GEORGETTE MODULE 1 AND 2
COMPREHENSIVE EXAM SCRIPT 2026
COMPLETE QUESTIONS AND SOLUTIONS
GRADED A+
⩥ mediates motor movements.
- Dopamine blockade in this pathway can lead to increase acetylcholine
levels (increase salivation, lacrimation, blurry vision).
- Blockade of dopamine D2) receptors in this pathway can lead to
extrapyramidal symptoms (EPS), e.g., dystonia, parkinsonian symptoms,
and akathisia.
- Long-standing D2 blockade in the nigrostriatal pathway can lead to
tardive dyskinesia.
- EPS: Increase acetylcholine levels and decrease dopamine levels.
Answer: Dopamine pathways Nigrostriatal pathway:
⩥ - Blockade of D2 receptors in this pathway can lead to increase
prolactin levels leading to hyperprolactinemia which clinically manifests
as amenorrhea, galactorrhea (risperidone), and sexual dysfunction,
gynecomastia.
- Long-term hyperprolactinemia can be associated with osteoporosis.
Answer: Dopamine pathways Tuberoinfundibular pathway:
,⩥ Stooped posture, Shuffling gait, Rigidity, Bradykinesia, Tremors at
rest, Pill-rolling motion of the hand Answer: Extrapyramidal side effects
- Pseudoparkinsonism
⩥ Facial grimacing; Involuntary upward eye movement; Muscle spasms
of the tongue, face, neck and back (back muscle spasms cause trunk to
arch forward); Laryngeal spasms Answer: Extrapyramidal side effects -
Acute dystonia
⩥ Restless; Trouble standing still; Paces the floor; Feet in constant
motion, rocking back and forth Answer: Extrapyramidal side effects -
Akathisia
⩥ Protrusion and rolling of the tongue; Sucking and smacking
movements of the lips; Chewing motion; Facial dyskinesia; Involuntary
movements of the body and extremities Answer: Extrapyramidal side
effects - Tardive dyskinesia
⩥ Muscle spasms of face, neck, tongue, especially back or neck
muscles; stiff neck, subjectively painful; facial grimacing. Answer:
Acute Dystonia:
⩥ Often mistaken for agitation or unusual, stereotypic movements
characteristic of schizophrenia. Answer: Acute Dystonia:
,⩥ Other rare presentations of acute dystonia include, ----- which can
lead to permanent injury. On physical exam, patients have prolonged
involuntary upwards deviation of the eyes bilaterally. Answer:
oculogyric crises
⩥ oculogyric crises treatment Answer: Cogentin (Benztropine)
⩥ Often mistaken for increased anxiety. A commonly used rating scale
for the measurement of ---- includes the Barnes
Akathisia Rating Scale and Extrapyramidal Symptom Rating Scale.
Answer: Akathisia
⩥ Akathisia Treatment Answer: o Betablocker like propranolol
(betablockers can cause bronchospasm, betablockers are contraindicated
in patients taking bronchodilators like Albuterol)
o Benztropine (Cogentin)
Benzodiazepine
⩥ Absence of movement, difficulty initiating motion, subjective feeling
of lack of motivation to move
Note: Often mistaken for laziness or lack of interest. Answer: Akinesia
⩥ Akinesia treatment Answer: Cogentin (Benztropine)
, ⩥ - Presence of symptoms of Parkinson's disease produced by D2
blockade.
- Muscle rigidity
- Shuffling gait
- Motor slowing
-Mask-like facial expression
- Pill rolling tremors in fingers Answer: 4. Pseudo-Parkinsonian
symptoms:
⩥ . Pseudo-Parkinsonian treatment Answer: o Cogentin (Benztropine)
⩥ - Involuntary abnormal muscle movement of the mouth, tongue, face,
and jaw that may progress to limbs; can be irreversible.
o Protrusions and rolling of tongue
o Lip smacking and sucking
o Chewing motion
o Facial dyskinesia
o Can take up to 1-2 years to occur
Can occur as an acute process at initiation of medications Answer:
Tardive dyskinesia:
⩥ aids in the early detection of tardive dyskinesia. Answer: - The AIMS
(Abnormal Involuntary Movement Scale)
COMPREHENSIVE EXAM SCRIPT 2026
COMPLETE QUESTIONS AND SOLUTIONS
GRADED A+
⩥ mediates motor movements.
