Clinical Medicine II-Spring 2012
Help!
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| How do we diagnose movement disorders | after r/o other causes such as drugs, lesions, systemic illnesses
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| Overall tx of a movement d/o | symptomatic
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| Three classifications of abnl movement | Impaired voluntary: paralysis, ataxia, impaired motor planning, abnl muscle tone: spasticity, rigidity, involuntary movements: tremor, chorea/athetosis/dystonia, tics/myoclonus
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| Dance like movement uncontrolled | chorea
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| Twisting, rotational involuntary movement | athetosis
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| Myoclonic movement | falling asleep in class and jolting awake: nl, not nl is involuntary happening frequently
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| Where is the parkinson’s belt | upper Midwest, most per capita is in ND
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| Pathology of Parkinson’s | sustantia nigra: dopamine producing cells→by product is melonin linked to parkinson’s movements?
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| With someone is having parkinson’s movements, what should we look for | skin cancer: melanoma
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| Cause of parkinson’s | both environmental and possibly genetic, not set and stone pathology
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| At dx, how much damage is happening | ~70 at start of of sxs, slow onset, hard to dx sometimes
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| Core motor features of Parkinson’s | resting tremor, bradykinesia, rigidity, posture/balance changes
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| Pt’s with simultaneous PD, dementia, and hallucinations | lewy body dz
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| Sxs with rididity of trunk, falling, unable to look up/down | supranuclear palsy-no tremor
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| How do we test for PD | can’t actually test for it, just r/o other causes, r/I by clinical sxs: give them a PD drug see if +result
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| What is the tx for PD | no tx just treat the symptoms, MC levodopa (dopamine), or dopamine agonists,
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| SE’s of levodopa | nausea, postural hypotension, dyskinesia, motor fluctuations
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| As dz progresses, what happens to sxs | need more meds, cells die, need more dopamine, sxs: tremors/can’t move, take pills, control, dyskinesia,then can’t move again
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| When do the motor complications of PD start | 3-10yrs post start of levodopa: dyskinesias
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| What does deep brain stimulation do | high frequency pulsatile, to “ablate” the overactive nerves, targets the nucleus (subthalamic)
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| When do we do the DBS to the brain | middle dz when drugs aren’t nearly as effective, but before in nursing home
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| What are some sxs that will precede the motor sxs of parkinsons | REM, constipation, loss of smell
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| Cause of death in pt’s w/ PD | pulmonary infx/aspiration, UTI, PE, complications w/ falls and fxs
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| Classification of Essential tremor | Action or postural tremor or kinetic with tasks, can move to rest post action
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| Two most common places to see E.T. | Hands and voice, usually bilaterally
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| Secondary criteria for identifying E.T | long duration to dx, Fhx, beneficial response to EtOH
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| What can a “neck tremor” be | contraction of sternocleidomastoid muscle: torticollis
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| Cause of E.T and Dx | Genetic, Fhx, Dx: clinical hx, movement tremor,
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| Tx for E.T. | none, life modifications, wrist weights, biofeedback, BB’s primidone, benzodiazepines, thalamic DBS
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| Desire to move in association w/ paresthesias/dysethesias of the limbs | Restless legs syndrome
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| Is jerking while sleeping at night RLS? | no it is most likely nocturnal myoclonus
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| Two types of RLS | idiopathic, or secondary RLS d/t renal failure, DB neuropathy, RA, radiculopathy, preggo, iron def,
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| Pathophysiology of RLS | CNS abnormality, dopamine dysfx, endogenous opiate system
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| Why does iron deficiency cause RLS | iron a cofactor for dopamine production
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| Tx RLS | tx underlying dz, remove potential aggravators, ↑sleep hygiene, relaxation techniques, Dopamine agonists 1st line drug
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| Problem with shorter length drugs | Levodopa: sxs will start occurring more and more throughout the day
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| When would we use opioids for RLS tx | usually only when there are other sxs with pain
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| Neurologic movement d/o w/ sustained muscle contractions that cause twisting or repetitive movements w/abnl sometimes painful, postures or positions | Dystonia
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| What is primary dystonia | only sign, no specific pathology, DYT1 mutation inheritation
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| What is secondary dystonia | from drugs, w/ parkinsonism, psychogenic causes
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| 5 types of dystonia | focal, segmental, multifocal, generalized, hemidystonia
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| MC types of focal dystonia | laryngeal dystonia
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| Tx of dystonia | botox, inject while in a flexed position, just enough to relax/paralysis the muscle good for focal
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| How do we dx dystonia | r/o other causes
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| Dry eye syndrome or tics | blepharospasm
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| Subtypes of dystonia | Blepharospasm, cervical dystonia, writer’s cramp
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| What is a sign associated with problems in Upper motor neurons | Babinski sign + for spasticity
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| What signs are associated w/ spasticity | muscle shortening, motor weakness, + Babinski, muscle overactivity
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| Tx of spasticity | oral meds, muscle relaxants: careful d/t weakness in muscles can turn into jelly, PT, Denervation, intrathecal drug delivery, botox,
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| What is poor coordination, examples? | ataxia, dysmetria of eye movements, nystagmus, dysarthria, limb dysmetria, gait ataxia
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| Trouble forming words | dysarthria
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| When does ataxia occur | anytime from many causes
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| Workup of ataxia | look for underlying causes and treatable conditions, Brain MRI: detect cerebellar atropy and lesions
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| DDx of Ataxia | toxins, paraneoplastic cerebellar syndrome, sporadic cerebellar degeneration or hereditary
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| Tx of ataxia | supportive, assistive devices
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| What diz has chorea or involuntary movements, later dystonia, and voluntary motor dyscontrol, cognitive, and emotional d/o | Huntinton’s disease
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| Dx and patho of HD | gene test, autosomal dominant, attacks the caudate nucleus and putamen, and secondary atrophy in the brain
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| When does HD set in | age 30-40, survival about 15-20yo
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| Tx HD | none, tx sxs: antipsycotic or dopamine antagonists, therapy: PT, OT, speech, nutrition, social services
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| What is the genetic testing for HD | repeated CAG (poly Q) in the HD gene, blood test
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