Movement Disorders — MCQs

10 questions

A 3 year old child is brought to you with history of frequent, violent and rapid swinging movement of the left arm for one week duration. What is the condition described in this scenario called?

Lesions within the basal ganglia produce the following signs except:

Which of the following is a feature of Sydenham's chorea?

In Huntington's chorea, which of the following is not typically associated?

Drug of choice for initial pharmacological treatment of Tourette syndrome -

Dysdiadochokinesia refers to:

Tics, hair pulling, and nail biting behaviors are best treated with?

An 8 month old female has history of kernicterus. On sudden movement of the baby’s neck, the following features were seen abduction and extension of the arms, opening of hands and adduction of arms in front of the body. Which reflex is elicited in this infant?

An otherwise healthy 43-year-old woman comes to the physician because of several episodes of involuntary movements of her head over the past few months. They are sometimes associated with neck pain and last minutes to hours. Neurologic examination shows no abnormalities. During examination of the neck, the patient's head turns horizontally to the left. She states this movement is involuntary, and that she is unable to unturn her head. After 5 minutes, her head re-straightens. Which of the following best describes this patient's disorder?

Q10

Chorea is NOT seen in

Movement Disorders Indian Medical PG Practice Questions and MCQs

Question 1: A 3 year old child is brought to you with history of frequent, violent and rapid swinging movement of the left arm for one week duration. What is the condition described in this scenario called?

A. Athetosis
B. Dystonia
C. Chorea
D. Hemiballismus (Correct Answer)

Explanation: ***Hemiballismus*** - **Hemiballismus** is characterized by sudden, involuntary, wild, rapid, and **flailing movements** of one side of the body, primarily affecting the proximal musculature such as the arm and leg. - The description of "frequent, violent and rapid swinging movement of the left arm" perfectly aligns with the clinical presentation of hemiballismus, often resulting from a lesion in the **subthalamic nucleus**. *Athetosis* - **Athetosis** involves slow, writhing, involuntary movements, especially in the distal parts of the limbs (fingers and toes). - This condition is typically slower and more sustained than the "violent and rapid swinging" described in the scenario. *Dystonia* - **Dystonia** is characterized by sustained or intermittent muscle contractions causing abnormal, often repetitive, movements or postures. - While it can involve forceful movements, it usually results in sustained postures or twisting movements rather than the rapid, flailing motion described. *Chorea* - **Chorea** refers to irregular, unpredictable, brief, and jerky movements that flow from one body part to another in a dance-like manner. - Unlike the violent, large-amplitude movements of hemiballismus, chorea typically involves more distal and less organized movements.

Question 2: Lesions within the basal ganglia produce the following signs except:

A. Hypotonia (Correct Answer)
B. Hemiballismus
C. Athetosis
D. Tremor

Explanation: ***Hypotonia*** - **Hypotonia** is characterized by decreased muscle tone and is typically associated with lesions of the **cerebellum**, lower motor neurons, or sensory pathways, not primarily the basal ganglia. [1] - Basal ganglia disorders usually manifest with either **hypertonia** (rigidity) or dystonia, rather than hypotonia. [1] *Hemiballismus* - **Hemiballismus** is a rapid, involuntary, and flailing movement of a limb on one side of the body, often caused by a lesion in the **subthalamic nucleus**, which is part of the basal ganglia circuit. [2] - This symptom is a classic example of **hyperkinetic movement disorder** resulting from basal ganglia dysfunction. [2] *Athetosis* - **Athetosis** involves slow, writhing, involuntary movements, especially in the distal parts of the limbs, and is commonly seen in lesions affecting the **globus pallidus** and striatum, components of the basal ganglia. [2] - It is classified as an **extrapyramidal symptom** indicative of basal ganglia pathology. *Tremor* - **Tremor**, particularly at rest (e.g., in Parkinson's disease) or postural tremor, is a common sign of **basal ganglia dysfunction**, specifically involving the dopaminergic pathways. [1], [2] - Lesions affecting the **substantia nigra** or other basal ganglia structures can disrupt motor control and lead to various types of tremors.

Question 3: Which of the following is a feature of Sydenham's chorea?

A. Chorea (Correct Answer)
B. Unintelligible speech
C. Emotional lability
D. Hypotonia

Explanation: ***Chorea*** - **Chorea** refers to sudden, involuntary, jerky, and uncoordinated movements, which are the hallmark clinical presentation of **Sydenham's chorea** [1]. - These characteristic movements can be generalized or localized, affecting the face, trunk, and extremities, often interfering with voluntary actions [1]. *Hypotonia* - While some patients with Sydenham's chorea may exhibit mild **hypotonia**, it is not considered a primary or defining feature. - **Hypotonia** is more commonly associated with other neurological conditions such as cerebellar dysfunction or certain types of muscular dystrophy [2]. *Unintelligible speech* - Although **dysarthria** (impaired articulation) can occur in severe cases of Sydenham's chorea due to involvement of orofacial muscles, **unintelligible speech** is not a universal or primary feature [2]. - The speech difficulties are usually a result of the choreiform movements affecting the muscles involved in speech production rather than a direct impairment of language comprehension or production. *Emotional lability* - **Emotional lability**, characterized by rapid and exaggerated changes in mood, can be a feature of Sydenham's chorea, especially in children and adolescents. - However, it is a behavioral symptom rather than a primary motor feature like chorea, and its presence can vary among individuals.

