Movement Flashcards by Alex Matic

What is the most common initial sign of Parkinson Disease?

A. Gait Disturbances
B. Resting Tremor
C. Bradykinesia
D. Stiffness

B. Resting Tremor 70% of cases

Table 38.2

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What is this sign called? Inability to inhibit blinking in response to a tap over the bridge of the nose or glabella.

Myerson Sign

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Which of the following is the histopathologic finding in Parkinson Disease?

A. Pigmented nuclei show marked depletion of cells and replacement of gliosis; reduced quantities of melanin. Presence of Lewy Bodies
B. extensive loss of neurons in zona compacta of substantia nigra. No Lewy body or neurofibrillary tangles. Presence of Glial Cytoplasmic inclusions
C. Bilateral loss of neurons and gliosis in the
periaqueductal gray matter. Presence of Neurofibrillary tangles
D. Presence of achromatic cells in the posterior frontal or anterior parietal lobe. Degeneration of substantia nigra. Presence of corticobasal bodies composed of tau or globose tangles

A. Pigmented nuclei show marked depletion of cells and replacement of gliosis; reduced quantities of melanin. Presence of Lewy Bodies

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Which of the following is the histopathologic finding in Corticobasal degeneration?

D. Presence of achromatic cells in the posterior frontal or anterior parietal lobe. Degeneration of substantia nigra. Presence of corticobasal bodies composed of tau or globose tangles

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Which of the following is the histopathologic finding in Multiple System Atrophy?

B. extensive loss of neurons in zona compacta of substantia nigra. No Lewy body or neurofibrillary tangles. Presence of Glial Cytoplasmic inclusions

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Which of the following is the histopathologic finding in Progressive Supranuclear Palsy?

C. Bilateral loss of neurons and gliosis in the

periaqueductal gray matter. Presence of Neurofibrillary tangles

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Which among these genes is first identified in Parkinson's Disease?
A. SNCA
B. LRRK2
C. Parkin
D. UCHL-1

A. SNCA

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Which among these genes is the most common cause of late-onset and sporadic PD, autosomal dominant inheritance? Disease is slowly progressive and responds well with Levodopa.

A. SNCA
B. LRRK2
C. Parkin
D. UCHL-1

B. LRRK2

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Which among these genes is the first to be identified as an autosomal recessive inheritance that is slowly progressive and responds well with Levodopa? This accounts for 50% of Early-Onset Parkinson Disease

A. SNCA
B. LRRK2
C. Parkin
D. UCHL-1

C. Parkin

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It is an involuntary arrhythmic movement of a forcible, rapid and jerky type.

A. Athetosis
B. Chorea
C. Dystonia
D. Ballismus

B. Chorea

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Which of the following is not related with chorea gravidarum?

A. Close link to prior episodes of Syndenham chorea
B. May expose lupus-related chorea
C. Concordant with onset of Huntington Chorea
D. Pareneoplastic chorea associated with lung cancer (anti-CRMP or anti-Hu antibodies)
E. None of the above

E. None of the above

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Which of the following medication is not associated with Chorea or Dyskinesias?

A. Levofloxacin
B. Phenothiazine
C. Haloperidol
D. Levodopa
E. Atypical Antipsychotics

A. Levofloxacin

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Where can you localize chorea?

A. Striatum
B. Subthalamuc Nucleus of Luys
C. Globus pallidus interna
D. Posterior Limb of Internal Capsule
E. Globus Pallidus Externa

A. Striatum

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It is an involuntary movement described as uncontrollable, large amplitude, poorly patterned flinging movement of entire limb.

A. Athetosis
B. Chorea
C. Dystonia
D. Ballismus

D. Ballismus

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There is relatively slow, writhing or twisting, sinuous, purposeless movements that have tendency to flow into one another.

A. Athetosis
B. Chorea
C. Dystonia
D. Ballismus

A. Athetosis

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Where can you localize athetosis?

A. Caudate nucleus
B. Lenticular Nucleus
C. Thalamus
D. A&B
E. B&C

E. B&C

Where can you localize ballismus?

A. Caudate nucleus
B. Lenticular Nucleus
C. Thalamus
D. Subthalamic Nucleus of Luys
E. B&C

D. Subthalamic Nucleus of Luys

It is described as unnatural spasmodic movement or posture that puts the limb in a twisted position. There is involuntary co-contraction of agonist and antagonist muscles.

A. Athetosis
B. Tremor
C. Dystonia
D. Ballismus

C. Dystonia

15/Male sought consult for involuntary movements described as twisting or writhing movement of his arms described as choreoathetosis lasting for few seconds to minutes that is provoked by sudden movement or when he gets excited. During examination, you asked him to hyperventilate which aggravated his symptoms. What is the diagnosis?Which of the following is not true of his illness?

