Movement Disorders
QUESTIONS
1. A 34-year-old female presents with acute psychotic symptoms. She is described as being immobile, mute, and having a waxy flexibility. Which of the following statements is false?
A. Nonconvulsive status epilepticus is part of the differential.
B. An accurate history is rarely available from the patient.
C. Patients with this disorder only have symptoms while an examiner or bystander is present, and they disappear when no one is around.
D. Grasp reflex is a secondary feature of catatonia.
E. None of the above
View Answer
1. Answer: C. The patient has catatonia. This should be present in the setting of the examiner as well as when no one is present. If the symptoms resolve when no one is around, factitious disorder or somatoform disorder should be considered.
2. A 22-year-old female presents during pregnancy with abnormal movements. There is no family history of any neurologic disorders. She states that during stressful times, the movements become worse, and her husband states that they disappear during sleep. She is noted to have a “milkmaid” grip. Which of the following is true?
A. This is the most common neurologic disorder during pregnancy.
B. Rheumatic disease used to be a common cause for this disorder.
C. This is conversion disorder.
D. This is essential tremor.
E. None of the above
View Answer
2. Answer: B. The patient has chorea gravidarum. This is a rare disorder, however, and it used to be more common prior to antibiotic treatment. Rheumatic heart disease used to be the main culprit. Rheumatic fever and antiphospholipid syndrome are the main links to this disorder.
3. Chorea is defined as a state of excessive movements that are irregular, do not repeat, and are abrupt in character. Which of the following statements is false?
A. Huntington’s chorea is the most well-studied chorea syndrome.
B. The basal ganglia is the sight of dysfunction.
C. Physostigmine cannot overcome anticholinergic-induced chorea.
D. Decreased gamma-aminobutyric acid (GABA) levels in the basal ganglia is seen in these patients.
E. None of the above
View Answer
3. Answer: C. Chorea develops in patients on anticholinergic medications and can be overcome promptly by administering physostigmine.
4. A 75-year-old male develops progressive dementia, Parkinson’s features, and limb apraxia. On examination, the patient also has signs of supranuclear palsy. Which of the following is true?
A. The patient has Lewy-body dementia.
B. Males develop this disorder more frequently.
C. Resting tremor is the most common feature.
D. Hallucinations are not a common feature of this disorder.
E. None of the above
View Answer
4. Answer: D. The patient has cortical basal ganglionic degeneration, which has features of PD but typically, the rigidity and dystonia are more prominent. Resting tremor is not a feature. Hallucinations are typical of Lewy-body dementia and not this disorder. There is no gender predilection.
5. A 56-year-old male presents with complaints of difficulty feeding. He states his hand starts to shake when he brings a utensil to his mouth. Alcohol seems to relieve the problem, and therefore, he has started drinking more frequently. There are no problems when the patient is relaxed and sitting still. Which of the following is false?
A. The problem is located in the Mollaret triangle near the brain stem.
B. These symptoms often have isolated head tremor.
C. Both genders are affected equally.
D. About half the patients have a strong family history.
E. None of the above
6. Which of the following medications is the most effective treatment for essential tremor?
A. Clonidine
B. Methylpentynol
C. Ropinirole
D. Primidone
E. None of the above
View Answer
6. Answer: D. Primidone and propranolol are the most effective treatments for essential tremor with a reduction in tremor amplitude in about three quarters of all patients.
7. Which of the following is not an exclusion criteria for essential tremor?
A. Primary orthostatic tremor
B. Isolated voice tremor
C. Isolated leg tremor
D. Isolated head tremor
E. Writing tremor only
View Answer
7. Answer: D. Isolated head tremor but absence of abnormal posturing of the head is an inclusion criterion for essential tremor. The rest of the options are all exclusions.
8. Friedreich’s ataxia (FA) is inherited in what fashion?
A. Autosomal dominant
B. X-linked
C. Sporadic
D. Autosomal recessive
E. None of the above
View Answer
8. Answer: D. FA is the most common of all the autosomal recessive ataxias. Cardinal features include progressive limb and gait ataxia, dysarthria, posterior column deficits, and absent DTRs and positive Babinski’s sign.
9. What percentage of patients with FA are wheelchair-bound by their midfourth decade of life?
A. 10%
B. 25%
C. 50%
D. 75%
E. 95%
View Answer
9. Answer: E. FA is a progressive disorder with significant morbidity. Loss of ambulation usually occurs within 15 years of the start of the disease, and more than 95% of patients are wheelchair bound by age 45.
10. A patient presents with progressive dementia, chorea movements, and abnormal behavior. His father had a similar disease and died at an early age due to suicide. Which of the following statements is true?
A. This disorder is sporadic in nature.
B. It is due to an expansion of a cysteine-adenosine-guanine repeat.
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