Need some help understanding a few questions if anyone has input!
An 11-year-old girl presents to the office for evaluation of mood changes and abnormal movements. Three weeks ago, she became much more emotional, often crying for no reason, and her academic performance started to decline. About a week later, she developed fidgety movements of her extremities. She had a sore throat about 3 months ago but is otherwise healthy. On examination, she is emotionally labile, and her speech is dysarthric. She is mildly hypotonic throughout, with uncoordinated writhing and jerking movements of her extremities. Antinuclear antibodies and thyroid function tests are normal. Which of the following is a true statement about this condition?
Select one:
A. Diagnosis is based on abnormal brain imaging.
B. Affected patients should be evaluated with an echocardiogram-this is Sydenham's chorea but it's usually due to rheumatic fever
C. Repeated recurrences are common
D. Treatment consists of Penicillin G for 14 days
E. Clinical manifestations are caused by CNS demyelination
The answer is not D; is it B? If so, how does one differentiate?
A 9-year-old boy presents to the office for evaluation of an abnormal gait. About a year ago, his right foot began turning inward while he was walking, and in the past 6 months, his left foot has begun to do the same thing. His parents have noted that his symptoms are milder in the morning and more severe late in the day. On examination, you note a sustained twisting posture of both lower extremities that is characterized by plantar flexion and inversion of the feet. Genetic testing for idiopathic torsion dystonia (DYT1) is negative. Which of the following would be the most appropriate next step in this patient’s care?
Select one:
A. Initiation of baclofen
B. Empiric trial of levodopa-this is dopamine responsive dystonia, or Segawa's disease. It is one of several genetic dystonias (DYT5). It responds very well to levodopa, which is also diagnostic for this disroder
C. Referral to physical therapy
D. Referral to orthotist for ankle-foot orthoses
E. Referral to neurosurgery for deep brain stimulation
Answer is not C; D was the only other one I could come up with. Any thoughts?
A 4-year-old boy presents to your office for evaluation of abnormal movements that have been occurring intermittently since he was 10 months old. His mother reports that, whenever he gets excited, he lifts both arms and wiggles his fingers. These movements happen several times per day, but he does not seem to be aware of them. They have not changed in appearance over time, and he does not have any other abnormal movements or vocalizations. He had gastro-esophageal reflux as an infant and was treated with ranitidine and metoclopramide for about a month when he was 6 months old. He does not have any other health issues and does not take any medications. This patient’s presentation is most consistent with which of the following diagnoses?
A. Stereotypy-tardive dyskinesia normally involves the mouth, face, and tongue area after chronic dopamine blocker/neuroleptic use (>6 months); his movements are not involuntary and "snake like," r/o atheosis
B. Chronic tic disorder, motor type
C. Mannerism
D. Athetosis
E. Tardive dyskinesia
