-fiber electromyography

Question 75

_______________ is a blood test that can help diagnose MG.

Answer 75

Serum AChR antibodies test | Positive antibodies diagnostic- positive in 85-90%

Question 76

What class of meds is the 1st line treatment for pts with myasthenia gravis? Name a commonly used med in this class and its dose for MG.

Answer 76

Acetylcholinesterase inhibitors | Pyridostigmine (Mestinon) 30 mg PO q6-8 hrs

Question 77

True or false? Immunotherapy cannot be used with Acetylcholinesterase inhibitors when treating MG.

Answer 77

FALSE- pts with MG may require immunotherapy in addition to other meds (corticosteroids,etc)

Question 78

What type of surgery can be performed on pt's with MG?

Answer 78

Thymectomy (improves survivability in 85%)

Question 79

There are several classes of medications that should be avoided in pts with MG. What are some?

Answer 79

``` Quinolones Macrolides Beta blockers Anesthetics Botox quinine magnesium ```

Question 80

A neurological disorder manifested by multiple motor and phonic tics. Thought to be a disturbance in the striatal-thalamic-cortical (mesolimbic) system, which leads to disinhibition of the motor and limbic system.

Answer 80

Tourette Syndrome

Question 81

_____ are Sudden, brief intermittent movements or utterances. Considered involuntary, but can be suppressed at times

Answer 81

Tics

Question 82

Sometimes individuals with certain disorders, display _____________, meaning they imitate the movement of others, or _____________ meaning they repeat/mimic others' speech.

Answer 82

Echopraxia | Echolalia

Question 83

True or false? Tourette Syndrome typically develops in childhood and resolves on its own before age 18.

Answer 83

True | 50% resolve before 18 yrs old. May go into adulthood, but still usually decreases in severity over time.

Question 84

If a patient had Tourette's Syndrome and OCD, how would you treat them?

Answer 84

Behavioral therapy and an SSRI (Prozac) | If pt doesnt respond to that, try a 2nd gen antipsychotic (Seroquel, Abilify, Zyprexa)

Question 85

What med would you choose for a pt with Tourette's Syndrome and ADHD?

Answer 85

Clonidine

Question 86

2 drugs to treat dementia in FTT

Answer 86

Aricept and Namenda

Question 87

Best anti-depressant to treat FTT depression due to appetite stimulation

Answer 87

Mirtazipine (Remeron)

Question 88

3 Bad anti-depressants to treat depression in FTT due to weight loss S/E

Answer 88

Sertraline (Zoloft), Fluoxetine (Zoloft), Buproprion (Wellbutrin)