NS wk 1- Clinical Quiz

1. NS wk 1-Clinical Quiz - Neurodegenerative Disorders

2. Motor restlessness; constant semi purposeful movements of arms and leg? AKITHESIA • Sudden loss of muscle tone during sustained contraction of an outstretched limb? ASTERIXIS • Writhing, slow sinuous movements, especially of the hands and wrists ATHETOSIS

3. Sustained contraction of groups of agonist and antagonist muscles, usually in flexion or extremes of extension – resulting in bizarre postures • Dystonia • An exaggerated form of chorea involving one side of the body- wild flinging movements • Hemiballismus • A brief muscle contraction which causes a sudden purposeless jerking of a limb • Myoclonic jerk

4. A repeated contraction of a small muscle group, often involving the orbicularisoculi muscles • Myokymia • A repetitive irresistble movement which is purposeful or semi-purposeful Tic • Jerky small rapid movements, often disguised by the patient with a purposeful final movement CHOREA • Purposeless and continuous movements, often of the face and mouth DYSKINESIA

5. Tremor of rate between 3 and 5Hz is a SLOW TREMOR • Tremor of rate faster than 10Hz is a FAST TREMOR • Tremor mainly present during relaxation of muscles is a RESTING TREMOR • Tremor occuring with deliberate movement is a/an INTENTION TREMOR • A fine tremor associated with holding a posture or performing a movement slowly is a PHYSIOLOGICAL TREMOR (normal) • Shivering is a type of tremor T/F?? TRUE

6. Hyperkinetic Movements on a Scale from most jerky/violent to more sustained Chorea Myoclonus Dystonia Athetosis Ballismus 1. 2. 3. 4. 5.

7. 8 signs of a patient presenting with Parkinsonism • Tremor • Rigidity • Bradykinesia • Postural instability • Mask-like facies • Gait: festinating • Hypophonia • Micrographia

8. Pharm. - Selegiline is a MAO inhibitor (selective and irreversible) Its therapeutic effect is to inhibit breakdown of DA therefore enhancing the activity of DA - Entacapone is a COMT inhibitor Its therapeutic effect is to inhibit breakdown of DA and L-dopa therefore enhancing the activity of DA and L-dopa

9. Assessing a patient suspected to have Parkinson’s (from a Past Exam) • How would you assess tone? Assessing resistance to passive movement • What changes in tone would you expect with this patient? - Rigidity - a uniform resistance to passive movement throughout the full range of motion and at all speeds - Cogwheeling- brief, regular interruptions of resistance

10. List 2 psychiatric complications associated with Parkinson’s Depression Psychosis Dementia • This patient requests a CT – discuss 5 clinical and social factors that you would consider when deciding whether or not to order a CT Indications/contraindications for a CT Risks of CT - e.g. radiation dose Cost of the CT Any other investigations that would be better Suspicion of alternative diagnosis Usefulness of CT in detecting PD Would CT results change mgmt?