- Dopamine blockade in this pathway can lead to increase acetylcholine
levels (increase salivation, lacrimation, blurry vision).
- Blockade of dopamine D2) receptors in this pathway can lead to
extrapyramidal symptoms (EPS), e.g., dystonia, parkinsonian symptoms,
and akathisia.
- Long-standing D2 blockade in the nigrostriatal pathway can lead to
tardive dyskinesia.
- EPS: Increase acetylcholine levels and decrease dopamine levels.
Answer: Dopamine pathways Nigrostriatal pathway:
⩥ - Blockade of D2 receptors in this pathway can lead to increase
prolactin levels leading to hyperprolactinemia which clinically manifests
as amenorrhea, galactorrhea (risperidone), and sexual dysfunction,
gynecomastia.
- Long-term hyperprolactinemia can be associated with osteoporosis.
Answer: Dopamine pathways Tuberoinfundibular pathway:
,⩥ Stooped posture, Shuffling gait, Rigidity, Bradykinesia, Tremors at
rest, Pill-rolling motion of the hand Answer: Extrapyramidal side effects
- Pseudoparkinsonism
⩥ Facial grimacing; Involuntary upward eye movement; Muscle spasms
of the tongue, face, neck and back (back muscle spasms cause trunk to
arch forward); Laryngeal spasms Answer: Extrapyramidal side effects -
Acute dystonia
⩥ Restless; Trouble standing still; Paces the floor; Feet in constant
motion, rocking back and forth Answer: Extrapyramidal side effects -
Akathisia
⩥ Protrusion and rolling of the tongue; Sucking and smacking
movements of the lips; Chewing motion; Facial dyskinesia; Involuntary
movements of the body and extremities Answer: Extrapyramidal side
effects - Tardive dyskinesia
⩥ Muscle spasms of face, neck, tongue, especially back or neck
muscles; stiff neck, subjectively painful; facial grimacing. Answer:
Acute Dystonia:
⩥ Often mistaken for agitation or unusual, stereotypic movements
characteristic of schizophrenia. Answer: Acute Dystonia:
,⩥ Other rare presentations of acute dystonia include, ----- which can
lead to permanent injury. On physical exam, patients have prolonged
involuntary upwards deviation of the eyes bilaterally. Answer:
oculogyric crises
⩥ oculogyric crises treatment Answer: Cogentin (Benztropine)
⩥ Often mistaken for increased anxiety. A commonly used rating scale
for the measurement of ---- includes the Barnes
Akathisia Rating Scale and Extrapyramidal Symptom Rating Scale.
Answer: Akathisia
⩥ Akathisia Treatment Answer: o Betablocker like propranolol
(betablockers can cause bronchospasm, betablockers are contraindicated
in patients taking bronchodilators like Albuterol)
o Benztropine (Cogentin)
Benzodiazepine
⩥ Absence of movement, difficulty initiating motion, subjective feeling
of lack of motivation to move
Note: Often mistaken for laziness or lack of interest. Answer: Akinesia
⩥ Akinesia treatment Answer: Cogentin (Benztropine)
, ⩥ - Presence of symptoms of Parkinson's disease produced by D2
blockade.
- Muscle rigidity
- Shuffling gait
- Motor slowing
-Mask-like facial expression
- Pill rolling tremors in fingers Answer: 4. Pseudo-Parkinsonian
symptoms:
⩥ . Pseudo-Parkinsonian treatment Answer: o Cogentin (Benztropine)
⩥ - Involuntary abnormal muscle movement of the mouth, tongue, face,
and jaw that may progress to limbs; can be irreversible.
o Protrusions and rolling of tongue
o Lip smacking and sucking
o Chewing motion
o Facial dyskinesia
o Can take up to 1-2 years to occur
Can occur as an acute process at initiation of medications Answer:
Tardive dyskinesia:
⩥ aids in the early detection of tardive dyskinesia. Answer: - The AIMS
(Abnormal Involuntary Movement Scale)
