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Clin Med 3 Final (🐈🌭👵🏼) > Movement Disorders (lauren 🌭) > Flashcards

Movement Disorders (lauren 🌭) Flashcards

1
Q

What is this:

“A state of restlessness, “Can’t sit still””

A

Akathisia

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2
Q

What is this:

“Inability to coordinate movements of the trunk or limbs”

A

Ataxia

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3
Q

What is this:

“Involuntary writhing limb movements”

A

Athetosis

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4
Q

What is this:

“Flailing, ballistic, involuntary movements in a limb”

A

Ballism

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5
Q

What is this:

Quick, involuntary, dance-like movements

A

Chorea

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6
Q

What is this:

Involuntary movements, chorea-like or tic-like

A

Dyskinesias

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7
Q

What is this:

Abnormal muscle tone with sustained posture

A

Dystonia

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8
Q

What is this:

Involuntary, spasmodic, jerky movements

A

Myoclonus

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9
Q

What is this:

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

A

Tics

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10
Q

What is this:

Involuntary, rhythmic, repetitive movement

A

Tremor

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11
Q

When does your examination of a movement disorder patient begin?

A

When you enter the room

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12
Q

Should you ask every patient for a handwriting sample?

A

Yes

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13
Q

Parkinson Disease always starts (unilaterally/bilaterally)

A

Unilaterally

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14
Q

What is the 2nd most common Neurodegenrative disease?

A

Idiopathic Parkinson’s Disease

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15
Q

Let’s see a list of Parkinsonisms

A

Idiopathic Parkinson’s Disease

Drug-induced Parkinsonism

Normal Pressure Hydrocephalus

Progressive Supranuclear Palsy

Multiple-System Atrophy

Corticobasal Degeneration

Dementia with Lewy Bodies

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16
Q

What are the 4 CARDINAL Features of Idiopathic Parkinson’s Disease?

A

Rest Tremor- may be pill-rolling 💊👋🏼

Rigidity-lead pipe or cog wheel ⚙️

Akinesia-Bradykinesia- masked facies, loss of dexterity 👺🥴

Postural Instability- stooping, falling when turning, falls during “Pull Test” 🙇🏻‍♂️

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17
Q

Which one of the 4 cardinal features of Idiopathic Parkinson’s Disease comes on later in the disease and will never be the presenting symptom?
What condition DOES present with that feature?

A

Postural Instability.

ParkinsonISM presents with postural instability.

(So if their chief complaint is “falls,” you know it’s not Idiopathic Parkinson’s, but it might be Parkinsonism.

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18
Q

What causes idiopathic Parkinson’s Disease?

A

Loss of dopamine neurons in the Substanita Nigeria leads to a failure to inhibit ACh in the basal ganglia. (ACh is excitatory and Dopamine is inhibitory)

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19
Q

What are the features of Drug-Induced Parkinsonism that make it unique?

A

Symmetric Symptoms** (idiopathic started unilaterally)

Offending drug (anti-nausea, antipsychotic)

Absence of rest tremor

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20
Q

What are the features of Vascular Parkinsonism that make it unique?

A

Gait Disturbance***

Spasticity, hyper-reflexia (UMN signs)

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21
Q

What are the features of Normal Pressure Hydrocephalus that make it unique?

A

Apraxia of gait***

“Magnetic Gait” 🧲

Cognitive impairment

Urinary incontinence

WET WACKY WOBBLY

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22
Q

What are the features of Corticobasal Degeneration that make it unique?

A

Cognitive Disorder**

Have trouble with ONE limb

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23
Q

What are the features of Progressive Supranuclear Palsy that make it unique?

A

Early FALLS**

Gaze palsy (hard to look up and down)👀***

No tremor

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24
Q

What are the features of Multi-System Atrophy that make it unique?

A

Prominent AUTONOMIC features early on (BP drops, urinary incontinence, constipation, etc)**

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25
Q

What are the features of Dementia with Lewy Bodies that make it unique?

A

Hallucinations***🌌

Must meet criteria for dementia

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26
Q

Do you need to do a brain MRI for Idiopathic Parkinson Diseas?

A

No

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27
Q

Which Parkinsonism has the “Hot Cross Bun Sign” on MRI?

A

Multi-System Atrophy

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28
Q

Which Parkinsonism has the “Hummingbird Sign” on MRI?

A

Progressive Supranuclear Palsy

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29
Q

Anytime someone under the age of _____ shows up with a movement disorder, you need to rule out Wilson’s Disease

A

50

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30
Q

How do you test for Wilson’s Disease?

