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(3) Neurological Examination > S2_L2: Movement Disorders > Flashcards

S2_L2: Movement Disorders Flashcards

1
Q

What are the cardinal features of Parkinson’s disease?

A
  1. Tremor (Resting tremor)
  2. Rigidity
  3. Akinesia/ Bradykinesia
  4. Postural Instability
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2
Q

Most common toxic substance that can cause
Parkinsonism

A

Manganese (Mn)

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3
Q

Most common synthetic substance that can cause Parkinsonism

A

MPTP (1-methyl-4-phenyl-1,2,3,6)

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4
Q

Males more affected than females
A. Parkinson’s Disease
B. Multiple Sclerosis
C. Both

A

A. Parkinson’s Disease

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5
Q

It occurs in 21-40 years old individuals
A. Parkinson’s Disease
B. Multiple Sclerosis
C. Both

A

B. Multiple Sclerosis

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6
Q

Chief complaints include intention tremor, visual changes, fatigue, weakness, balance deficits and
incoordination, pain or paresthesia, and weakness
A. Parkinson’s Disease
B. Multiple Sclerosis
C. Both

A

B. Multiple Sclerosis

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7
Q

Chief complaints include resting tremor, rigidity/stiffness, slowness of movement or inability to move, frequent falls, difficulty initiating movement, shortness of breath
A. Parkinson’s Disease
B. Multiple Sclerosis
C. Both

A

A. Parkinson’s Disease

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8
Q

Parkinson’s disease is a chronic and progressive disorder of the central nervous
system affecting the ___ with motor and
non-motor symptoms.

A

basal ganglia

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9
Q

TRUE OR FALSE: Parkinson’s disease has an insidious onset with a rapid rate of progression.

A

False, it has a slow rate of progression (gradual)

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10
Q

What cells degenerate in Parkinson’s disease?

A

Dopaminergic cells of the substantia nigra

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11
Q

The following symptoms are present in patients with Parkinson’s Disease, EXCEPT:
A. Tremor
B. Rigidity
C. Akinesia
D. Postural Instability
E. None of the above

A

E. None of the above

Reference: De Lisa

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12
Q

The following symptoms are present in patients with Parkinson’s Disease, EXCEPT:
A. Tremor
B. Rigidity
C. Akinesia
D. Postural Instability
E. Bradykinesia

A

C. Akinesia

Reference: Braddom

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13
Q

2nd most common neurodegenerative disorder among
elderly people older than 65 years of age

A

Parkinson’s Disease

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14
Q

Most common neurodegenerative disorder affecting
elderly people

A

Alzheimer’s disease

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15
Q

3rd most common neurodegenerative disorder affecting
elderly people

A

Lewy body dementia

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16
Q

Average age of onset of Parkinson’s disease

A

50 to 60 y/o

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17
Q

Age range of Young-onset Parkinson’s Disease

A

21 to 40 y/o

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18
Q

Age range of Juvenile-onset Parkinson’s Disease

A

Less than 21 y/o

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19
Q

In Parkinson’s disease, women are more affected than men. In multiple sclerosis, women are more affected than men.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false

A

B. Only the 2nd statement is true

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20
Q

also known as Paralysis agitans
A. Primary Parkinsonism
B. Secondary Parkinsonism
C. Parkinsonism Plus Syndromes

A

A. Primary Parkinsonism

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21
Q

Has an identifiable cause due to toxins, drugs, and viruses
A. Primary Parkinsonism
B. Secondary Parkinsonism
C. Parkinsonism Plus Syndromes

A

B. Secondary Parkinsonism

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21
Q

Syndromes that mimic Parkinson’s disease, but it is caused by other
neurodegenerative disorders
A. Primary Parkinsonism
B. Secondary Parkinsonism
C. Parkinsonism Plus Syndromes

A

C. Parkinsonism Plus Syndromes

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22
Q

(+) Apomorphine Test
A. Primary Parkinsonism
B. Secondary Parkinsonism
C. Parkinsonism Plus Syndromes

A

A. Primary Parkinsonism

Pt improves after taking PD medication (levodopa)

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23
Q

Can be classified as Tremor Predominant or Postural Instability Gait Disturbance (PIGD)
A. Primary Parkinsonism
B. Secondary Parkinsonism
C. Parkinsonism Plus Syndromes

A

A. Primary Parkinsonism

Note: PIGD is more severe, but tremor predominant is more common.