Question 4: In Huntington's chorea, which of the following is not typically associated?

A. Slurred speech
B. Dysmetria (Correct Answer)
C. Degeneration of striatal GABA-ergic neurons
D. Progressive dementia

Explanation: ***Dysmetria*** - **Dysmetria**, an inability to control the distance, speed, or coordination of movements, is more characteristic of **cerebellar dysfunction**, not typically a primary feature of Huntington's chorea [3]. - While some motor incoordination can occur, profound dysmetria specifically points away from the classic basal ganglia pathology of Huntington's disease. *Slurred speech* - **Dysarthria**, or slurred speech, is a very common symptom in Huntington's chorea due to the involuntary movements affecting the muscles of articulation. - The progressive neurological degeneration impacts various motor functions, including speech production. *Progressive dementia* - **Progressive dementia** is a hallmark feature of Huntington's chorea, manifesting as cognitive decline, executive dysfunction, and memory impairment. - This cognitive deterioration is often a significant and debilitating aspect of the disease. *Degeneration of striatal GABA-ergic neurons* - **Degeneration of striatal GABA-ergic neurons** within the caudate and putamen is the primary neuropathological finding in Huntington's chorea [1]. - This loss of inhibitory neurons leads to the characteristic hyperkinetic movements, such as chorea [2].

Question 5: Drug of choice for initial pharmacological treatment of Tourette syndrome -

A. B complex
B. Clonidine (Correct Answer)
C. Haloperidol
D. Valproate

Explanation: ***Clonidine*** - **Clonidine** is often considered a first-line treatment for Tourette syndrome, especially in children and adolescents, due to its favorable side effect profile compared to typical antipsychotics. - As an **alpha-2 adrenergic agonist**, it helps reduce tic severity and associated symptoms like ADHD and impulsivity by modulating neurotransmitter release in the brain. *B complex* - **B vitamins** are generally not indicated for the treatment of Tourette syndrome, as there is no robust scientific evidence to support their efficacy in managing tics. - While essential for overall neurological health, they do not directly address the pathophysiology of tic disorders. *Haloperidol* - **Haloperidol**, a **first-generation antipsychotic**, is highly effective in reducing tics but is generally reserved for severe cases due to its significant side effects, including extrapyramidal symptoms and sedation. - It works by blocking **dopamine D2 receptors** but its adverse effects limit its use as an initial agent of choice. *Valproate* - **Valproate** is an anticonvulsant and mood stabilizer primarily used for epilepsy, bipolar disorder, and migraine prevention. - It is not a standard or preferred treatment for Tourette syndrome, as its efficacy in tic reduction is limited and it carries significant side effects.

Question 6: Dysdiadochokinesia refers to:

A. Inability to Perform Rapid Alternating Movements (Correct Answer)
B. Intention Tremor
C. Tremor of the Eyeballs
D. Failure of Progression in Talking

Explanation: ***Inability to Perform Rapid Alternating Movements*** - **Dysdiadochokinesia** is a neurological sign indicating an impaired ability to perform **rapid alternating movements**, such as pronation and supination of the forearms [1]. - It is a key indicator of **cerebellar dysfunction**, as the cerebellum is responsible for coordinating the rate, range, and force of movements [1]. *Intention Tremor* - An **intention tremor** is a tremor that worsens during purposeful movement towards a target, not a difficulty with alternating movements themselves. - While also a sign of **cerebellar damage**, it manifests as oscillations during voluntary action, distinct from dysdiadochokinesia. *Tremor of the Eyeballs* - This condition is known as **nystagmus**, which refers to involuntary rhythmic eye movements [2]. - While nystagmus can be associated with **cerebellar dysfunction**, it is a distinct sign separate from the ability to perform rapid alternating limb movements [2]. *Failure of Progression in Talking* - This symptom is characteristic of **dysarthria**, a motor speech disorder that impacts articulation, phonation, and prosody [2]. - While certain types of dysarthria can be linked to **cerebellar disease**, "failure of progression in talking" specifically describes speech difficulties, not the coordination of limb movements [2].

Question 7: Tics, hair pulling, and nail biting behaviors are best treated with?

A. Behavior therapy (Correct Answer)
B. Psychodynamic therapy
C. ECT
D. Medications

Explanation: ***Behavior therapy*** - **Behavior therapy**, particularly **Habit Reversal Training (HRT)**, is the first-line and most effective treatment for tics, hair pulling (trichotillomania), and nail biting (onychophagia). - It involves teaching individuals to identify triggers and recognize urges, and then substituting the undesirable behavior with a competing response. *Psychodynamic therapy* - This therapy focuses on uncovering **unconscious conflicts** and past experiences that may contribute to symptoms. - While it can be helpful for some psychological issues, it is generally **less effective** for directly addressing specific behavioral symptoms like tics or body-focused repetitive behaviors. *ECT* - **Electroconvulsive therapy (ECT)** is a powerful somatic treatment primarily used for severe mental illnesses like **treatment-resistant depression** or catatonia. - It is **not indicated** for tics, hair pulling, or nail biting due to the high risks and lack of evidence for its efficacy in these conditions. *Medications* - While some medications (e.g., **antipsychotics** for severe tics, **SSRIs** for co-occurring anxiety/OCD) can be used as an adjunct, **behavioral therapy** is generally more effective and the first-line approach for these specific behaviors. - Medications alone rarely resolve these behaviors completely without behavioral intervention, and they often come with side effects.

