Which of the following is an example of an involuntary risk?
Involuntary movements compose a group of uncontrolled movements that may manifest as a tremor, tic, myoclonic jerk, chorea, athetosis, dystonia or hemiballism. Show
Recognition of involuntary movements associated with hyperkinetic movement disorders is an important diagnostic skill. This page describes the diagnosis of the major categories of hyperkinetic movement disorders. General Definitions
Physiologic Tremor
"Essential" Tremor (ET) (Kinetic Tremor / Familial Tremor)
Intention Tremor ( Cerebellar Tremor)
Parkinsonian Tremor
Note: There can be overlap between these categories. For example, certain forms of Parkinson's disease will exhibit postural tremor. Conversely, severe essential tremor will be present at rest. It is important to look for other signs of the suspected diagnosis to make sure you don't miss the correct one!
Myoclonus may be benign (as in hypnopompic and hypnagogic jerks) or disabling. Myoclonic jerks may occur with voluntary movement (action myoclonus) or as a result of a stimulus (startle or reflex myoclonus). Unlike tics, myoclonus is not suppressible. Myoclonus is often associated with CNS pathology, hypoxic damage (e.g. during cardiac arrest), neurodegenerative disorders, and encephalopathy.
Huntington's DiseaseHuntington's chorea is arrhythmic, nonrepetitive, semi-purposeful and involves the limbs, trunk, and face. Early manifestations are mild and may be unnoticed or attributed to restlessness. Motor impersistence (e.g. inability to sustain tongue protrusion) is a common feature. See the Abnormal Gaits Page for description and demonstration of the Choriform gate. Other Choreas
Tourette's Syndrome (TS) is a neurobehavioral disorder predominately affecting males and typified by multiple motor tics and vocalizations. Such tics may be repressed for short periods of time or even become absent for days to weeks. Onset is most common before the age of 15 years and often lessens or even resolves in adulthood. TS is associated with anxiety, depression, ADHD, and OCD. Adult onset is associated with several medical conditions such as Parkinson's Disease, dystonia, drugs (e.g. neuroleptics, levodopa), and trauma. Dystonia exists in a broad spectrum from a contraction of a single muscle group to a disabling dysfunction of multiple groups. Commonly, dystonia is initiated by voluntary motion (action dystonia) but may later become sustained and extend to other body regions. Classically, stress or fatigue worsen dystonia, relaxation or sensory stimulation reduce it. Primary Dystonias
Focal DystoniasThis is the most common type of dystonia, commonly presenting in the 4th to 6th decade of life, affecting females more than males. Frequently misdiagnosed as psychiatric or orthopedic conditions.
Secondary DystoniasMost commonly caused by medications (see below), brain lesions, or brainstem pathology. Most such dystonias are segmental in distribution. Less commonly, peripheral nerve injury may cause dystonia. Dystonic StormDystonic storm is an acute, generalized dystonic contraction that may include vocal cords or laryngeal muscles, leading to potentially fatal respiratory obstruction. Patients with a history of dystonia and subject to acute stress (such as surgery) are in jeopardy. Potential complications include rhabdomyolysis and renal failure. Dystonic storm is best managed in the ICU. Acute
Subacute
Tardive Syndromes
Neuroleptic malignant syndrome (NMS) is typified by rigidity, hyperthermia, AMS, tachycardia, and renal failure. Onset usually occurs days to weeks after exposure to medication. It might also be precipitated by discontinuation of antiparkinsonian medications. Other drugs associated with hyperkinetic movement disorders include phenytoin, carbamazepine, TCAs, fluoxetine, oral contraceptives, buspirone, digoxin, cimetidien, diazoxide, lithium, methadone, and fentanyl. Psychogenic movement disorders are common and may mimic any of the conditions described above. Affected patients are most often female and debilitated by their condition. Particularly somatoform, conversion disorder, malingering, and factitious disorder are associated with psychogenic movements.
What are the elements of dynamic risk assessment?The definition of a dynamic risk assessment is: “The continuous process of identifying hazards, assessing risk, taking action to eliminate or reduce risk, monitoring and reviewing, in the rapidly changing circumstances of an operational incident.”
What does risk mean in public health?A public health risk is something that is likely to be harmful to human health or contribute to disease in humans, such as germs carried by rats, mice and mosquitoes. Harmful germs came can also be transmitted from waste, water, dead or living animals and harmful substances in the environment.
Is the potential to cause harm?Basically, a hazard is the potential for harm or an adverse effect (for example, to people as health effects, to organizations as property or equipment losses, or to the environment). Sometimes the resulting harm is referred to as the hazard instead of the actual source of the hazard.
What degree of risk is acceptable?Acceptable risk: That risk for which the probabil- ity of a hazard-related incident or exposure occur- ring and the severity of harm or damage that may result are as low as reasonably practicable (ALARP) and tolerable in the setting being con- sidered.
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