A

Urine copper

Serum ceruloplasmin

Eye exam for Kayser-Fleischer rings

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31
Q

You should do thyroid studies anytime a patient shows up with a _________

A

Tremor

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32
Q

In Parkinson patients, you need to monitor their Vitamin _____ levels

A

D

Since they fall a lot

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33
Q

Do we use PET scans in clinical practice for Parkinson?

A

No, only in research

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34
Q

What study do you need to do if a parkinson patient has dysphagia

A

Swallow study

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35
Q

All patients with a ______ change need a Speech Evaluation

A

Voice

Lol

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36
Q

A SPECT (DaTSCAN) is used when someone has a mixed tremor. It can only help you distinguish between ________ and _________

A

Parkinson Disease

Essential tremor

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37
Q

What are the main classes of drugs we use to treat Idiopathic Parkinson Disease?

A

Carbidopa/Levodopa

Dopamine Agonists

MAO-B inhibitors

COMT inhibitors

Anti-cholinergics

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38
Q

ALL Idiopathic Parkinson’s patients over the age of _____ get treated with Carbidopa-Levodopa (Sinemet)

A

70

39
Q

When do we give Carbidopa-Levodopa (Sinemet) to Idiopathic Parkinson’s patients who are UNDER the age of 70?

A

Only when other medications dont work. (We usually try dopamine agonists first)

40
Q

Long term use os Carbidopa-Levodopa (Sinemet) causes:

A

Motor fluctuations (on and off periods)

41
Q

What are the side effects of Carbidopa-Levodopa?

A

Nausea**

Impulse Control Disorders 🎰🛍

42
Q

What are the 3 dopamine agonists she listed

A

Pramipexole

Ropinirole

Rotigotine

43
Q

What are the side effects of Dopamine agonists?

A

Sleepiness

Nausea

Orthostatic hypotension

hallucinations

Impulse control disorders (gambling, shopping, hypersexualtiy)

44
Q

If an Idiopathic Parkinson patient is under age 70, they start treatment with ________

If they’re over 70, they start treatment with _______

A

Under 70: Dopamine Agonists

Over 70: Carbidopa-Levodopa

45
Q

What are the treatments for Sialorrhea (drooling)?

A

Robinul

Botox injected into salivary glands :)

46
Q

When would we use Deep Brain Stimulation for Idiopathic Parkinson Disease?

A

No cognitive impairment (demented pts don’t do well)

Maxed out on meds

Still Levodopa responsive

47
Q

What is an enhanced physiologic tremor?

A

Your underlying physiologic tremor gets ENHANCED with drugs, caffeine, stress, etc

48
Q

What is an Essential Tremor?

A

A tremor that you inherited due to your genes

49
Q

EtOH (improves/worsens) essential tremor

A

Improves

50
Q

Caffeine (improves/worsens) essential tremor

A

Worsens

51
Q

What are some of the treatment options for Essential tremor?

A

Wrist weights🏋🏻‍♀️

Weighted utensils 🍴

Propranolol

Primidone

Gabapentin/Topamax

Botox for head tremors

52
Q

What are the 4 features of Restless Leg Syndrome?

A

Abnormal urge to move the legs

Occurs at rest

Alleviated by movement

Worse at night

53
Q

What things can worsen restless leg syndrome?

A

Neuropathy

Iron deficiency

Pregnancy

Renal failure

54
Q

How do you treat Restless Legs Syndrome?

A

Iron replacement

Dopamine Agonists

55
Q

What is the rule for taking dopamine agonists for restless leg syndrome?

A

Take it once a day ONLY AT NIGHT!!!!

If you take it more often, you will CAUSE the patient to have 24hr restless leg syndrome

56
Q

If you cut open the brain of someone with Huntington disease, what will you see?

A

Butterfly ventricles (due to atrophy of caudate)

57
Q

What are the motor signs of Huntington Disease?

A

Chorea*******

Motor impersistence (milk maid grasp, fly-catcher tongue)

Wide-based gait

58
Q

Does Huntington’s Disease also have cognitive deficits??

A

Yes. Defects in executive function and visual-spatial abilities

59
Q

What is the average age of onset of Huntington’s diseas?

A

35-40 yrs old

Die within 15 years of diagnosis

60
Q

What is the treatment of Huntington’s Disease?

A

Anti-dopaminergic drugs (they have too much movement)

Benzos

Antidepressants

61
Q

What is the treatment for chronic motor tic disorder?

