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X Clin Med III Final Exam > Movement Disorders > Flashcards

Flashcards in Movement Disorders Deck (72)
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1

What is akathisia?

State of restlessness (can't sit still)

2

What is ataxia?

Inability to coordinate movements of the trunk or limbs

3

What is athetosis?

Involuntary writhing limb movements

4

What is ballism?

Flailing, ballistic, involuntary movements in a limb

5

What is chorea?

Quick involuntary, dance-like movements

6

What are dyskinesias?

Involuntary movements, chorea-like or tic-like

7

What is dystonia?

Abnormal muscle tone with sustained posture

8

What is myoclonus?

Involuntary spasmodic jerky movements

9

What are tics?

Habitual, semi-voluntary, spasmodi, quick, brief movements

10

What PE to do for a movement disorder

MSE
Handwriting sample
Cranial nerves
Motor (rest, posture and kinetic movements, rapid alternating movements)
Reflexes
Sensory
Coordination
Station/stance and pull-testing
Gait

11

Types of Parkinsonisms

Idiopathic Parkinson's Disease
Drug-induced parkinsonism
Vascular parkinsonism
Normal pressure hydrocephalus
Progressive supranuclear palsy
Multiple system atrophy
Corticobasal degeneration
Dementia with lewy bodies

12

Disease course of Idiopathic Parkinson's

Symptom free honeymoon about 3 yrs after diagnosis
Motor complications at about 5-7 yrs
Onset to death about 20 years

13

Pathophysiology of Parkinsons

Degeneration of DA neurons in substantia nigra pars compacta

14

Cardinal features of Idiopathic Parkinson's

Rest tremor
Rigidity
Akinesia-bradykinesia
Postural instability

15

Rest tremor of Idiopathic Parkinson's

Unilateral
4-7 Hz and can be pill rolling (slow and at rest)

16

Rigidity of Idiopathic Parkinson's

Sustained resistance through passive range of motion
Lead pipe or cog wheeling
Muscle stretch receptors are normal

17

Akinesia-bradykinesia of Idiopathic Parkinson's

Masked facies, loss of manual dexterity, getting out of chairs, loss of spontaneous animation, loss of associated movements

18

Postural instability of Idiopathic Parkinson's

Stooping and retropulsion
Falls with turning (center of gravity)
*should be the last of the 4 to be seen in PD

19

Rating scales for Idiopathic Parkinson's

-Unified Parkinson's Disease Rating scale (UPDRS):
I is mentation, mood and behavior
II is activities of daily living
III is motor exam
IV is complications of therapy
-Modifies Hoehn and Yahr staging (stages 0-5)

20

Drug-induced Parkinsonism

Find the offending drug (anti-nausea, anti-psychotic basically anything anti-dopamines)
Absence of rest tremor
Associated akathisia
SYMMETRIC sxs

21

Vascular Parkinsonsim

GAIT DISTURBANCE
Spasticity and hyperreflexia
Pseuchobulbar affect

22

Normal Pressure Hydrocephalus

APRAXIA OF GAIT
Rigidity
Cognitive impairment
Urinary incontinence
(wet, wacky and wobbly)

23

Corticobasal degeneration Parkinsonism

COGNITIVE DISORDER
Limb apraxia
Unilateral limb rigidity
Dystonia or myclonus

24

Progressive supranuclear palsy related Parkinsonism

Psuedobulbar affect
SUPRANUCLEAR GAZE PALSY (vertical gaze, down > up gaze)
Falls!!
Slowed saccades, axial rigidity, absence of tremor, spastic-ataxic dysarthria, poor L-dope response

25

Multi system atrophy Parkinsonsim

Falls, axial dystonia, respiratory stridor, akinesia, absence of rest tremor, dysmetria
Prominent autonomic features!!!
Poor l-dope response

26

Dementia with lewy bodies

HALLUCINATIONS
Cognitive disorder: prominent dream enactment behavior, mild autonomic sxs

27

When to do MRI of the brain

Gait disorder and falling
Cognitive disorder

28

Multisystem atrophy on MRI

Hot cross bun sign

29

Progressive supranuclear palsy on MRI

Hummingbird sign due to midbrain atrophy

30

What to rule out in all pts <50 with movement disorder

Wilson's disease