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clin med III final > movement disorders > Flashcards

movement disorders Flashcards

1
Q

a state of restlessness, can’t sit still

A
  • akathisia
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2
Q

inability to coordinate movements of the limbs or trunk

A

ataxia

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3
Q

involuntary writhing limb movements

A
  • athetosis
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4
Q

cause of idiopathic parkinson’s disease

A
  • destruction of Dopamine in the substantia nigra pars compacta
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5
Q

four cardinal features of idiopathic parkinson’s disease

A
  1. rest tremor
  2. rigidity
  3. akinesia-bradykinesia
  4. postural instability
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6
Q

describe rest tremor in idiopathic parkinson’s disease

A
  • unilatearl
  • can be pill-rolling
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7
Q

explain rigitidy of idiopathic parkinson’s disease

A
  • sustained resistance through passive range of motion
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8
Q

describe akinesia-bradykinesia associated with idiopathic parkinson’s disease

A
  • loss of manual dexterity
  • reduced facial expression (masked facies)
  • slowing of movement
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9
Q

describe postural instability associated with idiopathic parkinson’s disease

A
  • stooping
  • retropulsion: tendency to walk backwards
  • falls with turning
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10
Q

what are the autonomic features associated with idiopathic parkinson’s disease

A
  • sweating abnormalities
  • orthostatis hyoptension
  • impotence
  • constipation
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11
Q

two common rating scales for idiopathic partkinson’s disease

A
  • unified parkinson’s disease rating scale
  • modified hoehn and yahr staging
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12
Q

how does drug induced parkinsonism differ from idiopathic parkinson’s disease

A
  • offending drug (phenergan, anti-psychotic)
  • absence of rest tremor
  • symmetric symtpoms
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13
Q

how does vascular disease differ from idiopathic parkinson’s disease

A
  • gait disturbance
  • spasticity
  • hyper-reflexia
  • pseudobulbar affect: inappropriate involuntary laughing/crying
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14
Q

how does normal pressure hydrocephalus differ from idiopathic parkinson’s disease

A
  • apraxia of gait (feet stuck to ground, magnetic gait)
  • cognitive impairment
  • urinary incontinence
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15
Q

how does corticobasal degeration differ from idiopathic parkinson’s disease

A
  • cognitive disorder
  • limb apraxia
  • unilateral limb rigidity
  • myoclonus or dystonia
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16
Q

describe Progressive Supranuclear palsy

A
  • pseudobulbar affect
  • supranuclear gaze palsy (vertical gaze, down>up gaze)
  • early falls
  • absence of tremor
  • poor L-dopa response
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17
Q

describe multi-system atrophy

A
  • prominent autonomic features early on
    • severe constipation, orhostatic BP changes
  • falls
  • axial dystonia
  • no rest tremor
  • poor L-dopa response
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18
Q

describe dementia with lewy bodies

A
  • cognitive disorder
  • hallucination
  • prominent dream enactment behavior
  • mild autonomic symptoms
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19
Q

multi-system atrophy (MSA) has what sign on MRI

A
  • hot cross bun
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20
Q

progressive supranuclear palsy has what sign on MRI

A

hummingbird sign

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21
Q

diagnostic workup if you suspect parkinsonism

A

MRI brain

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22
Q

normal pressure hydrocephalus has what sign on MRI

A

massively enlarged ventricles

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23
Q

any patient < 50 yo who presents with a movement disorder, you need to rule out

A
  • wilson’s disease
    • serum ceruloplasmin
    • K-F rings
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24
Q

any patient who presents with a tremor, check these labs

A

thyroid studies

25
Q

all patients who you follow with Parkinsons disease, check this lab

A

vitamin D

26
Q

how should sinemet immediate release and continued release be taken

A
  • IR: empty stomach
  • CR: with meals
27
Q

all parkinsonism patients get put on a trial of

A
  • Sinemet (carbidopa/levodopa)
28
Q

Sinemet (carbidopa/levodopa) is given to what patients with IPD

A
  • all patients with IPD > 70
    • IPD pts < 70 if other Rx not working
29
Q

long term use with Sinemet (carbidopa/levodopa) causes

A
  • motor fluctuations
30
Q

side effects of Sinemet (carbidopa/levodopa)

