Clinical Medicine II-Spring 2012
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How do we diagnose movement disorders | show 🗑
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Overall tx of a movement d/o | show 🗑
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Three classifications of abnl movement | show 🗑
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Dance like movement uncontrolled | show 🗑
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Twisting, rotational involuntary movement | show 🗑
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Myoclonic movement | show 🗑
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show | upper Midwest, most per capita is in ND
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show | sustantia nigra: dopamine producing cells→by product is melonin linked to parkinson’s movements?
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show | skin cancer: melanoma
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Cause of parkinson’s | show 🗑
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show | ~70 at start of of sxs, slow onset, hard to dx sometimes
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Core motor features of Parkinson’s | show 🗑
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Pt’s with simultaneous PD, dementia, and hallucinations | show 🗑
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show | supranuclear palsy-no tremor
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show | 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 | show 🗑
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SE’s of levodopa | show 🗑
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show | 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 | show 🗑
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show | 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 | show 🗑
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What are some sxs that will precede the motor sxs of parkinsons | show 🗑
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Cause of death in pt’s w/ PD | show 🗑
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show | 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. | show 🗑
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Secondary criteria for identifying E.T | show 🗑
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What can a “neck tremor” be | show 🗑
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show | Genetic, Fhx, Dx: clinical hx, movement tremor,
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Tx for E.T. | show 🗑
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Desire to move in association w/ paresthesias/dysethesias of the limbs | show 🗑
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show | no it is most likely nocturnal myoclonus
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Two types of RLS | show 🗑
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Pathophysiology of RLS | show 🗑
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Why does iron deficiency cause RLS | show 🗑
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show | tx underlying dz, remove potential aggravators, ↑sleep hygiene, relaxation techniques, Dopamine agonists 1st line drug
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Problem with shorter length drugs | show 🗑
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show | 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 | show 🗑
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show | only sign, no specific pathology, DYT1 mutation inheritation
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show | from drugs, w/ parkinsonism, psychogenic causes
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show | focal, segmental, multifocal, generalized, hemidystonia
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MC types of focal dystonia | show 🗑
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show | botox, inject while in a flexed position, just enough to relax/paralysis the muscle good for focal
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show | r/o other causes
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show | blepharospasm
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show | Blepharospasm, cervical dystonia, writer’s cramp
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show | Babinski sign + for spasticity
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What signs are associated w/ spasticity | show 🗑
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Tx of spasticity | show 🗑
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show | ataxia, dysmetria of eye movements, nystagmus, dysarthria, limb dysmetria, gait ataxia
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show | dysarthria
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When does ataxia occur | show 🗑
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Workup of ataxia | show 🗑
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show | toxins, paraneoplastic cerebellar syndrome, sporadic cerebellar degeneration or hereditary
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show | supportive, assistive devices
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show | Huntinton’s disease
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Dx and patho of HD | show 🗑
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show | age 30-40, survival about 15-20yo
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Tx HD | show 🗑
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What is the genetic testing for HD | show 🗑
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