Movement Disorder

Question 1

CHOREA causes 🌟 CHOREA

Answer 1

CHOREA gravidarum
Huntingtons CHOREA
Ocp
Rheumatoid CHOREA
Endocrine ( thyrotoxicosis )
Arteriosclerotic / senile chorea

Question 2

Types of movement disorder

Answer 2

Dykinetic
Hypokinetic
HYPERKINETIC

Question 3

Cause of dyskinesia

Answer 3

Drug induced / tardive dyskinesia

Question 4

Hypokinetic movement dis causes

Answer 4

Parkinsonism

Parkinson’s dis
Secondary parkin
Parkinson plus syndrome

Question 5

Parkinson triad

Answer 5

Tremor
Rigidity
Bradykinesia

Question 6

DEFN of Parkinson’s disease

Answer 6

Neurodegenerative progressive disorder characterized by. Tremor, rigidity, bradykinesia

Aka - paralysis agitans

Question 7

Punch drunk syndrome

Answer 7

Secondary parkinsonism as a result of head injury

Question 8

Classification of Parkinson’s disease

Question 9

Hallmark of PD

Answer 9

Degeneration and depletion of dopaminergic neurons in Substantia nigra pars compacta

Presence of LEWY BODIES - tangles of Alpha synuclein and ubiquitin

Question 10

LEWY bodies

Answer 10

Alpha synuclein + ubiquitin
Seen in Nigral cells ( Substantia nigra )

Question 11

Environmental factors causing PD

Answer 11

Oxidative stress ( MPTP mitochondrial toxin )
Pesticide exposure
Smoking is protective

Question 12

Genetic causes of PD

Answer 12

PARK 1-11 FAMILIAL
SPORADIC

Question 13

Motor symptoms of PD

Answer 13

Tremor
Rigidity
Bradykinesia
Gait
Posture
Cognition
Speech

Question 14

Tremor of PD

Answer 14

Pill rolling
4-6 hz
Prominent at rest
Worsens with emotional stress
Rythmic flexion extension
Disappears on sleep or voulntary movement

Question 15

Rigidity of PD

Answer 15

Increased resistance to passive movements
Lead pipe rigidity ( aka)

Question 16

Cogwgheel rigidity

Answer 16

Tremor superimposed on rigidity
Leading to jerkiness on passive resistance

Question 17

Bradykinesia of PD

Answer 17

Slowing of movements
Difficulty in voluntary movement
Fixed facial expressions - MASK LIKE FACIES
sustained blink response on Glabellar tap ( 2 hz) - MYERSONS SIGN
illegible / difficult handwriting - MICROGRAPHIA

Question 18

MYERSONS SIGN / REPTILIAN STARE SIGN

Answer 18

In PD
Sustained blink response on Glabellar tap at 2 hz
Progressive supranuclear palsy also +

Question 19

Posture in PD

Answer 19

Stooped

Question 20

Gait in PD

Answer 20

Slow shuffling
Frozen
Festinating ( rapid short steps)

Question 21

Speech in PD

Answer 21

Hypophonia - soft voice
Monotonous stuttering

Question 22

Cognitive changes in PD

Answer 22

Depression
Dementia
Sleep ABN

Question 23

Non motor symptoms of PD

Answer 23

ANS - hypotension , bladder bowel incontinence , sexual problem

NEUROPSYCHIATRIC- anxiety , depression , apathy , psychosis

SENSORY - hyposmia , pain

SLEEP ABN - Restless leg syndrome, insomnia , day time somnolence

RHEUMATOLOGICAL - Frozen shoulder , swan neck deformity

Question 24

Psp / Steele Richardson olszewski syndrome

Answer 24

PD + PSP
MRI - humming bird sign ( atrophy of mid brain )

Question 25

MSA / Shy drager syndrome / hot cross burn sign

Answer 25

Parkinson + cerebellar signs + prominent autonomic dysfunction Hot cross burn sign - cerebellar brain stem atrophy MSA - multiple system atrophy

Question 26

Corticobasal ganglionic degeneration / rebeiz kolodny Richardson syndrome

Answer 26

PD+ DYSTONIA OF LIMBS + CORTICAL DISTURBANCES ( apraxia, agnosia, myoclonus )

Question 27

Parkinsonism dementia complex guam

Answer 27

PD+ MND

Question 28

Guadelopean parkinsonism

Answer 28

Levidopa unresponsive Parkinson's

Question 29

Causes of Asterixis / Flapping tremors 🌟 RUSH

Answer 29

Respiratory failure Uremia Severe heart failure Hepatic failure

Question 30

Causes of tremors 🌟 WMAT PID

Answer 30

Question 31

Huntingtons CHOREA (🌟 huntingtons fourea )

Answer 31

Chromosome no 4 Increase in no of CAG REPEATS >40 POLYGLUTAMINE REPEATS

Question 32

Most common cause of Chorea in children

Answer 32

Syndrnhams chorea / Saint vitus dance Complication of ARF , group A beta hemolytic streptococcal inf Sign - motor impersostence MGT - Sodium valproate 200mg tid Haloperidol 0.5-1.5 mg BD PEnicillin prophylaxis for future streptococcal inf

Question 33

Milk maid sign

Answer 33

Milking action of patients fingers if asked to grasp physicians hand Seen in CHOREA

Question 34

Pronator sign

Answer 34

Seen in CHOREA Inability to hold hands above the face with palms facing each other as it results in pronation of arms so that palms face outwards

Question 35

Jack in the box sign

Answer 35

Involuntary protrusion and retraction of tongue

Question 36

Features of extrapyramidal lesions 🌟 DR MCH²

Answer 36

Question 37

Site of lesion in CHOREA

Answer 37

Caudate nucleus

Question 38

Site of lesion in Hemiballisbus

Answer 38

Subthalamic nucleus

Question 39

Site of lesion in dystonia / athetosis

Answer 39

Putanen