WBR0617
| Author | [[PageAuthor::Ayokunle Olubaniyi, M.B,B.S [1]]] |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Genetics, MainCategory::Pathology |
| Sub Category | SubCategory::Neurology |
| Prompt | [[Prompt::A 13 year old Norwegian girl is brought to the outpatient neurology clinic by her parents, and she is being evaluated for a suspected anxiety disorder. She was a product of a full term pregnancy, and labor and puerperium were uneventful. There was no delay in attaining developmental milestones. She attended primary school with no problems until age 5 when her teachers reported some learning difficulties when compared to her mates. Her parents are concerned about her inability to easily make friends and also maintain a normal relationship. Physical examination was satisfactory except for some multiple eye-rolling movements and occasional teeth grinding which increased during the course of the examination.
Which of the following is not usually associated with this disorder?]] |
| Answer A | AnswerA::Attention deficit hyperactive disorder (ADHD) |
| Answer A Explanation | AnswerAExp::This is associated with Tourette syndrome. Management of this complication involves the use of stimulants or the use of guanfacine, atomoxetine and tricyclics when stimulants fail. |
| Answer B | AnswerB::Sleep disorders |
| Answer B Explanation | AnswerBExp::Sleep disorders such as longer sleep period time, longer sleep latency, reduced sleep efficiency, and prolonged wakefulness after sleep onset are common in patients with Tourette syndrome. |
| Answer C | AnswerC::Mental retardation |
| Answer C Explanation | AnswerCExp::Tourette syndrome in itself is not associated with mental retardation. Patients have normal intelligence despite learning difficulties. |
| Answer D | AnswerD::Obsessive-compulsive disorder (OCD) |
| Answer D Explanation | AnswerDExp::OCD is a common complication of Tourette syndrome. |
| Answer E | AnswerE::Depression |
| Answer E Explanation | AnswerEExp::This is a relatively common complication of Tourette syndrome. |
| Right Answer | RightAnswer::C |
| Explanation | [[Explanation::This patient’s symptoms are highly suggestive of Tourette syndrome. This is an inherited neuropsychiatric disorder with onset in childhood, characterized by multiple physical (motor) tics and at least one vocal (phonic) tic. The hallmark of Tourette syndrome is tics. A tic is an unusual movement or sound that is involuntary, with little or no control by the individual. They may start from any age, but they are commoner between the ages of 6 and 18 years. These tics characteristically wax and wane, can be suppressed temporarily, and are preceded by a premonitory urge. Tics may be worsened anxiety, fatigue, excitement, and head injury.
There are two types of tics: 1) Physical (motor) tics – e.g. blinking, eye-rolling, grinding of teeth, head jerking, neck twisting. 2) Phonic (vocal) tics – Grunts, squeaks, coughing, barking, hiccuping, words or phrases. The cause is unknown but experts believe that damages to the basal ganglia contribute to the disease. Other theory is childhood infection with streptococcal infection. This condition is associated with attention deficit hyperactive disorder (ADHD), learning difficulties, obsessive-compulsive disorder (OCD), depression, anxiety disorders, and sleep disorders. Despite all these complications, majority of patients with Tourette syndrome have normal intelligence and life expectancies. Management involves both pharmacological and non-pharmacological therapies. Medications include antihypertensives, muscle relaxants (baclofen and clonazepam) and neuroleptics. Non-pharmacological treatment involves the use of behavioral therapy (habit reversal). Educational Objective: Tourette syndrome is characterized by tics (motor or vocal) and it is associated with ADHD, OCD, sleep disorders. Although patients have learning difficulties, majority of them have normal intelligence and normal life expectancies. Reference: http://www.wikidoc.org/index.php/Tourette_syndrome |
| Approved | Approved::No |
| Keyword | WBRKeyword::Tourette syndrome |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |