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Physician Assistant (PA)
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PANCE Prep Pearls: 3rd Ed. (2019)
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Movement Disorders

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PANCE Prep Pearls: 3rd Ed. (2019) | Physician Assistant (PA) School Study Aid

Movement Disorders
20 Picmonics to Learn | 39 mins
Huntington's Disease
Pathophysiology
Autosomal Dominant
Trinucleotide Repeat
CAG Repeats
Chromosome 4
Anticipation
Caudate
Decrease of ACh
Decrease of GABA
Signs and Symptoms
Chorea
Dementia
Depression
Glutamate Toxicity
Neuronal Death via NMDA Binding
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3 mins
Essential Tremor
Characteristics
Most Common Tremor in Adults
Positive Family History
Clinical Findings
Bilateral Upper Extremities
Worse with Physical and Psychological Stress
Better with Rest and Alcohol
Management
Beta Blockers
Primidone
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1 min
Parkinson's Disease Assessment
Assessment
Decreased Dopamine
Older Adult
Cogwheel Rigidity
Bradykinesia
Shuffling Gait
Resting Tremor
Pill-Rolling
Mask-Like Face
Cognitive Decline
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2 mins
Parkinson's Disease Interventions
Medications
Levodopa/Carbidopa (Sinemet)
Entacapone (Comtan)
Selegiline (Eldepryl)
Amantadine (Symmetrel)
Bromocriptine (Parlodel)
Benztropine (Cogentin)
Considerations
Allow Extra Time
Ensure Patient Safety
Surgery As Last Resort
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2 mins
Parkinson's Drugs
Parkinsons Characteristics
Decreased Dopamine
Increased Acetylcholine
Drug Names
BALSA Acronym
Bromocriptine
Amantadine
Levodopa
Selegiline
Antimuscarinics
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2 mins
Levodopa/Carbidopa (Sinemet)
Indications
Parkinson's Disease
Mechanism of Action
Increase Dopamine in Brain
Cross blood-brain barrier
Increase bioavailability
Side Effects
Arrhythmias
Dyskinesia
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1 min
Monoamine Oxidase Inhibitors (MAO-Is)
Indications
Atypical Depression
Mechanism of Action
Increase Levels of Amine Neurotransmitters
Drugs
"Takes Pride In Shanghai"
Tranylcypromine
Phenelzine
Isocarboxazid
Selegiline
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1 min
Amyotrophic Lateral Sclerosis (ALS)
Assessment
Progressive Muscle Weakness
Systemic Muscle Wasting
Fasciculations
Spasticity
Fatigue
Considerations
Riluzole (Rilutek)
Stretching
Little to No Cognitive Decline
Respiratory Support
Palliative Care
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2 mins
Tourette Syndrome
Characteristics
Motor and Vocal Tics
Onset Before Age 18
> 1 year
Associations
Obsessive-Compulsive Disorder (OCD)
Attention Deficit Hyperactivity Disorder (ADHD)
TREATMENT
Cognitive Behavioral Therapy
High-Potency Antipsychotics
Atypical Antipsychotics
Alpha-2 Agonists
Tetrabenazine
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4 mins
Cerebral Palsy (CP)
Cause/Mechanism
Maternal Infections
Fetal Hypoxia
Assessment
Developmental Delay
Neurological Dysfunction
Spasticity
Dysphagia
Interventions
Muscle Relaxants
Muscle Exercises
Assistive Devices
Braces
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2 mins
Restless Legs Syndrome
Pathophysiology
Idiopathic
Iron Deficiency
Parkinson's Disease
Signs and Symptoms
Urge to Move the Legs
Unpleasant Sensations in Legs
Worsens with Inactivity
Relieved by Movement
Treatment
Iron Supplementation
Self-care
Gabapentin
Pramipexole
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2 mins
Facial Nerve Lesions
Etiology
Diabetes Mellitus
Sarcoidosis
Tumors
Herpes Simplex Virus (HSV)
Bell's palsy
Varicella Zoster Virus (VZV)
Lyme Disease
Treatment
Corticosteroids
Acyclovir
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2 mins
Guillain-Barre Syndrome Assessment
Assessment
Ascending Paralysis
Muscle Weakness
Paresthesias (Pins and Needles)
Diplopia
Difficulty Speaking
Dysphagia
Labile Blood Pressure
Loss of Bowel and Bladder Control
Considerations
Aggressive Airway Management
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2 mins
Myasthenia Gravis
Mechanism
Antibodies to Acetylcholine Receptor
Symptoms
Ptosis
Diplopia
Weakness with Muscle Use
Respiratory Death
Thymus Associated
Treatment
Acetylcholinesterase Inhibitors
Plasmapheresis
Thymectomy
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1 min
Myasthenia Gravis Assessment
Weakness with Muscle Use
Diplopia
Ptosis
Dysphagia
Difficulty Speaking
Fatigue
Complications
Cholinergic Crisis
Overmedicated
Myasthenic Crisis
Not Enough Medication
Respiratory Muscle Paralysis
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2 mins
Lambert-Eaton Syndrome
Mechanism
Autoantibody to the Presynaptic Calcium Channel on Motor Neurons
Inhibits Acetylcholine (ACh) Release at Neuromuscular Junction
Paraneoplastic Syndrome
Small Cell Lung Cancer
Symptoms
Proximal Muscle Weakness
Improves with Muscle Use
Autonomic Symptoms
Extraocular Muscle Sparing
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2 mins
Multiple Sclerosis Features and Mechanisms
Features
More Common in Women
Presents in 20's and 30's
Northern Europeans
Mechanism
Unknown mechanism, genetic factor
HLA-DRB1
Autoimmune Demyelination of CNS
White Matter of Brain and Spinal Cord
T Cell Mediated Inflammation
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2 mins
Internuclear Ophthalmoplegia
ETIOLOGY
Multiple Sclerosis
Medial Longitudinal Fasciculus
Mechanism
CN VI Nucleus
CN III Nucleus
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2 mins
Multiple Sclerosis Assessment
Cause/Mechanism
Nerve Fiber Demyelination
Assessment
Motor Issues
Cerebellar Signs
Fatigue
Paresthesias
Spasticity
Urinary Incontinence
Optic Neuritis
Considerations
Women Between 20-50 Years Old
Relapse and Remission of Symptoms
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2 mins
Multiple Sclerosis Interventions
Drug Therapy
Corticosteroids
Interferon Beta
Dimethyl Fumarate (Tecfidera)
Fingolimod (Gilenya)
Mitoxantrone (Novantrone)
Natalizumab (Tysabri)
Considerations
Increase Exercise
Identify Triggers
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2 mins

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