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24
Q

(-) Apomorphine Test
A. Primary Parkinsonism
B. Secondary Parkinsonism
C. Parkinsonism Plus Syndromes

A

C. Parkinsonism Plus Syndromes

Do not react to the medication for Parkinson’s
Disease (Levodopa)

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25
Q

Drugs that can produce extrapyramidal dysfunction that can mimic the signs of Parkinson’s Disease or cause it.
A. Primary Parkinsonism
B. Secondary Parkinsonism
C. Parkinsonism Plus Syndromes

A

B. Secondary Parkinsonism

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26
Q

Post-infectious / Post-encephalitic Parkinsonism, where a slow virus affects the brain
A. Primary Parkinsonism
B. Secondary Parkinsonism
C. Parkinsonism Plus Syndromes

A

B. Secondary Parkinsonism

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27
Q

What are the 3 classes of drugs that can induce Parkinsonism?

A
  1. Neuroleptic drugs
  2. Antidepressant drugs
  3. Anti-hypertensive drugs
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28
Q

Metabolic Parkinsonism is caused by?

A

Problem with calcium metabolism

Note: Calcium can cause calcification in the basal ganglia, which can lead to sx of PD

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29
Q

Corticostriatal Fibers release glutamate. Striatopallidal Fibers release GABA.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false

A

C. Both statements are true

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30
Q

Striatonigral fibers release GABA. Nigrostriatal fibers release glutamate.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false

A

A. Only the 1st statement is true

Nigrostriatal fibers release dopamine

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31
Q

Tremor occurs with overactivity of direct
pathway and underactivity of indirect pathway. Bradykinesia occurs with overactivity of direct
pathway and underactivity of indirect pathway.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false

A

A. Only the 1st statement is true

Bradykinesia: overactivity of indirect pathway and
underactivity of direct pathway

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32
Q

Postural instability occurs with overactivity of indirect pathway and
underactivity of direct pathway. Rigidity occurs with overactivity of direct
pathway and underactivity of indirect pathway.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false

A

C. Both statements are true

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33
Q

Leadpipe rigidity is jerky-ratchet-like resistance to passive movement. Cogwheel rigidity is Sustained resistance to passive movement with no fluctuation.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false

A

D. Both statements are false

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34
Q

TRUE OR FALSE: Rigidity is not velocity-dependent.

A

True

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35
Q

Increased resistance to passive motion due to simultaneous
contraction of both agonist and antagonist muscles.

A

Rigidity

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36
Q

Tremor present in both rest and with movement

A

Senile tremor

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37
Q

Known as tremor in the hands

A

Pill rolling tremor

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38
Q

Most common sx of PD according to De Lisa

A

Tremors

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39
Q

Frequency of tremors

A

4-6 Hz

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40
Q

The substantia nigra pars
compacta (SNc) and ventral tegmental area (VTA) release what neurotransmitter?

A

Dopamine

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41
Q

Enumerate all structures in the direct & indirect pathways that release GABA

A
  1. Striatum
  2. Substantia nigra pars
    reticulata (SNr)
  3. Globus pallidus interna (GPI)
  4. Globus pallidus externa
    (GPE)
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42
Q

The subthalamic nucleus and thalamus release what neurotransmitter?

A

Glutamate

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43
Q

Progression of Parkinson’s disease is evident because of the presence of the ___ in MRI.

A

lewy bodies

  • Sign of basal ganglia degeneration. Imaging hallmark of PD.
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44
Q

It has more resistance in one direction than the other direction. It is velocity-dependent and more noticeable with faster movements.
A. Spasticity
B. Rigidity
C. Dystonia

A

A. Spasticity

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45
Q

Rigidity is commonly seen in Parkinson’s Disease. Rigidity doesn’t increase with the speed of movement, you can feel it even with very slow movements and it’s present in both directions of limb movement.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false

A

C. Both statements are true

46
Q

The most common type of high muscle tone. It’s common in people who have had a stroke,
brain injury, or cerebral palsy.

