Neurology-Movement-Disorders-and-others

Question 1

Types of tremors: 5

Answer 1

1. Resting
2. Postural
3. Action
4. Postural-action
5. Intention

Rhythmic and oscillatory movement of a body part with a relatively constant frequency and variable amplitude. It is caused by either alternating or synchronous contractions of antagonistic muscles

Tremors may be broadly classified into resting, postural, action, postural-action, and intention tremors

Question 2

Tremor present when holding up a newspaper versus when pouring a cup of tea

Answer 2

Postural versus Action

Postural tremors occur with the body part suspended against gravity. Action tremors remain unchanged during the course of a voluntary movement.

Question 3

also known as cerebellar tremor, is a dyskinetic disorder characterized by a broad, coarse, and low frequency (below 5 Hz) tremor. The amplitude increases as an extremity approaches the endpoint of deliberate and visually guided movement

Answer 3

Intention tremor

(kinetic tremor subtype)

Question 4

involuntary, rhythmic oscillations of one or more body parts

Answer 4

Tremor

Question 5

Differentiate ET from Parkinsons’: parameters

Answer 5

1. Laterality: Parkinson’s is unilateral
2. Action vs rest
3. Alcohol response: improves ET, no effect in Parkinson’s
4. Speed: Fast (6-10) hz, Slow (4-6) hz
5. Movement: flexion-extension, pill rolling

Question 6

Which tremor has a genetic component?

Answer 6

ET

Question 7

1. Involuntary excessive muscle contractions that tend to be sustained and patterned,
2. initiated or worsened by voluntary action and associated with overflow muscle activation
3. abnormal postures or movement
4. dysfunction of the basal ganglia, cerebellum, cortex

Answer 7

Dystonia

Question 8

Drug groups causing dystonias

Answer 8

1. Anti-emetics
2. Anti-psychotics

Question 9

Stroke in this part can cause dystonia

Answer 9

Putamen

Question 10

Dystonia classification basis

Answer 10

Body part affected

Eg: spasmodic dysphonia: vocal cords,

Question 11

Treatable causes of dystonia

Answer 11

1. Wilson’s
2. Dopa-responsive dystonia
3. DYT1 gene–associated dystonia

Question 12

Rx: focal dystonias

Answer 12

Botulinum

Question 13

Where is the putamen?

Answer 13

This is a transverse section of the striatum from a structural MR image. The striatum includes the caudate nucleus (top) and putamen (right) and the globus pallidus (left).

The putamen and caudate nucleus together form the dorsal striatum.

Question 14

Involuntary, irregular, unpatterned, and unsustained movements with variable timing and distribution

Answer 14

Chorea

Question 15

Involuntary slow and irregular writhing movements most often affecting the distal limbs

Answer 15

Athetosis

Question 16

Involuntary, large-amplitude, flinging movements, typically involving proximal muscles that move an entire limb

Answer 16

Ballism

Question 17

Autosomal dominant inheritance with gene test for triplet nucleotide repeat. Chorea, psychiatric symptoms, and cognitive dysfunction progress over 10 to 20 years until death.

Answer 17

Huntington

Question 18

Strokes in this basal ganglia nucleus will cause choreoathetoid movements

Answer 18

sub-thalamic

Question 19

disorder of childhood resulting from infection via Group A beta-hemolytic streptococcus (GABHS), characterized by rapid, irregular, and aimless involuntary movements of the arms and legs, trunk, and facial muscles

Answer 19

Sydenham’s chorea

Question 20

Prognosis of chorea from stroke

Answer 20

Ofent improves on its own

Question 21

Drug-induced movement disorders can include

Answer 21

1. Tremor
2. Parkinsonism
3. Choreoathetosis
4. Acute dystonia
5. Tardive dystonia

Question 22

Tetrabenazine

Answer 22

symptomatic treatment of hyperkinetic movement disorders

Question 23

Involuntary, abrupt, brief and jerky movement of a body part. Often described as “lightning fast.”

Answer 23

Myoclonus

Question 24

What sort of involuntary movement is a hiccup?

