Parkinson's

Question 1

what are the pathological changes seen with Parkinson’s?

Answer 1

degeneration of dopamine neurones within the substantia nigra
accumulation of Lewy bodies (initially substantia nigra then widespread)

Question 2

is Parkinson’s symmetrical or asymmetrical?

Answer 2

asymmetrical onset - initially affected side will always be worse
red flag -> absence of asymmetry

Question 3

what are the main motor symptoms in Parkinson’s?

Answer 3

tremor
rigidity
bradykinesia

Question 4

what are the main non motor symptoms in Parkinson’s?

Answer 4

REM sleep disorders
autonomic - constipation, urinary urgency, frequency
depression, dementia, personality changes

Question 5

how is Parkinson’s diagnosed?

Answer 5

clinically

if there is any uncertainty SPECT scan can be done

Question 6

what is the gold standard treatment for Parkinson’s?

Answer 6

levodopa and carbidopa
(dopamine precursor and peripheral antagonist to prevent breakdown)
- taken same time everyday

Question 7

what are the side effects of levodopa?

Answer 7

nausea and vomiting
dyskinesia/dystonia (involuntary writhing movements)
‘off states’
psychosis, hallucinations, reduced impulse control

Question 8

what are the names of some dopamine agonists?

Answer 8

roprinirole
pramipexole
apomorphine

Question 9

what is the name of a COMT inhibitors?

Answer 9

entacapone

Question 10

what are the names of some MOAB inhibitors?

Answer 10

selegeline

rasagiline

Question 11

what is apomorphine used for in Parkinson’s?

Answer 11

rescue for sudden off states

Question 12

what is one of the most common side effects of the medication for Parkinson’s? what is used to treat it?

Answer 12

nausea
-> domperidone
selective to peripheral dopamine so won’t affect activity of levodopa in brain

Question 13

what is Parkinsonism? how is it different to PD?

Answer 13

associated symptoms but defined underlying cause

absence of asymmetry, fast progression, sensory disturbance and pyramidal signs

Question 14

what is progressive supranuclear palsy?

Answer 14

vertical gaze palsy
lack of tremor
early insatiability and falls
speech and swallowing problems

Question 15

what is seen on MRI in progressive supranuclear palsy?

Answer 15

Mickey Mouse sign

Question 16

what is multi-system atrophy?

Answer 16

pyramidal signs
jerky, postural tremor
ataxia and cerebellar signs
early autonomic disturbance - postural hypotension, bladder dysfunction

Question 17

what is seen on MRI of multi-system atrophy?

Answer 17

hot cross bun sign

cerebellar and pontine atrophy

Question 18

how is vascular Parkinson’s differentiated from PD?

Answer 18

caused by multiple small infarcts
mainly gain disturbance
poor levodopa response

Question 19

how is dementia with lewy bodies differentiated from PD?

Answer 19

cognitive decline with visual hallucinations

- cognitive decline before Parkinson symptoms

Question 20

what drugs can cause drug induced Parkinson’s?

Answer 20

anti-psychotics
amiodarone
metaclopramide

Question 21

what is Wilson’s disease?

Answer 21

hepatic and renal failure
behavioural changes and cognitive decline
- keyser fisher rings in the eyes

Question 22

what is a resting tremor?

Answer 22

a tremor that occurs when muscles are relaxed

Question 23

what is a postural tremor?

Answer 23

tremor that is absent at rest and worse when maintaining a posture
doesn’t get worse with movement

Question 24

what can cause a postural tremor?

Answer 24

anxiety
alcohol withdrawal
benign essentail tremor

Question 25

what is the genetic aspect of a benign essential tremor?

Answer 25

autosomal dominant condition

Question 26

what are the features of a benign essential tremor?

Answer 26

worse if arms outstretched
bilateral, fast, low amplitude tremor
symptoms improve with alcohol and rest

Question 27

what is the treatment for a benign essential tremor?

Answer 27

propanolol

Question 28

what is an intention tremor?

Answer 28

task orientated and made worse throughout the range of movement

Question 29

what can cause an intention tremor?

Answer 29

cerebellar disease (MS, stroke, haemorrhage)

Question 30

what is dystonia?

Answer 30

involuntary, sustained muscle spasms that result in abnormal posturing and repetitive movements in the context of an associated tremor

Question 31

what can cause drug induced dystonia?

Answer 31

levodopa
anti-psychotics
metoclopramide

Question 32

how does acute dystonia present?

Answer 32

torticollis (cervical neck)
trismus (jaw clenching)
oculogyric crisis (eyes drawn up)

Question 33

how do you treat dystonia?

Answer 33

anti-spasmodics -> baclofen
botox (focal dystonia)
anti-cholinergic -> procyclidine (acute dystonia)

Question 34

what is chorea?

Answer 34

non-rhythmic irregular purposeless movements that move from one body part to another

Question 35

what genetic condition is chorea seen in?

Answer 35

Huntington’s disease

Question 36

what is the genetic mutation seen in Huntington’s disease?

Answer 36

autosomal dominant

CAG expansion on chromosome 4

Question 37

what does it mean if Huntington’s shows acceleration?

Answer 37

gets worse as it is passed down through the generations

Question 38

what are the early symptoms seen in huntington’s disease?

Answer 38

clumsiness, chorea

irritability, agitation, depression

Question 39

what are the advanced symptoms seen in hungtington’s disease?

Answer 39

chorea, myoclonus, rigidity, fits
cognitive decline and dementia
loss of ability to speak of swallow
saccadic eye movements

Question 40

what is the management for Huntington’s disease?

Answer 40

supportive treatment

15 year life span after diagnosis

Question 41

what is syndemans chorea?

Answer 41

self-limiting chorea usually seen in children

develops after strep throat

Question 42

what is myoclonus?

Answer 42

sudden, involuntary focal or generalised muscle jerks

Question 43

what condition is myoclonus seen in? what is the triad of symptoms it presents as?

Answer 43

Creutzfeldt–Jakob disease

dementia, ataxia, myoclonus