Final cheat sheet

Question 1

What is hypokinesia?

Answer 1

A decrease in bodily movement due to excessive inhibition in basal ganglia circuits, often seen in Parkinson’s disease.

Question 2

What is hyperkinesia?

Answer 2

An increase in abnormal or involuntary movements caused by insufficient inhibition in basal ganglia circuits, as in Huntington’s disease.

Question 3

How does the basal ganglia circuitry differ in hypokinetic vs hyperkinetic disorders?

Answer 3

Hypokinetic: overactive indirect pathway and underactive direct pathway → too much thalamic inhibition. Hyperkinetic: loss of inhibitory striatal neurons → reduced indirect pathway activity → excessive thalamocortical drive.

Question 4

Give two clinical signs of hypokinesia.

Answer 4

Bradykinesia (slowness of movement) and difficulty initiating movement (akinesia).

Question 5

Give two clinical signs of hyperkinesia.

Answer 5

Chorea (dance-like movements) and dystonia (sustained abnormal postures).

Question 6

What is the hallmark movement pattern in Parkinson’s disease?

Answer 6

Hypokinetic features: resting tremor, bradykinesia, rigidity, and postural instability.

Question 7

What is the hallmark movement pattern in Huntington’s disease?

Answer 7

Hyperkinetic features: choreiform, writhing, and fidgety movements.

Question 8

Where is the primary neurodegeneration located in Parkinson’s disease?

Answer 8

In the dopaminergic neurons of the substantia nigra pars compacta projecting to the striatum.

Question 9

Where is the primary neurodegeneration located in Huntington’s disease?

Answer 9

In the striatum, especially GABAergic and cholinergic neurons of the caudate and putamen.

Question 10

How does dopamine change in Parkinson’s disease?

Answer 10

Dopamine levels fall in the striatum due to degeneration of substantia nigra neurons.

Question 11

What is a Lewy body?

Answer 11

An intracellular inclusion composed mainly of misfolded α-synuclein found in dopaminergic neurons in Parkinson’s disease.

Question 12

What is the classic clinical triad of Parkinson’s disease?

Answer 12

Resting tremor, bradykinesia, and postural instability (often with rigidity as a key feature).

Question 13

What is the typical age of onset for Parkinson’s disease vs Huntington’s disease?

Answer 13

Parkinson’s: usually 50–70 years. Huntington’s: usually 30–60 years.

Question 14

What is the inheritance pattern of Huntington’s disease?

Answer 14

Autosomal dominant with complete penetrance.

Question 15

Name two major non-motor features that may appear in Parkinson’s disease.

Answer 15

Depression and dementia (plus autonomic symptoms like orthostatic hypotension or constipation).

Question 16

Describe the imaging hallmark of Huntington’s disease.

Answer 16

Caudate atrophy causing enlargement of the frontal horns of the lateral ventricles; quantified using the bicaudate ratio.

Question 17

Describe the imaging hallmark often seen in Parkinson’s disease.

Answer 17

Reduced signal in the substantia nigra on MRI and reduced dopamine uptake in the putamen on DAT scans.

Question 18

What is osteoarthritis (OA)?

Answer 18

A degenerative joint disease where hyaline cartilage wears down, leading to joint space narrowing, osteophytes, and mechanical pain.

Question 19

What is rheumatoid arthritis (RA)?

Answer 19

A chronic autoimmune inflammatory disease in which synovial tissue proliferates and destroys cartilage and bone.

Question 20

List three risk factors for osteoarthritis.

Answer 20

Aging, joint trauma/repetitive use, and obesity.

Question 21

List three risk factors for rheumatoid arthritis.

Answer 21

Genetic susceptibility (HLA-DR), smoking, and being an older adult woman.

Question 22

How does the pattern of joint involvement differ between OA and RA?

Answer 22

OA: often asymmetric, weight-bearing joints (knees, hips, spine, hands). RA: typically symmetric, small joints of hands and wrists.

Question 23

How does morning stiffness differ between osteoarthritis and rheumatoid arthritis?