Answer 24

Myoclonus

Question 25

Jerky movements when falling asleep

Answer 25

Hypnic jerks

Question 26

Lance-Adams syndrome

Answer 26

Post-hypoxic myoclonus

Question 27

Asterixis is a type of:

Answer 27

Myoclonus

Question 28

Unverricht-Lundborg disease,neuronal ceroid lipofuscinoses, sialidosis, and Lafora body disease are all:

Answer 28

Myoclonic epilepsies The one that was left out: myoclonic epilepsy with ragged red fibers,

Question 29

Brief stereotyped movements, preceded by an urge, followed by a sense of relief,

Answer 29

Tic

Question 30

Tourette syndrome: Multiple motor and vocal tics beginning before age _ and lasting for at least _ months

Answer 30

Tourette syndrome: Multiple motor and vocal tics beginning before age 18 and lasting for at least 6 months

Question 31

Which movement disorder is associated with: Iron deficiency anemia, end-stage renal disease, pregnancy, peripheral neuropathy, lumbar radiculopathy, autoimmune disorders, vitamin B12, folate, or magnesium deficiencies

Answer 31

Secondary Restless Legs Syndrome

Question 32

sympatholytic drug used in the treatment of attention deficit hyperactivity disorder (ADHD), anxiety and hypertension

Answer 32

Guanfacine

Question 33

Parkinsonism

Answer 33

1. **bradykinesia** 2. rest tremor 3. rigidity 4. postural instability Most sensitive: Bradykinesia is a generalized slowness of movement, and is present at onset of PD in approximately 80 percent of patients [17]. It is arguably the major cause of disability in PD and is eventually seen in almost all patients.

Question 34

Difference between Parkinsonism and Parkinson's

Answer 34

Parkinsonism :collection of symptoms that can have many different etiologies Parkinson disease: specific disorder that is the most common cause of parkinsonism

Question 35

Parkinsonism, gaze palsies, slow saccades, imbalance with falls, dysarthria, or truncal dystonia

Answer 35

PSP

Question 36

Parkinsonism, early dementia, fluctuating alertness, early visual hallucinations

Answer 36

Dementia with Lewy bodies

Question 37

Parkinsonism, asymmetrical stiffness, apraxia, or dysfunction of one arm, dysarthria, or dementia

Answer 37

Corticobasilar degeneration

Question 38

Parkinsonism, early autonomic dysfunction, sometimes cerebellar ataxia

Answer 38

MSA

Question 39

Prominant gait dysfunction (imbalanced, slow, feet sliding on ground), dementia, urinary incontinence, possible parkinsonism

Answer 39

NPH

Question 40

Parkinsonism of the lower body more than upper body, prominent gait disability, cognitive dysfunction (or dementia)

Answer 40

Vascular parkinsonism

Question 41

Accumulation of small or large strokes that may produce parkinsonism more centered in the lower half of the body

Answer 41

Vascular parkinsonism

Question 42

Parkinson's disease is caused by the progressive degeneration of dopaminergic neurons within the:

Answer 42

substantia nigra

Question 43

[Where is the substantia nigra?](http://en.wikipedia.org/wiki/Substantia_nigra#/media/File:Substantia_nigra.gif)

Answer 43

Midbrain

Question 44

Aetiologyof Parkinson's

Answer 44

Most are idiopathic

Question 45

Parkinson's disease: Rx

Answer 45

1. Carbidopa/levodopa (Sinemet) is still the most effective treatment. Typically: complicated by wearing off and dyskinesias. 2. Dopamine agonists: Pramipexole, ropinirole. These have longer lasting effects than carbidopa/levodopa but usually more side effects, especially in the elderly. 3. MAO-B inhibitors: Selegiline, rasagiline. Mild benefits but may prolong the per dose benefits of carbidopa/levodopa. Some neuroprotective effects. 4. Catechol-O-methyltransferase (COMT) inhibitors: Entacapone + carbidopa/levodopa prolongs the effect. Tolcapone also may be used though hepatic monitoring is required. 5. Amantadine: Weak

Question 46

Deep brain stimulation Rx of Parkinson's disease: stimulation of the

Answer 46

subthalamic nucleus or the globus pallidus

Question 47

A motor and behavioral dysregulation syndrome with the inability to move despite full physical capability, with difficulty initiating and terminating movement. Postures become frozen or oddly positioned, and actions become contrary to intent.