A

Clonus

47
Q

Sustained muscle contraction causing abnormal postures and twisting or repetitive movements. It is worse with intention or when you really try to do
something.
A. Spasticity
B. Rigidity
C. Dystonia

A

C. Dystonia

48
Q
  1. Dysmetria, hypermetria, hypometria
  2. Resting tremor
  3. Athetosis
  4. Asynergia, Dyssynergia
  5. Akinesia, Bradykinesia,
    Hypokinesia

A. Cerebellum pathology
B. Basal ganglia pathology
C. Both
D. Neither

A
  1. A
  2. B
  3. B
  4. A
  5. B
49
Q
  1. Asthenia
  2. Rigidity
  3. Hemiballismus
  4. Dysdiadochokinesia
  5. Gait disorders

A. Cerebellum pathology
B. Basal ganglia pathology
C. Both
D. Neither

A
  1. A
  2. B
  3. B
  4. A
  5. A
50
Q
  1. Chorea
  2. Rebound phenomenon
  3. Dystonia
  4. Intention tremor
  5. Dysarthria

A. Cerebellum pathology
B. Basal ganglia pathology
C. Both
D. Neither

A
  1. B
  2. A
  3. B
  4. A
  5. B
51
Q

Gait pattern where the person is usually in trunk flexion, has a prolonged movement preparation (start hesitation), and excessive forward movement with fast and
decreased step length (quick walking).

A

Festinating gait

52
Q

Gait pattern characterized by clumsy voluntary movement, the pt will present with clumsy walking. Foot goes in different directions when
walking.

A

Gait ataxia (specifically, cerebellar ataxia)

53
Q

What cranial nerve/s are important to assess in Multiple Sclerosis?

A

CN II (Optic)

54
Q

What cranial nerve/s are important to assess in Parkinson’s disease?

A

CN III, VII, IX

55
Q

TRUE OR FALSE: Multiple sclerosis has a genetic predisposition due to the human leukocyte antigen major histocompatibility complex gene.

A

True

56
Q

Most disabling sign of PD according to O’Sullivan

A

Bradykinesia

57
Q

Reduced amplitude of movements, referring to slowed and reduced movements

A

Hypokinesia

58
Q

Enumerate the contributory factors for bradykinesia

A
  1. tremor
  2. weakness
  3. rigidity
59
Q

The most disabling and least specific sign of Parkinson’s according to De Lisa

A

Postural instability

60
Q

Slouched posture even
during supine that is usually seen in pts with Parkinson’s disease

A

Phantom pillow posture

61
Q

Motor planning manifestation: prolonged movement hesitation that is aka motor en block
A. Start hesitation
B. Micrographia
C. Freezing episodes
D. Hypomimia
E. Uniplanar movements

A

A. Start hesitation

62
Q

Related to uniplanar movements. Once rotatory movement occurs, the individual experiences ____

A

Freezing episodes

63
Q

Has intact immediate, short and long term memory but struggles in step-by-step procedure of motor tasks

A

Procedural learning

64
Q

Excessive drooling as a result of increased saliva production and decreased spontaneous swallowing.

A

Sialorrhea

65
Q

Decreased voice volume, monotonous tone, problem in articulation, imprecise or distorted articulation, and uncontrollable speech rate

A

Hypokinetic dysarthria

66
Q

According to O’Sullivan, this is the most common
complaint in pulmonary function because of the
restrictive lung dysfunction

A

Airway obstruction

67
Q

Enumerate components of striatal toe

A

big toe extension

68
Q

Enumerate components of striatal hand

A

ulnar deviation of the wrist, MCP flexion, and IP extension

69
Q

Most common virus causing infection and autoimmune disease in Multiple Sclerosis

A

Epstein-Barr virus

70
Q

Document the finding: Shaking of both hands was evident at rest and disappeared during movement.

A

O > OI > (+) resting tremor on (B) hands

71
Q

Document the finding: Upon passive range of motion of the (B) UE, you felt alternating resistance and relaxation of the muscles.
You moved the part slowly.

A

O > Palpation > (+) cogwheel rigidity on (B) UE

72
Q

Document the finding: Patient has parkinson’s disease. During examination, the patient was unable to balance himself after a backward pull on his shoulders.

