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Session 4 CM Neur-10

CM- Neuro -10- Movement Disorders

What are tremors rhythmic oscillation of the body usually in distal body parts
What are the major metabolic causes of tremors uremia and liver failure
what are the major endocrine causes of tremors hypoglycemia, pheochromocytoma, thyrotoxicosis
What are the common drugs that are associated with tremors Caffeine, Theophylline, Amphetamines, Alcohol, Lithium, Beta-Agonists, Bronchodilators, tricyclics, Valproic Acid, Amiodarone, Nifedipine
What is an action tremor/intention tremor tremor provoked by movement usually indicates brain stem disorder or cerebellar disease
What is a resting tremor and what is it common in tremor that is present in absence of voluntary muscle activity usually seen in Parkinson's
What is a postural tremor tremor that occurs while trying to maintain posture, physiologic tremor and drug induced
What disease is associated with chorea (choreoathetosis movements) jerking Huntington's Disease
What type of tremor or movement disorder is characterized by involuntary jerky nonrhythmic semi purposeful movements that occur predominantly in the limbs but can be in head, neck, lips, tongue tardive dyskinesia
What type of movement is seen in senile chorea buccolingual dyskinesia
What type of movement disorder can the following drugs induce- Phenytoin, L-Dopa, Psychotropic's Drug induced Chorea
What type of movement disorder is marked by large flinging ballistic movements of the arms and legs Hemiballismus- associated with Lacunar CVA, subthalamic basal ganglia disorders
What are the following characterized as? Spasmodic torticollis, segmental and generalized dystonia focal dystonias
What type of movement disorder are the following characterized as? Oculogyric crisis, torticollis, tongue protrusion and opisthotonos Acute Dystonic Reaction
What is the tx for acute dystonic reaction and paroxysmal dystonia botulinum toxin
Which is more common Parkinson's' tremor or essential tremor Essential tremor affects any age usually >60, affect both sexes, no racial predilection
What are something's that can reduce the essential tremors a pt experiences alcohol and beta-blockers
Your pt has what you think is an essential tremor just to be careful what intoxication should you rule out manganese or organic solvents can case essential like tremors
What type of inheritance is seen with essential tremor autosomal dominant
what conditions can worsen essential tremors emotion, hunger, and fatigue
How do essential tremors typically start in one upper limb then involves other legs are less likely to be affected
what activities of daily living are affected most by essential tremors hand writing, holding up a glass small manual dexterity tasks
What is the biggest difference between essential tremor and Parkinson's disease essential tremor is tremor with action while Parkinson's exhibits a tremor at rest
One of your differentials of essential tremor is hyperthyroidism how would you rule this out look for other s/sx of hyperthyroidism they will have increased appetite, weight loss, increased sweating, exophthalmos and lid lag, tachycardia, abnormal thyroid function tests
One of the differentials of essential tremors is cerebellar disease how would you rule this out look for other s/sx of cerebellar disease such as tremor increases with intensity as target is approached, slow rate of tremor, broad ataxic gait, movements are clumsy, get brain imaging, hypotonia, past pointing
What questions would you want to ask a pt with suspected essential tremor what makes it go away- alcohol, sleep. What makes it worse- Anxiety; Family hx
What tests should you order in suspected essential tremor pt get thyroid tests, CT/MRI scans to rule hyperthyroidism and Cerebellar disease or tumor
What is the tx for essential tremor most just need reassurance that they don't have Parkinson's but if activities of daily living are impacted beta blockers are effective
What is often the first line therapy for essential tremors especially in younger pts Beta Blocker such as propanolol, Primidone is now being used as first line as well
What are some second line therapies for essential tremors Anticonvulsants such as gabapentin and topiramate
When would surgery be considered as tx option for essential tremors when all other tx has failed and the tremors are debilitating (surgery involves deep brain stimulation or thalamotomy)
what are the guidelines for starting propanolol to tx essential tremors start low and go slow
What are the contraindications for using propranolol to tx essential tremors hypersensitivity to tx, sinus bradycardia, heart block > 1st degree, sick sinus syndrome, overt heart failure, asthma
What type of drug is primidone that is used sometimes to tx essential tremors antiepileptic drug start low and go slow with elderly
T/F clonazepam is ineffective at tx essential tremors F it is effective but should be reserved for after Beta-Blocker or primidone
What is a common cause of restless leg syndrome Iron deficiency
What are tx for restless leg syndrome Iron supplements if serum iron is low, Sinemet, dopamine agonists (pergolide, ropinirole) and Gabapentin can all be used
Created by: smaxsmith