A

Clonidine

62
Q

Tic disorders are (involuntary/semi-voluntary/voluntary)

A

Semi-voluntary

63
Q

Which two conditions are associated with tics?

A

OCD

ADHD

64
Q

What are the diagnostic criteria for Tourette’s Syndrome/

A

2 motor tics AND 1 phonic tic for more than 1 year

Onset before age 18

65
Q

What is copralalia?

A

Cussing a lot

66
Q

Do most patients with Tourette’s exhibit copralalia?

A

No less than 10%

67
Q

What is the treatment for Tourette’s??

A

“Meds”

Botox for excessive blinking

68
Q

What is meant by a “sensory trick” for cervical dystonia/anterocollis?

A

Touching one side of the face allows the neck to straighten

69
Q

What is a task-specific dystonia?

A

A dystonia that ONLY happens when you do a certain task (ex: writing/playing guitar)

70
Q

What is the treatment for task-specific dystonia?

A

Botox injections

71
Q

What is “Writer’s Cramp”?

A

Task-specific dystonia only when writing

72
Q

What is Generalized Dystonia?

A

Whole body is affected. Childhood onset

73
Q

What are some examples of Focal Dystonias?

A

Cervical (torticollis)

Blepharospasm (blinking)

Task specific

Oral-mandibular (jaw stuck open or closed)

Laryngeal (vocal cords cause breathy or strained speech)

74
Q

What is secondary dystonia?

A

Dystonia casued by a neurodegenerative disease or medication

75
Q

What is Geste Antagoniste**?

A

The “Sensory Trick” that allows focal dystonias to loosen up for a short period if you touch part of the face

76
Q

What is the BEST treatment for focal Dystonia?

A

BOTOX***

Deep brain stimulation if failed Botox treatment

77
Q

What is a hemifacial spasm?

A

Involuntary spasms of half of the face

78
Q

Where does a hemifacial spasm begin?

A

Periorbital muscles

79
Q

2/3 of hemifacial spasms are caused by:

A

CN VII compression

80
Q

What is the treatment for hemifacial spasm?

A

Botox

81
Q

What is the treatment for functional/psychogenic movement disorder?

A

Psych referral

82
Q

Should you date the physician who treats you?

A

No, but you can date your preceptors

83
Q

Is functional/psychogenic movement disorder an actual neurogenic disorder?

A

No.

84
Q

Functional/psychogenic movement disorders are associated with organic disease in ____% of patients

A

10%

Ex: Parkinson’s patient is stressed out and develops a stutter

85
Q

What will be in the history of someone with functional/psychogenic movement disorder?

A

Multiple somatizations

Childhood psychological, physical, or sexual abuse

Personal encounters or knowledge of similar illnesses that they model

Recent family stressors or work-related life events

Possible secondary gain

Lack of concern vs exaggerated symptoms and anxiety

Multiple prior investigations

Selective disability

(You probably dont need to know all these but i just find this fascinating)

86
Q

What are the characteristic features of functional/psychogenic movement disorder?

A

Abrupt onset or triggered by minor trauma with rapid progression to peak severity

Bizarre movement, exaggerated effort with EXTREME slowness, suggestible, entrainment of movement, coactivation sign

Distraction and inconsistent movements (ask them to do something else and the tremor changes)

Spontaneous remissions

Self-inflicted injuries

Give-way weakness (go limp like a noodle during strength testing, which is not how people with actual weakness perform)

Lateralization of tuning fork

87
Q

I’m sorry for these cards. I really didn’t know what was important here

A

😳

88
Q

Which Parkinsonism:

Symmetric symptoms

A

Drug-induced Parkinsonism

89
Q

Which Parkinsonism:

Gait Disturbance

Hyper-reflexia and spasticity (UMN signs)

A

Vascular Parkinsonism

90
Q

Which Parkinsonism:

Apraxia of gait “magnetic gait”

Urinary incontinence

Cognitive impairment

A

Normal pressure hydrocephalus

91
Q

Which Parkinsonism:

Cognitive disorder

One limb causes problems

A

Corticobasal degeneration

92
Q

Which Parkinsonism:

FALLS

EYE MOVEMENTS WEIRD

A

Progressive Supranuclear Palsy

93
Q

Which Parkinsonism:

Prominent autonomic features

A

Multi-system Atrophy

94
Q

Which Parkinsonism:

Hallucinations

Dementia

A

Dementia with Lewy Bodies

Clin Med 3 Final (🐈🌭👵🏼) (2 decks)

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