A

O > Neurological Examination > Basal Ganglia > Equilibrium > Unable to recover on retropulsion test

73
Q

Continuous progression of symptoms
A. Relapsing remitting MS
B. Primary progressive MS
C. Secondary progressive MS
D. Progressive relapsing MS

A

B. Primary progressive MS

74
Q

Progression of relapsing remitting MS to steady and irreversible decline with or without continued
acute attacks.
A. Relapsing remitting MS
B. Primary progressive MS
C. Secondary progressive MS
D. Progressive relapsing MS

A

C. Secondary progressive MS

75
Q

Example: Optic neuritis and spasticity
Presentation of both → intensity
lessens → presentation of both &
weakness → intensity lessens →
the intensity of all Sx will increase → the intensity of all Sx will decrease

A. Relapsing remitting MS
B. Primary progressive MS
C. Secondary progressive MS
D. Progressive relapsing MS

A

D. Progressive relapsing MS

76
Q

Initial symptom of multiple sclerosis

A

Optic neuritis

77
Q

Enumerate the cardinal symptoms of multiple sclerosis

A
  1. Scanning speech or dysarthria
  2. Intention tremor
  3. Nystagmus or oscillation of the eye

Aka Charcot’s triad

78
Q

Uthoff’s symptoms:
Adverse reaction to (1)___ for temperatures (2)___ degrees celsius.

A
  1. heat
  2. > 29
79
Q

Most disabling symptom of Multiple Sclerosis according to O’Sullivan

A

Fatigue

80
Q

Upon pupillary light reflex, instead of
constriction of the pupil, there was dilation (paradoxical widening) of the pupil. This manifestation is known as?

A

Marcus Gunn pupil

81
Q

The accommodate reflex is spared/intact, but
upon pupillary light reflex, the eyes did not react whether dilating or constricting.

A

Argyll-Robertson pupil / Prostitute’s eye

82
Q

Frequent blinking of the eyes

A

Blepharospasm

83
Q

Blinking / fluttering of the eyes even when the eyes are closed.

A

Blepharoclonus

84
Q

The imaging hallmark of Multiple Sclerosis that indicates demyelination has occurred

A

Dawson’s fingers

85
Q

Multiple sclerosis usually occurs in the white matter. Enumerate its 4 areas of predilections.

A
  1. Optic nerves
  2. Cerebellar peduncles
  3. Spinal cord (corticospinal and posterior white
    columns)
  4. Periventricular white matter
85
Q

Unilateral symptoms, minimal or absent
A. Hoehn-Yahr Stage 1
B. Hoehn-Yahr Stage 2
C. Hoehn-Yahr Stage 3
D. Hoehn-Yahr Stage 4
E. Hoehn-Yahr Stage 5

A

A. Hoehn-Yahr Stage 1

86
Q

Minimal bilateral or midline involvement.
Balance is spared / not impaired.
A. Hoehn-Yahr Stage 1
B. Hoehn-Yahr Stage 2
C. Hoehn-Yahr Stage 3
D. Hoehn-Yahr Stage 4
E. Hoehn-Yahr Stage 5

A

B. Hoehn-Yahr Stage 2

87
Q

Can live independently, and continue some forms of employment.
Has impaired righting reflexes, and there is unsteadiness when turning or rising from a chair.
A. Hoehn-Yahr Stage 1
B. Hoehn-Yahr Stage 2
C. Hoehn-Yahr Stage 3
D. Hoehn-Yahr Stage 4
E. Hoehn-Yahr Stage 5

A

C. Hoehn-Yahr Stage 3

88
Q

All symptoms are present & severe.
Standing and walking are possible only with assistance
A. Hoehn-Yahr Stage 1
B. Hoehn-Yahr Stage 2
C. Hoehn-Yahr Stage 3
D. Hoehn-Yahr Stage 4
E. Hoehn-Yahr Stage 5

A

D. Hoehn-Yahr Stage 4

89
Q

Confined to bed and wheelchair
A. Hoehn-Yahr Stage 1
B. Hoehn-Yahr Stage 2
C. Hoehn-Yahr Stage 3
D. Hoehn-Yahr Stage 4
E. Hoehn-Yahr Stage 5

A

E. Hoehn-Yahr Stage 5

90
Q

Enumerate the positive prognosticating factors for Parkinson’s disease

A
  1. Early onset
  2. Family history
  3. Rigidity
  4. Early tremor
91
Q

Determine the affected structure causing the ff signs & symptoms

  1. Asynergia
  2. Scotoma
  3. Loss of consciousness
  4. Loss of epicritic sensation
  5. Visual agnosia
  6. Vertical diplopia

A. Reticular activating system
B. Trochlear nerve
C. Dorsal column medial lemniscus
D. Optic nerve
E. Cerebellum
F. Cerebrum

A
  1. E
  2. D
  3. A
  4. C
  5. F
  6. B
92
Q

Gait pattern characterized by lateral movement with fast and decreased step and stride
length, decreased
cadence and velocity

A

Shuffling gait

93
Q

Parkinson’s disease is diagnosed with the presence of at least 2 of the 4 cardinal signs. One of which must be _____.

