movement disorders

Question 1

What is the definition of a tremor

Answer 1

rhythmical, involuntary and oscillatory movement of a body part (need all 3 descriptors)

Question 2

What is rhythmical movement

Answer 2

regular and repetitive in timing

Question 3

What type of tremor is always action based

Answer 3

essential tremor

Question 4

What is the most common rest tremor

Answer 4

parkinsons

Question 5

What type of disease starts with a “pill rolling” tremor

Answer 5

Parkinsons

Question 6

What is an essential tremor

Answer 6

Bilateral, symmetric, persistent, and mostly seen in hands/arms

Question 7

What is the cause of a functional tremor

Answer 7

usually from trauma or stressors and will not be picked up on an MRI or EEG

Question 8

What type of tremor will not progress

Answer 8

essential

Question 9

What can reduce an essential tremor

Answer 9

alcohol

Question 10

what pt. history can help indicate an essential tremor

Answer 10

family hx of one
slow progressive nature
No other neuro signs
can control for short periods

Question 11

What is the best way to diagnose an essential tremor

Answer 11

A spirograph

Question 12

If a patient shows signs of Brady kinesia, what is this indicative of

Answer 12

parkinsons

Question 13

What is the mainstay treatment for an essential tremor

Answer 13

propanolol or primidone

Question 14

Which patients would you avoid propranolol with

Answer 14

Asthma
COPD

Question 15

What is Wilsons disease

Answer 15

poor metabolization of copper

Question 16

What are red flags against essential tremors

Answer 16

Bradykinesia
nystagmus
hemiparesis/weakness
hepatic dysfunction

Question 17

What helps differentiate a functional tremor

Answer 17

distractibility
entertainment
may move around the body
sudden onset
mixed tremors

Question 18

What is the cause of parkinsons

Answer 18

loss of dopamine neurons
presence of Lewey bodies

Question 19

What is needed to confirm a parkinsons diagnosis

Answer 19

Bradykinesia and either
rigidity OR rest tremor

Question 20

What signs rule out parkinsons

Answer 20

strictly lower limb involvement
early/severe dementia
cerebellar abnormalities
normal DaT imaging

Question 21

What are red flags against parkinsons

Answer 21

Severe autonomic failure within the first 5 years

Question 22

What early signs can be seen in someone who has NOT been diagnosed with parkinsons

Answer 22

constipation
loss of smell
mood disorders
acting out dreams/restless leg

Question 23

What test will you preform during an exam for parkinsons

Answer 23

Romberg and tandem walk
pull test
extremity rigidity
finger taps

Question 24

What is the first line treatment for parkinsons

Answer 24

exercise and monitoring of symptoms

Question 25

What is the mainstay therapy for parkinsons

Answer 25

levodopa / carbidopa

Question 26

What is Huntingtons disease

Answer 26

Progressive inherited neurodegenerative disease in an autosomal dominant pattern

Question 27

What gene abnormality causes Huntingtons

Answer 27

CAG trinucleotide

Question 28

What is the most common movement with Huntingtons

Answer 28

Chorea

Question 29

What is the presentation of Huntingtons look like

Answer 29

psychiatric issues before motor involvment
depression / apathy
hallucination / paranoia
OCD / psychosis

Question 30

What is the most common disease presentation besides motor function with Huntingtons

Answer 30

executive dysfunction-> problems with multitasking

Question 31

What will you see on an exam with someone who has Huntingtons

Answer 31

delay in eye movement
unable to keep tongue out
tics/myoclonus