Question 8: An 8 month old female has history of kernicterus. On sudden movement of the baby’s neck, the following features were seen abduction and extension of the arms, opening of hands and adduction of arms in front of the body. Which reflex is elicited in this infant?

A. Asymmetric tonic reflex
B. Moro’s reflex (Correct Answer)
C. Startle reflex
D. Parachute reflex

Explanation: ***Moro’s reflex*** - The description of **abduction and extension of the arms**, opening of hands, and then adduction fits the classic presentation of the **Moro reflex**, which is a normal primitive reflex in infants. - A prominent Moro reflex at 8 months, especially in a child with a history of **kernicterus**, suggests **neurological dysfunction** as it should have integrated by 6 months of age. *Asymmetric tonic reflex* - Also known as the **"fencing reflex,"** this reflex involves the baby extending the arm and leg on the side to which the head is turned, while flexing the opposite limbs. - The description provided does not match this unilateral posture. *Startle reflex* - The startle reflex is a general response to a sudden loud noise or bright light, characterized by a **rapid, whole-body jerk** or flinch. - While similar to the Moro reflex in being a protective response, the specific arm movements of abduction, extension, and then adduction are characteristic of Moro. *Parachute reflex* - The parachute reflex is a **protective postural reflex** that develops around 6-9 months, where an infant extends their arms forward as if to "break a fall" when their body is quickly tilted downward. - This reflex is an indication of normal neurological development and is not consistent with the described movements.

Question 9: An otherwise healthy 43-year-old woman comes to the physician because of several episodes of involuntary movements of her head over the past few months. They are sometimes associated with neck pain and last minutes to hours. Neurologic examination shows no abnormalities. During examination of the neck, the patient's head turns horizontally to the left. She states this movement is involuntary, and that she is unable to unturn her head. After 5 minutes, her head re-straightens. Which of the following best describes this patient's disorder?

A. Dystonia (Correct Answer)
B. Athetosis
C. Akathisia
D. Hemiballismus
E. Chorea

Explanation: ***Dystonia*** - This patient presents with **sustained, involuntary muscle contractions** causing repetitive, twisting movements and abnormal postures [1], which are characteristic features of **dystonia**, specifically **cervical dystonia (torticollis)**. - The description of the head turning involuntarily to the left and inability to unturn it, lasting minutes to hours, fits the pattern of intermittent or spasmodic dystonia. *Athetosis* - **Athetosis** involves slow, sinuous, **writhing involuntary movements**, particularly affecting distal limbs [1]. - These movements are often continuous and slow, unlike the more sudden, sustained contractions seen in the patient. *Akathisia* - **Akathisia** is characterized by an internal feeling of **restlessness** and a strong urge to move, often described as an inability to sit still. - It results in fidgeting and pacing, rather than sustained, involuntary posturing of a specific body part. *Hemiballismus* - **Hemiballismus** involves **large-amplitude, involuntary, flinging movements** of one side of the body [1]. - This symptom typically arises from lesions in the **subthalamic nucleus** and is distinct from the sustained, twisting movements described [1]. *Chorea* - **Chorea** presents as **brief, irregular, rapid, and unpredictable involuntary movements** that flow randomly from one body part to another [1]. - Unlike the sustained, fixed posturing seen in dystonia, choreiform movements are often described as "dance-like" and are not maintained.

Question 10: Chorea is NOT seen in

A. Rheumatic fever
B. Tourette syndrome (Correct Answer)
C. Creutzfeldt-Jakob disease
D. Huntington's disease

Explanation: ***Tourette syndrome*** - **Tourette syndrome** is primarily characterized by **motor and vocal tics**, which are sudden, repetitive, nonrhythmic movements or vocalizations. - While it involves involuntary movements, these are distinct from the continuous, flowing, dance-like movements of **chorea**. *Rheumatic fever* - **Sydenham's chorea** (St. Vitus' dance) is a major manifestation of **acute rheumatic fever**, particularly in children. - It is characterized by **involuntary, purposeless, jerky movements** affecting the face, trunk, and extremities. *Creutzfeldt-Jakob disease* - This rapidly progressive, fatal neurodegenerative disease often presents with various neurological symptoms including **chorea**, **myoclonus**, and ataxia. - The abnormal movements are due to widespread neuronal loss, particularly in the **basal ganglia**. *Huntington's disease* - **Huntington's disease** is a classic cause of **chorea**, characterized by progressive degeneration of neurons in the **caudate and putamen** [1]. - The chorea is typically generalized and worsens over time, accompanied by cognitive decline and psychiatric symptoms.

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