A
  • nausea
  • rare drop in BP
  • impulse control disorders
31
Q

List the Dopamine agonists used for IPD

A
  • Pramipexole
  • Ropinirole
  • Rotigotine (patch)
32
Q

side effects of Dopamine agonists

A
  • sleepiness
  • nausea
  • orthostatic hypotension
33
Q

indication for use of Dopamine agonists in tx of IPD

A
  • patient < 70
  • mild symptoms
  • dyskinesias
34
Q

what medication can be given in IPD patients for drooling

A
  • Robinul - anticholinergic
  • botulinum toxins
35
Q

indications for DBS surgery

A
  • significant disability
  • motor fluctuations with maximized medications
  • still levodopa responsive
  • no cognitive impairment
36
Q

essential tremor is caused by

A
  • autosomal dominant inheritane with variable penetrance
    • FET1/ETM1
    • FET2/ETM2
37
Q

features of essential tremor

A
  • postural or kinetic, typically bilateral upper extremities (hands)
  • rest tremor may develop later on
  • may improve with ETOH
  • may have head, chin or voice tremor
38
Q

DOC treatment options for essential tremor

A
  • wrist weights
  • propranolol
39
Q

treatment of head tremor associated with essential tremor

A

botulinum toxin

40
Q

list the 4 criteria for diagnosis of restless leg syndrome

A
  1. abnormal sensations with urge to move legs
  2. occurs at rest
  3. alleviated by movement
  4. symptoms worse at night
41
Q

restless leg syndrome is associated with what movements

A

PLM: periodic limb movement

42
Q

secondary causes of RLS

A
  • neuropathy
  • Fe deficiency
  • pregnancy
  • renal failure
43
Q

treatment of Restless leg syndrome

A
  • Dopamine Agonists (pramipexole, ropinirole, rotigotine)
    • only use at night
    • helps both RLS and PLM
44
Q

what can happen in RLS if patient is taking dopamine agonists TID

A
  • rebound and augmentation
    • symtpoms spread from legs to arms and occurs all day long and becomes very hard to treat
45
Q

cause of huntington’s disease

A
  • autosomal dominant with high penetrance
  • CAG repeat
46
Q

treatment of symptomatic huntington’s disease

A
  • anti-dopaminergic drugs - typically antipsychotic
  • benzodiazepines
  • anti-depressants
47
Q

huntington’s disease presents with what deficits

A
  • motor
    • wide based gait, chorea
  • cognitive
    • executive function, visual-spatial abilities
  • psychiatric
    • depression, psychosis
48
Q

differentiate between transient and chronic tic disorders

A
  • transient < 6 months
49
Q

Tics are associated with what conditions

A
  • OCD
  • ADD
50
Q

what are some drug classes that induce Tics

A
  • stimulants
  • steroids
  • neuroleptics
51
Q

treatment of Tics

A
  • Clonidine
  • neuroleptics (halidol)
  • Benzodiazepines
52
Q

diagnostic criteria for Tourettes syndrome

A
  • motor tics and phonic tics for > 1 yr
  • no secondary causes
  • onset before 18 yo
53
Q

generalized Dystonia

A
  • idiopathic torsion dystonia
  • childhood onset
54
Q

focal dystonia comes in what categories

A
  • cervical
  • blepharospasm (excessive blinking or squinting)
  • task-specific
  • lingual
  • laryngeal
55
Q

focal dystonia seen in what patient population

A

adults

56
Q

treatment of Dystonia

A

botulinum toxins

57
Q

what are hemifacial spasms? where do they begin

A
  • involuntary, intermittent spasms of half of the face
  • perioribital muscles
58
Q

causes of hemifacial spams

A
  • CN VII compression: most common
  • CVA, MS, post bell’s palsy
59
Q

tx of hemifacial spams

A
  • BTX-A

clin med III final (7 decks)

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