A. It is X-linked in inheritance
B. It responds well with Phenytoin and Carbamazepine
C. It is due to mutation of PRRT2 (Proline-Rich Transmembrane Protein)
D. It is inherited via autosomal dominant pattern

A. It is X-linked in inheritance

Paroxysmal Kinesigenic Choreoathetosis

18/Male presented for involuntary movement. His movements were described as his left hand having dystonic spasms lasting for 30minutes (max of 4hrs). This is usually aggravated during examination or when he drinks coffee. His last attack was 5 years ago when he was tired. What is your diagnosis? Which of the following is true?

A. It does not respond well with benzodiazepines
B. It is inherited via autosomal recessive
C. He may have relatives presenting with diplopia and spasticity
D. There is no familial tendency to develop infantile convulsions

Nonkinesogenic Illness

C. He may have relatives presenting with diplopia and spasticity

It is described as involuntary rhythmic oscillatory movement produced by alternating or irregularly synchronous contractions of reciprocally innervated muscles.

A. Athetosis
B. Chorea
C. Dystonia
D. Tremor

D. Tremor

RHYTHMIC QUALITY THAT DISTINGUISHES TREMOR FROM OTHERS

Frequency 8-13Hz, predominant on the hands, enhanced by epinephrine and Beta-adrenergics. Responds well with Alcohol.
Which type of tremor?

A. Enhanced Physiologic Tremor
B. Essential Tremor (Familial, Senile)
C. Cerebellar Tremor
D. Postural Tremor

A. Enhanced Physiologic Tremor

Frequency 4-8Hz, predominant on the hands, head and vocal cords.
enhanced by anxiety or fright, exercise, fatigue, Beta-adrenergics. Responds well with Alcohol, propranolol and primidone.
Which type of tremor?

A. Enhanced Physiologic Tremor
B. Essential Tremor (Familial, Senile)
C. Cerebellar Tremor
D. Postural Tremor

B. Essential Tremor

Frequency 5-8Hz, predominant on the hands.
enhanced by anxiety or fright, exercise, fatigue, Beta-adrenergics. Responds well with Beta-adrenergic antagonist.
Which type of tremor?

A. Enhanced Physiologic Tremor
B. Essential Tremor (Familial, Senile)
C. Cerebellar Tremor
D. Postural Tremor

D. Postural Tremor

Tremor that is present on repose/resting but worsens on action. A. Rubral Tremor B. Parkinsonian Tremor C. Physiologic Tremor D. Essential Tremor

A. Rubral Tremor

Tremor that is present on repose/resting and improves on action. A. Rubral Tremor B. Parkinsonian Tremor C. Physiologic Tremor D. Essential Tremor

B. Parkinsonian Tremor

Symmetric at onset-type of tremor that is present on action. Best elicited on postural movement (with outstretched arms with fingers spread apart). A. Rubral Tremor B. Parkinsonian Tremor C. Physiologic Tremor D. Essential Tremor

C. Physiologic Tremor

Asymmetric (first at dominant hand) at onset-type of tremor that is present on action. Best elicited on postural movement (with outstretched arms with fingers spread apart). A. Rubral Tremor B. Parkinsonian Tremor C. Physiologic Tremor D. Essential Tremor

D. Essential Tremor

Goal-directed action tremor. A. Rubral Tremor B. Cerebellar Tremor C. Physiologic Tremor D. Essential Tremor

B. Cerebellar Tremor

Tremor with Frequency: 1-2Hz predominant on the palate, facial, pharyngeal, proximal limb muscles. Improves with clonazepam and valporate. Diagnosis?

Palatal Tremor

What is the mode of inheritance of essential tremor?

Autosomal Dominant pattern with high penetrance

What are the 2 possible generator of essential tremor? ``` A. Cortex and Striatum B. Cortex and Olivocerebellar circuit C. Olivocerebellar Circuit and Thalamus D. Striatum and Thalamus E. Cerebellum and Striatum ```

C. Olivocerebellar and Thalamus

What is the localization of Palatal Tremor or Palatal myoclonus?

Guillain-Mollaret Triangle | Dentate nucleus-brachium conjunctivum-red nucleus-central tegmental tract-olivary nucleus-dentate nucleus

Which is incorrect regarding Symptomatic Palatal Myoclonus? A. It is localized at Guillain-Mollaret Triangle B. It may present as an audible click that ceases during sleep C. It is associated with pendular nystagmus D. Imaging may be normal but there may be enlargement of inferior olivary nucleus E. Clonazepam and Valproate may be beneficial

B. It may present as an audible click that ceases during sleep (PERSISTS DURING SLEEP) essential palatal myoclonus- ceases during sleep

Unilateral asterixis in an arm and leg may be observed in... A. Infarction of Contralateral Anterior Thalamus B. Infarction of Contralateral Ventrolateral Thalamus C. Infarction of Ipsilateral Anterior Thalamus D. Infarction of Ipsilateral Ventrolateral Thalamus

A. Infarction of Contralateral Anterior Thalamus

Autosomal Recessive + Myoclonus + Cherry-Red Spot + Visual Loss + Unimpaired intellect Diagnosis?

Sialidase Deficiency