Answer 23

OA: morning stiffness usually < 30 minutes and improves quickly. RA: stiffness > 60 minutes and improves with continued movement.

Question 24

Describe the key pain pattern for osteoarthritis.

Answer 24

Pain worsens with use and improves with rest.

Question 25

Describe the key pain pattern for rheumatoid arthritis.

Answer 25

Pain and stiffness improve with movement but are worse after rest or in the early morning.

Question 26

What are osteophytes and in which arthritis are they typical?

Answer 26

Bony outgrowths at joint margins; typical of osteoarthritis.

Question 27

What is pannus and in which arthritis is it typical?

Answer 27

Inflamed proliferative synovial tissue that invades and destroys cartilage and bone; typical of rheumatoid arthritis.

Question 28

Define ataxia.

Answer 28

A lack of coordinated voluntary movement often due to cerebellar or sensory pathway dysfunction, causing jerky or inaccurate motion.

Question 29

Define spasticity.

Answer 29

A velocity-dependent increase in resistance to passive stretch, usually due to upper motor neuron lesions.

Question 30

Define rigidity.

Answer 30

A non–velocity-dependent increase in muscle tone and resistance to passive movement, commonly seen in basal ganglia disorders like Parkinson’s disease.

Question 31

Define akinesia.

Answer 31

Difficulty initiating or an absence of voluntary movement, typically associated with Parkinson’s disease.

Question 32

Define apraxia.

Answer 32

An inability to perform learned, purposeful movements despite intact strength and comprehension, usually from premotor or parietal cortical damage.

Question 33

Define dysmetria.

Answer 33

Inaccuracy of movement endpoint, with overshooting or undershooting a target, often due to cerebellar lesions.

Question 34

What are positive symptoms of schizophrenia?

Answer 34

Symptoms that reflect an excess or distortion of normal function: hallucinations, delusions, disorganized speech, and grossly disorganized or catatonic behavior.

Question 35

What are negative symptoms of schizophrenia?

Answer 35

Loss or diminution of normal functions such as affective flattening, avolition, alogia, and anhedonia.

Question 36

Define delusion.

Answer 36

A fixed, false belief not consistent with reality and resistant to logical argument or evidence.

Question 37

Define hallucination.

Answer 37

A sensory experience (hearing, seeing, feeling, smelling, tasting) without an external stimulus.

Question 38

What are delusions of grandeur?

Answer 38

Delusions in which an individual believes they are someone with great fame or power, such as a celebrity or religious figure.

Question 39

What does the term anhedonia mean in schizophrenia?

Answer 39

An inability to experience pleasure or react to enjoyable events.

Question 40

What is meant by the “downward drift” phenomenon in schizophrenia?

Answer 40

The tendency for individuals with schizophrenia to drift into lower socioeconomic status due to difficulty maintaining employment, housing, and social supports.

Question 41

In the Jack case

Answer 41

name two positive symptoms he exhibits.

Question 42

Why was Thorazine stopped in Jack’s case?

Answer 42

It caused painful twisting and contractions of his muscles, consistent with extrapyramidal side effects (acute dystonia).

Question 43

Why does stopping Haldol worsen Jack’s symptoms?

Answer 43

Because antipsychotics control his positive symptoms by blocking dopamine receptors; stopping them allows dopamine hyperactivity and psychosis to return.

Question 44

List two factors in Jack’s history that predict a poorer prognosis.

Answer 44

Early adult onset with repeated hospitalizations and medication non-adherence.

Question 45

List two supports that may improve Jack’s functional outcome.

Answer 45

Supported employment services and participation in a psychosocial clubhouse providing routine, social contact, and skill-building.

Question 46

What is tardive dyskinesia?

Answer 46

A late-onset movement disorder with involuntary repetitive movements (e.g., face, tongue, limbs) caused by long-term antipsychotic use.

Question 47

Why are movement disorders relevant in the context of antipsychotic treatment for schizophrenia?

Answer 47

Because dopamine-blocking antipsychotics can cause extrapyramidal side effects and tardive dyskinesia, which are movement disorders affecting quality of life.