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Movement Disorders Flashcards

1
Q

In general, what 4 classifications do we look at when a patient presents with a tremor?

A

Rest vs. Action Body Part Affected Frequency Amplitude (fine/course)

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2
Q

How do we tell if a patient has a resting tremor?

A

Support the body part against gravity

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3
Q

What can increase or decrease a resting tremor?

A

Movement

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4
Q

If a patient goes to grab something and the shake, what’s it called?

A

Intention tremor

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5
Q

If a patient presents with a tremor that is high-frequency, and low amplitude (fine & fast), what diagnosis?

A

Physiologic tremor

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6
Q

When does someone typically have a physiologic tremor?

A

Hyper-adrenergic states (anxiety, caffeine, or withdrawals of caffeine or alcohol)

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7
Q

If a 65 year old patient presents with a tremor that is in the right arm and has slowly gotten worse over the past couple months, and their neurological exam is normal, what ddx?

A

Benign essential tremor

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8
Q

What are the main things we think of for a benign essential tremor?

A

60+, UE tremor, starts on one side and move to bilateral, SLOW progression

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9
Q

How do we treat a benign essential tremor?

A

Beta blockers, rest/sleep, eat well

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10
Q

A patient presents with a tremor involving the left hand and the first two fingers that’s been there for the past year or so. They have noticed a decrease in their affect, on PE they have no weakness and no changes in DTR’s but they do have cogwheel, what ddx?

A

Parkinson’s

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11
Q

What is decreased in Parkinson’s disease?

A

Dopamine in the substantia nigra

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12
Q

What are the 4 cardinal signs of Parkinson’s disease?

A

Tremor, rigidity, bradykinesia, and postural impairment

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13
Q

What is Bradykinesia?

A

Slowness of movements (gait and speech)

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14
Q

What’s the classic name for a Parkinson’s gait? How do they turn?

A

Festinating gait with Turn “en bloc” (along with freezing)

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15
Q

Although there’s no definitive diagnosis for Parkinson’s what can we look at?

A

Dopamine levels – high suspicion. Refer

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16
Q

What symptoms are NOT Parkinson’s?

A

No response to levodopa, symmetrical, rapid progression, abnormal eye movements (that’s MS)

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17
Q

At what point do we treat Parkinson’s?

A

When functional disabilities begins

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18
Q

How can we treat Parkinson’s?

A

Levodopa (so dopamine can cross the BBB) but it wears off :(

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19
Q

What are some S/E of levodopa?

A

Increase in uncontrolled movement (Dyskinesias)

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20
Q

When Levodopa begins to wear off, what can you add?

A

Entacapone
Dopamine Agonists: Ropinirole
Anticholinergics: Benztropine (Cogentin)
MAO-B inhibitor: Selegiline

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21
Q

What’s the absolute last source of treatment for Parkinson’s?

A

Deep brain stimulation

22
Q

A 40 year old presents with spastic, involuntary movements of the arm, that they don’t seem to notice, ddx?

A

Huntington’s

23
Q

How do you describe the involuntary movements of Huntington’s?

A

Chorea with Hemiballismus

24
Q

What else would you notice about the movements of a person with Huntington’s?

A

Abnormal eye movements

25
What’s often untreated in Huntington’s?
Psych = Depression, OCD, Anxiety, Mania
26
What type of disease is Huntington’s?
Autosomal Dominant Disease
27
When treating a patient with Huntington’s what do we also need to consider?
Nutritional, PT/OT, Neuro, Speech Pathologist, Psych ANNNDD Genetic counseling
28
If a young boy presents with a very fine extra eye movement, such as excessive blinking, and tends to repeat the words of his parents excessively, what diagnosis?
Tourette’s
29
How can you actually make the diagnosis of Tourette’s?
It’s NOT explained by any other medical condition | It must occur almost every day for >1 year (most often before 18)
30
Where does Tourette’s initially start vs. over time?
Initially = head & face | Over Time = Changes with increasing complexity
31
When do tics increase vs. decrease?
Increase with stress & decrease with activities
32
How does Tourette’s change over the course of a lifetime?
Lifelong symptoms but often decrease in adulthood
33
When would you actually need to treat Tourette’s?
If their Tic presents a problem
34
What are some pharm & non-pharm treatments for Tourette’s?
``` Pharm = SSRI’s & Antianxiety Non-Pham = Habit reversal training, biofeedback, botox injections ```
35
What do many Tourette’s patients also have?
ADD, anxiety, OCD
36
What movement disorder involves intermittent or sustained muscle contractions causing twisting and repetitive movements?
Cerebral Palsy
37
If we see a child in the ER with CP, what do we always need to consider?
Non-traumatic fractures!
38
If a patient has a burning pain, often in the LE, what classification is this diagnosis?
Neuropathy
39
If a patient has a neuropathy what are the hypersensitive to?
Light touch
40
If a person show’s up with foot drop and after the excellent HPI you discover they were out drinking heavily last night and were fine when they went to bed, what diagnosis?
Saturday Night Palsy
41
If a swimmer presents with numbness and shooting pain through the upper extremity, what ddx? What special test to you do to confirm?
Thoracic Outlet Syndrome Adson’s sign!
42
If a patient is a long time ___ they can also get neuropathies
Alcoholic
43
If what levels in a diabetic are not well controlled they can develop diabetic neuropathies in the feet?
A1c's
44
What medications can cause neuropathies?
Chemotherapies, phenytoin, metronidazole
45
If a patient has intermittent, lancing, facial pain what ddx?
Trigeminal Neuralgia
46
How old are patient’s with trigeminal neuralgia? What if they are younger?
Older than 50. If younger, think MS
47
What type of pressure hurts vs. doesn’t hurt a patient with trigeminal neuralgia?
Hurts = Breeze, kiss, shave, chewing | Doesn’t hurt = Deep/Firm pressure
48
What would you see on PE in a patient with trigeminal neuralgia?
Normal except for pain with soft touch
49
If a patient allodynia (pain from a non-painful stimulus) in a dermatomal pattern, what ddx?
Zoster
50
How do we treat Zoster and WHY?
Acyclovir | Treat to PREVENT post herpetic neuralgia
51
What must we always do during PE before giving the Dx of Zoster?
Florescence dye exam of the eye

Neurology (11 decks)

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