Neuro E Movement Disorders

Question 1

Rate limiting step in DA creation

Answer 1

Tyrosine hydroxylase (Tyrosine -> L-Dopa)
(1st step)

Question 2

Rate limiting step in Parkinsons patient who you give L-Dopa

Answer 2

Dopa decarboxylase (L-Dopa -> Dopamine)

Question 3

Chorea

Answer 3

• Dance

- Irregular

Question 4

Sydenham’s Chorea

Answer 4

Secondary to Group A Strep infection

-Shows with carditis, arthritis, rheumatic fever

Question 5

Sydenham’s Chorea Dx

Tx

Answer 5

Antistreptolysin antibody titer

Antibacterial and Antipsychotics

Question 6

Huntington’s Disease Triad

Anatomy

Answer 6

Chorea, Dementia, Psychiatric D/O

Destruction of Caudate and Putamen

Question 7

Huntington’s genetics

Answer 7

Chromosome 4 CAG repeat (>36)

Anticipation

Question 8

Huntington’s Tx

Answer 8

Tetrabenazine, Antipsychotics (only for chorea)

Question 9

Hemiballismus - Anatomy

• Features
• Tx

Answer 9

• Lesion to contralateral subthalamic nucleus
• Unilateral wild limb jerking
• Antipsychotics

Question 10

Intention Tremor drug causes

Answer 10

Alcohol, Anticonvulsants, Sedatives

Cerebellum

Question 11

Postural (physiologic) Tremor drug causes

Physiologic causes

Answer 11

Lithium, Bronchodilators, Theophylline, Alcohol withdrawal

Hyperthyroidism, Anxiety

Question 12

Spasticity v Rigidity problem location

Answer 12

Corticospinal v Basal Ganglia

Question 13

Cogwheel rigidity

Answer 13

Parkinsonian

Tremor on top of Rigidity (BG)

Question 14

Lewy Body protein

Answer 14

Alpha Synuclein

Question 15

Parkinsons Tx

Answer 15

symptom based (bradykinesia)
-L-Dopa - Carbodopa (peripheral blocker)
-Anticholinergics
-Amantadine (antiviral)
MAO B inhibitor

Question 16

NT from Frontal Lobe to Basal Ganglia (excitatory)

Answer 16

Acetylcholine

Question 17

Parkinsons drug Tx theory

Answer 17

Give direct agents first, DA later. This delays “on/off” phenomenon

Question 18

Direct Dopamine Agonists

Answer 18

Ropinirole

Pramipexole

Question 19

Anticholinergics

Answer 19

Benztropine

Trihexyphenidyl

Question 20

Surgical Tx of Parkinsons

Answer 20

DBS of Thalamus and Globus Pallidus

Question 21

Restless Leg Syndrome drug Tx

Answer 21

DA agonist
Iron supplementation
Sedatives

Question 22

RLS anatomy

Answer 22

Reticular Formation

Question 23

Parkinsonism drug causes

Answer 23

Antipsychotics

Question 24

“Parkinson’s Plus” Syndrome

Answer 24

Parkinsons-like, but different clinical presentation and different L-Dopa response

Question 25

Parkinson's Plus Syndromes (3)

Answer 25

- Progressive Supranuclear Palsy - Multiple System Atrophy - Diffuse Lewy Body Dementia

Question 26

Dystonia

Answer 26

Slow twisting of body, fixed posturing

Question 27

Torticollis

Answer 27

Cervical dystonia, often with arm held in hyperpronated position

Question 28

Blepharospasm

Answer 28

Forced closure of eyelids for period of time, often with facial grimacing

Question 29

Writer's cramp

Answer 29

Dystonic posture of hand & forearm when pen is held

Question 30

Wilson's Disease drug Tx

Answer 30

Penicillamine (copper chelator)