Movement Disorders

Question 1

Huntington disease is a neurological disorder characterized by a classic triad of:

Answer 1

• Choreiform movement
• Dementia/depression
• Behavioral changes

Question 2

What is a common unnatural cause of death in patients with Huntington disease?

Answer 2

Suicide

Question 3

Atrophy of the striatum, especially in the caudate nucleus, with consequent enlargement of ventricles (i.e., ex vacuo ventriculomegaly) is characteristic of:

Answer 3

Huntington Disease

Question 4

What is the mode of inheritance of Huntington disease?

Answer 4

Autosomal dominant

Question 5

Which movement disorder presents as a slow, zigzag motion when pointing / extending toward a target?

Answer 5

Intention tremor

Question 6

Patient who presents with an intention tremor and hypermetria, both of which indicate cerebellar dysfunction. The most likely cause of cerebellar dysfunction in a woman in her 40s is:

Answer 6

Multiple sclerosis,

Question 7

Which type of tremor is often familial?

Answer 7

Essential tremor

Question 8

Which movement disorder presents as a high-frequency tremor with sustained posture (e.g., outstretched arms)?

Answer 8

Essential tremor

Question 9

Essential tremor is treated with(2):

Answer 9

Propranolol or primidone

Question 10

What are the characteristics of tremor in Parkinson disease vs. essential tremor?
- Parkinson tremor = worse ____
- Essential tremor = worse ____

Answer 10

• during rest
• during movement

Question 11

Parkinson disease is characterized by degeneration of dopaminergic neurons in the:

Answer 11

Substantia nigra of the basal ganglia

Question 12

Parkinson disease is characterized histologically by _____ which are round, eosinophilic inclusions composed of α-synuclein

Answer 12

Lewy bodies

Question 13

The motor clinical features of Parkinson disease may be remembered with the mnemonic “TRAPSS”:

Answer 13

Tremor
Rigidity
Akinesia/bradykinesia
Postural instability
Shuffling Gait
Small handwriting

Question 14

Tremor and rigidity 2° to Parkinson disease is managed with:

Answer 14

Benztropine or trihexyphenidyl a(anticholinergics)

Question 15

What is the treatment of choice for Parkinson disease patients that are functional AND under 70 years old?

Answer 15

Dopamine agonists (e.g. pramipexole, ropinirole)

Question 16

Psychotic symptoms in Parkinson disease can be treated with anti-Parkinson medication dose reduction and/or adding a low-potency antipsychotic such as:

Answer 16

Clozapine or quetiapine

Question 17

Multiple system atrophy triad: .

Answer 17

• Motor abnormalities (tremor and rigidity)
• Autonomic dysfunction (orthostatic hypotension and urinary incontinence)
• Cerebellar symptoms (dysdiadochokinesia, gait disturbances, dysarthria)

Question 18

What neurological pathology manifests as parkinsonism with orthostatic hypotension, impotence, incontinence, or other autonomic dysfunction?

Answer 18

Multiple system atrophy (Shy-Drager syndrome)

Question 19

Which Parkinson-plus syndrome presents with rapidly progressive bradykinesia, postural instability, executive function loss, and vertical gaze palsy?

Answer 19

Progressive supranuclear palsy (PSP)

Question 20

Midbrain atrophy with an intact pons (hummingbird sign) is seen in patients with:

Answer 20

progressive supranuclear palsy

Question 21

What is the most likely diagnosis in a patient with history of an intermittent, high-frequency tremor that worsens with stress who now has more persistent/severe presentation since starting SSRI?

Answer 21

Enhanced physiologic tremor

Question 22

• A 60-year-old with a 10-year history of bilateral hand tremor that improves with alcohol and has a family history:
• A healthy young person with fine hand tremor before public speaking that disappears at rest:

Answer 22

• Essential tremor
• Physiologic tremor

Question 23

Are dopamine agonists or carbidopa-levodopa associated with a higher risk of psychosis?

Answer 23

Dopamine agonists (pramipexole, ropinirole)

Question 24

What anti-Parkinson’s medication can cause ataxia, livedo reticularis, peripheral edema, and orthostatic dysregulation?

Answer 24

Amantadine

Question 25

________ is characterized by improvement with distraction, changeable/inconsistent features, and inconsistency with known tremor syndromes; presents abruptly and causes significant disability

Answer 25

Functional tremor

Question 26

A positive entrainment test is used to diagnose this type of tremor:

Answer 26

Functional tremor

Question 27

Horizontal gaze nystagmus is a classic finding in:

Answer 27

Wernicke encephalopathy

Question 28

Triad of Wernicke encephalopathy

Answer 28

- Encephalopathy - Ophtalmoplegia - Ataxia

Question 29

Order of treatment in Wernicke encephalopathy:

Answer 29

Always thiamine before glucose

Question 30

Best therapy Parkinson disease: mild to moderate symptoms + impact daily living:

Answer 30

DA receptor agonists(pramipexole, ropinirole, rotigotine)

Question 31

Anticholinergic side effects: - Blind as a bat - Mad as a hatter - Red as a beet - Hot as a hare - Dry as a bone - The bowel and bladder lose their tone - The heart runs alone

Answer 31

- Mydriasis - Altered mental status - Flushing - Hyperthermia - Dry mucosae + skin - Organ paralysis - Tachycardia

Question 32

What neurological disorder is associated with iron deficiency and chronic kidney disease?

Answer 32

Restless legs syndrome

Question 33

What are the first-line medical treatments for chronic persistent symptoms of restless legs syndrome?

Answer 33

Gabapentin or pregabalin (α2δ Ca2+ channel inhibitors)

Question 34

What are the first-line medical treatments for intermittent restless legs syndrome?

Answer 34

Carbidopa-levodopa or benzodiazepine