Neurology Drx - Movement Disorders And Associated Pharmacology
Questions and Answers
- 1.
How would you treat generalized dystonia (Recall that a generalized dystonia is multifocal and involves several body parts?)
- 2.
Which pharmacologic therapies can be used for Huntington’s?
- 3.
What is the clinical term of the movement she is describing?
- 4.
At the onset of PD symptoms, approximately ____% of dopamine neurons are lost?
Explanation
At the onset of PD symptoms, approximately 80% of dopamine neurons are lost. This means that a significant majority of these neurons are already damaged or destroyed when the symptoms of Parkinson's disease first appear. This loss of dopamine neurons is a key factor in the development of the motor symptoms associated with PD, such as tremors, stiffness, and difficulty with movement. Understanding the extent of this neuronal loss helps to explain the severity of symptoms and guides treatment approaches aimed at increasing dopamine levels in the brain.Rate this question:
- 5.
What drug is thought to reduce the progression of Parkinson Disease?
Explanation
MAO-B inhibitors are drugs that are thought to reduce the progression of Parkinson's disease. These drugs work by blocking the enzyme monoamine oxidase-B, which is responsible for breaking down dopamine in the brain. By inhibiting this enzyme, MAO-B inhibitors help to increase dopamine levels and improve motor symptoms in Parkinson's disease. Rasagaline is a specific MAO-B inhibitor that has been shown to be effective in slowing the progression of Parkinson's disease. Therefore, MAO-B inhibitors, including Rasagaline, are believed to be beneficial in reducing the progression of Parkinson's disease.Rate this question:
- 6.
This class of drugs, used to treat PD has the unfortunate side effects of nausea/vomiting, hallucinations, psychosis, orthostatic hypotension and psychosis ______________
Explanation
Dopamine agonists are a class of drugs used to treat Parkinson's disease. However, they have the unfortunate side effects of nausea/vomiting, hallucinations, psychosis, orthostatic hypotension, and psychosis. These side effects can be quite severe and can significantly impact the quality of life for individuals taking these medications.Rate this question:
- 7.
From the list below, select the four cardinal motor features/sx of Parkinson’s Disease.
- A.
Postural Instability (shuffling gait, stooped stance)
- B.
Masked facies
- C.
Bradykinesia
- D.
Resting Tremor (aka pill rolling tremor)
- E.
Dystonia
- F.
Essential tremor
- G.
Rigidity
Correct Answer(s)
A. Postural Instability (shuffling gait, stooped stance)
C. Bradykinesia
D. Resting Tremor (aka pill rolling tremor)
G. RigidityExplanation
The four cardinal motor features/sx of Parkinson's Disease are postural instability (shuffling gait, stooped stance), bradykinesia, resting tremor (aka pill rolling tremor), and rigidity.Rate this question:
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- 8.
_________________ is a drug currently used to treat to PD, but was previously used as an antimicrobial agent.
Correct Answer(s)
AmantadineExplanation
Amantadine is a drug that is currently used to treat Parkinson's disease (PD). However, it was previously used as an antimicrobial agent. This means that it was originally developed and used to combat microbial infections. Over time, researchers discovered that amantadine also had beneficial effects in treating the symptoms of PD, leading to its current use in this context.Rate this question:
- 9.
What is the most common movement disorder? (Questions 9 -14 are based on the answer to this question)
Correct Answer(s)
Essential TremorExplanation
Essential Tremor is the most common movement disorder. It is a neurological condition characterized by involuntary shaking or trembling of different parts of the body, most commonly the hands. The tremors can range from mild to severe and can affect daily activities such as writing, eating, or speaking. Essential Tremor is often hereditary and typically worsens over time. While it is not life-threatening, it can significantly impact a person's quality of life. Treatment options include medications, lifestyle changes, and in severe cases, surgical interventions.Rate this question:
- 10.
The condition in question #8 is a(n) ____________ tremor.
Correct Answer(s)
Action tremorExplanation
The condition in question #8 is referred to as an action tremor. Action tremor is a type of tremor that occurs during voluntary movements and is often triggered or worsened by actions such as reaching for objects or performing fine motor tasks. This type of tremor is different from other types such as resting tremor, which occurs when the muscles are at rest.Rate this question:
- 11.
ET is known to most commonly affect the head, upper extremeties and __________________
Correct Answer(s)
Voice - 12.
True of False: ET is responsive to anti-PD drugs.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
The statement is false because ET (essential tremor) is not typically responsive to anti-PD (anti-parkinson's disease) drugs. Essential tremor is a neurological disorder characterized by involuntary shaking or trembling of certain parts of the body, usually the hands or arms. While anti-PD drugs are commonly used to manage Parkinson's disease, they are not effective in treating essential tremor. Different medications, such as beta blockers or anticonvulsants, are often prescribed to help manage the symptoms of essential tremor.Rate this question:
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- 13.