Answer 47

Catatonia

Question 48

Examples of catatonia occur non-psych conditions

Answer 48

1. Drug intoxication 2. Tumor 3. Encephalitis 4. Post-liver transplant

Question 49

Forms of catatonia

Answer 49

Hypokinetic, Excited, Malignant

Question 50

Effect of benzodiazepines on catatonia

Answer 50

Improves symptoms within minutes

Question 51

Dysfunction in performing learned, skilled movements that is not due to primary neurologic dysfuntions such as weakness, sensory loss, changes in posture or tone, incoordination, or impaired attention, comprehension of the task, or cooperation

Answer 51

Apraxia

Question 52

Apraxia localization

Answer 52

parietal lobes, frontal lobes, and their subcortical connections

Question 53

Incoordination arising from dysfunction in timing, rhythm, accuracy (targeting), and smoothness of movement

Answer 53

Ataxia

Question 54

Ataxias are usually due to abnormalities in the __ or its motor and/or sensory pathways (\_\_ ataxia)

Answer 54

usually due to abnormalities in the cerebellum or its motor and/or sensory pathways (spinocerebellar ataxia)

Question 55

Irregular timing or trajectory of targeted movements

Answer 55

Dysmetria

Question 56

Breakdown of the normal timing and sequencing of rapid alternating movements

Answer 56

Dysdiadochokinesis

Question 57

Common symptoms include imbalance, wide-based gait, falls, dysarthria, eye movement abnormalities, intention tremor, and mistargeting with the limbs (trouble pouring water, poor handwriting, knocking over objects, etc.)

Answer 57

Ataxia ie: 1. Stroke to cerebellum or brainstem 2. Autoimmune: Includes celiac disease, anti-GAD syndrome, Miller Fisher syndrome 3. Inherited disorders: Spinocerebellar ataxia, Friedreich ataxia, ataxia-telangiectasia, 4. Metabolic/toxic: Vitamin E deficiency, hypothyroidism, chronic alcoholism 5. Antiepileptics 6. Infections 7. Tumor/mass, or paraneoplastic/parainfectious

Question 58

A 38-year-old man with an unknown psychiatric history is brought to the emergency room for bizarre behavior. While waiting for the psychiatry resident to evaluate the patient, you are asked by the nurses to give him haloperidol to control his behavior, as he is placing the staff at risk. Twenty minutes later you are called to see him because the patient became stiff and unable to speak, with his eyes rolling back in his head and his jaw and neck stiffening. He has remained conscious throughout this episode. Appropriate treatment at this time would be Phenytoin Lorazepam Risperidone Diphenhydramine

Answer 58

Diphenhydramine Dx: acute dystonic reaction from haloperidol. Patients with acute dystonic reaction maintain consciousness.

Question 59

Central vertigo: SySx

Answer 59

1. Persistent: No change with position 2. Directional nystagmus 3. Severe truncal instability 4. Negative head thrust

Question 60

Vestibular neuritis vs BPPV

Answer 60

1. BPPV: symptoms caused by head motion. 2. BPPV: Recurrent 3. BPPV: symptoms last seconds 4. VN: Single, acute episode, 5. VN: head thrust +ve 6. VN: prodromal viral infection

Question 61

Vertigo: causes

Answer 61

1. BPPV 2. VN 3. Meniere's 4. Vestibular migraine 5. Brainstem CVA 6. Vertebrobasilar TIA 7. Cerebellar CVA

Question 62

Vertigo: Peripheral causes

Answer 62

1. BPPV 2. VN 3. Meniere's

Question 63

Vertigo: Central causes

Answer 63

1. Vestibular migraine 2. Cerebellar TIA/CVA 3. Brainstem CVA

Question 64

Vasomotor rhinitis with prominent watery rhinorrhea: Rx

Answer 64

Ipratopium nasal spray

Question 65

Vasomotor rhinitis

Answer 65

Nonallergic rhinitis (NAR) is a syndrome in which some combination of sneezing, rhinorrhea, nasal congestion, and postnasal drainage is present over time without a specific cause. The pathogenesis is not known. Other terms for this condition include vasomotor rhinitis, idiopathic rhinitis, nonallergic-noninfectious rhinitis, and intrinsic rhinitis.

Question 66

Vasomotor Rhinitis: Rx

Answer 66

1. mild symptoms: intranasal glucocorticoid (INGC) or an intranasal antihistamine spray 2. Moderate-to-severe symptoms: INGCs + intranasal antihistamine 3. ipratropium nasal spray for patients with prominent watery rhinorrhea without other symptoms 4. NAR and prominent nasal congestion: azelastine, Pseudoephedrine PRN Neti pot

Question 67

keratinized, desquamated epithelial collection in the middle ear or mastoid and may occur secondary to tympanic membrane perforation, but also may occur as a primary lesion.

Answer 67

Cholesteatoma

Question 68

Vertigo: recurrent episodes lasting less than a minute

Answer 68

BPPV

Question 69

Vestibular migraine vs BPPV

Answer 69

1. Vestibular migraine symptoms last longer. 2. VM: dx requires accompanied by aura or migraine headache