A

Resting tremors

93
Q

A criteria for diagnosing Parkinson’s disease is clinical course of at least ___ years.

A

10

94
Q

Occurs in females more than males
A. Parkinson’s Disease
B. Multiple Sclerosis
C. Both

A

B. Multiple Sclerosis

94
Q

In Parkinson’s disease, proprioception is usually affected, with less problem on superficial sensations. In multiple sclerosis, the priority is on superficial sensations (pain, paresthesia, pins & needles) as these sensations are usually affected.
A. Only the 1st statement is true
B. Only the 2nd statement is true
C. Both statements are true
D. Both statements are false

A

C. Both statements are true

95
Q

The most common rating scale for multiple sclerosis

A

Kurtzke Expanded Disability Status Scale

96
Q
  1. Change in EDSS was two levels (one full point)
  2. Pyramidal and cerebellar signs with involvement at multiple sites
  3. Benign and relapsing
    remitting multiple sclerosis

A. Good prognosticating factor for Multiple Sclerosis
B. Poor prognosticating factor for Multiple Sclerosis

A
  1. A
  2. B
  3. A
97
Q
  1. One symptom; initial attack of optic neuritis
  2. Female
  3. Primary progressive multiple sclerosis
  4. Half-point changes in EDSS score

A. Good prognosticating factor for Multiple Sclerosis
B. Poor prognosticating factor for Multiple Sclerosis

A
  1. A
  2. A
  3. B
  4. B
98
Q
  1. Young age at onset (<40 y/o)
  2. Longer time first to second attack (>5 years)
  3. Fewer than two relapses in the first 5 years
  4. Complete recovery at first
    attack (RRMS)

A. Good prognosticating factor for Multiple Sclerosis
B. Poor prognosticating factor for Multiple Sclerosis

A
  1. A
  2. A
  3. A
  4. A
99
Q

In the McDonald Criteria for MS, 2 or more attacks and 1 lesion site require what additional criteria for diagnosis as MS?

A

Dissemination in space on MR

100
Q

In order for the patient to be diagnosed with definite Multiple sclerosis, there should be how many attacks and lesion sites?

A

2 or more attacks
2 or more lesion sites

101
Q

In the McDonald Criteria for MS, 1 attack and 2 lesion sites require what additional criteria for diagnosis as MS?

A

Dissemination in time on MR

102
Q

TRUE OR FALSE: There is no cure for Parkinson’s disease.

A

True

103
Q

Most common medication for treating Parkinson’s disease

A

Sinemet

-Combination of carbidopa & levodopa

104
Q

Characterized by dramatic initial functional improvements from symptoms of Parkinson’s disease

A

Honeymoon period

105
Q

Characterized by worsening of symptoms during expected time frame of medication effectiveness in Parkinson’s disease

A

Wearing-off state

-End of dose deterioration

106
Q

TRUE OR FALSE: In the early rigidity stages, the presentation is asymmetric and more in the proximal parts (neck & the head). In the later stages, it becomes symmetrical and
usually on the distal extremities.

A

True

107
Q

In multiple sclerosis, migration studies indicate that the geographical risk
associated with an individual’s birthplace is retained if emigration occurs after the age of ____.

A

15 years

108
Q

Most common, characterized by discrete attacks of neurological deficits with either full or partial recovery in subsequent weeks to months
A. Relapsing remitting MS
B. Primary progressive MS
C. Secondary progressive MS
D. Progressive relapsing MS

A

A. Relapsing remitting MS

109
Q

Type of multiple sclerosis in which the pt. remains fully functional in all neurological systems 15 years after
onset.

A

Benign MS

110
Q

Type of multiple sclerosis characterized by rapid onset and almost continual progression leading to significant disability or death within a relatively short time after onset.

A

Malignant MS / Marburg disease

(3) Neurological Examination (8 decks)

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