Classically ET abates with ______________consumption (Hint: it is a non-pharmacologic agent)
Correct Answer
AlcoholExplanation
Classically, ET (essential tremor) abates with alcohol consumption. This means that drinking alcohol can temporarily reduce the symptoms of essential tremor. However, it is important to note that this effect may vary from person to person, and excessive alcohol consumption can worsen the condition in the long run. The mechanism behind this phenomenon is not fully understood, but it is believed that alcohol affects certain neurotransmitters in the brain, leading to a temporary suppression of tremors. It is worth mentioning that alcohol should not be considered as a long-term treatment for essential tremor, and individuals should consult with a healthcare professional for appropriate management.Rate this question:
- 14.
Which of the following pharmacologic agents are typically used to treat ET?
- A.
Benzodiazepines
- B.
Antipsychotics
- C.
Vigabitrin
- D.
Topiramate
- E.
Propanalol
- F.
Clozapine
- G.
Primidone
- H.
Carbamazepine
Correct Answer(s)
A. Benzodiazepines
D. Topiramate
E. Propanalol
G. PrimidoneExplanation
Benzodiazepines, topiramate, propranolol, and primidone are typically used to treat essential tremor (ET). Benzodiazepines are a class of drugs that have sedative and muscle relaxant effects, which can help reduce tremors. Topiramate is an anticonvulsant medication that can also be effective in reducing tremors. Propranolol is a beta-blocker that can help control tremors by blocking the effects of adrenaline. Primidone is an anticonvulsant that can also be used to reduce tremors. These medications are commonly prescribed to manage the symptoms of ET and improve quality of life for individuals with this condition.Rate this question:
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- 15.
DBT (deep brain stimulation therapy) can be used to treat severe forms of ET by targeting this (an organ)__________ in the CNS.
Correct Answer(s)
Ventro-intermediate nucleus (VIM) of thalamusExplanation
DBT (deep brain stimulation therapy) is a treatment method that involves the implantation of electrodes in specific areas of the brain to alleviate symptoms of certain neurological disorders. In the case of severe forms of essential tremor (ET), DBT can be used to target the Ventro-intermediate nucleus (VIM) of the thalamus. The VIM is a part of the central nervous system (CNS) and is involved in motor control. By stimulating the VIM, DBT can help regulate abnormal neural activity and reduce the tremors associated with ET.Rate this question:
- 16.
Questions 15-21 are based on the following scenario: 30 yr old woman somes to your office with complaints of involuntary limb movements. Her partner also states that she hasn’t been herself lately, like her personality is changing. Her mother died in her 40s due to a neurologic disorder. What is your leading diagnosis?
Correct Answer(s)
1. Huntington's Disease 2. Chorea 3. Caudate and putamen 4. Yes. Huntington is a hereditary disease 5. Autosomal Dominant 6. Chromosome 4 7. CAGExplanation
The leading diagnosis for the 30-year-old woman with involuntary limb movements and personality changes, along with a family history of a neurologic disorder, is Huntington's Disease. This is supported by the presence of chorea (a characteristic symptom of Huntington's Disease) and the involvement of the caudate and putamen regions of the brain. Additionally, Huntington's Disease is known to be hereditary, autosomal dominant, and caused by a mutation on chromosome 4 with an expansion of CAG repeats.Rate this question:
- 17.
Imaging studies of her brain will show atrophy of what CNS structures?
- A.
Thalamus
- B.
Cortex
- C.
Putamen
- D.
Globus Pallidus
- E.
Caudate
- F.
Myelin
Correct Answer(s)
C. Putamen
E. CaudateExplanation
Imaging studies of her brain will show atrophy of the putamen and caudate. Atrophy refers to the shrinkage or loss of cells in a particular structure. The putamen and caudate are both part of the basal ganglia, which are important for motor control and coordination. Atrophy in these structures can lead to movement disorders such as Parkinson's disease or Huntington's disease. The other options listed, such as thalamus, cortex, and myelin, are not specifically mentioned as being affected by atrophy in this case.Rate this question:
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- 18.
Assuming this is a hereditary disease, how is it passed on?
Correct Answer(s)
Autosomal DominantExplanation
Autosomal Dominant inheritance means that the disease is caused by a mutation in one copy of a gene, and an affected individual has a 50% chance of passing the mutated gene to each of their children. This type of inheritance does not skip generations and can affect both males and females equally.Rate this question:
- 19.
The mutation responsible for this disease is found on what chromosome _____ (a number)?
Correct Answer(s)
4
FourExplanation
The correct answer is 4. The question asks for the chromosome where the mutation responsible for the disease is found. The answer "4" indicates that the mutation is located on chromosome 4. The alternative answer "Four" is simply the written form of the number 4.Rate this question:
- 20.
This disease involves a trinucleotide repeat. Which sequence is involved?
- A.
CCG
- B.
CAG
- C.
CGG
- D.
GAC
Correct Answer
B. CAGExplanation
This disease involves a trinucleotide repeat, meaning that a specific sequence of three nucleotides is repeated multiple times. The sequence involved in this disease is CAG.Rate this question:
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- 21.
There is a pharmacologic cure for Huntington's Disease.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
There is no cure for Huntington's, but you can treat it symptomatically. In general, you will use anti-dopaminergic drugs.Rate this question:
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