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1.08) NEUROLOGY > 3. MTB Step 3 - Parkinson Disease (PD) > Flashcards

3. MTB Step 3 - Parkinson Disease (PD) Flashcards

Cards Complete:

1
Q

PARKINSON DISEASE (PD)

PRESENTATION

What are (2) Presenting Signs of Parkinson Disease (PD)?

A
  1. Tremulous patient
  2. Slow, abnormal “Festinating” Gait
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2
Q

PARKINSON DISEASE (PD)

PRESENTATION

What are (6) Physical Finding in Parkinson Disease (PD)?

A
  1. “Cogwheel” Rigidity
  2. Resting Tremor (resolves when the patient moves or reaches for something)
  3. Hypomimia (masklike, underreactive face)
  4. Micrographia (small writing)
  5. Orthostasis
  6. Intact cognition and memory
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3
Q

PARKINSON DISEASE (PD)

DIAGNOSIS

How is Parkinson Disease (PD) diagnosed?

A

Clinically

There are NO specific diagnostic tests to prove someone has PD

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4
Q

PARKINSON DISEASE (PD)

SEVERITY

What is defined as “Severe Symptoms” of Parkinson Disease (PD)?

A

The inability to perform Activities of Daily Living (ADLs):

  • Cooking
  • Cleaning
  • Personal Grooming
  • Shopping
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5
Q

PARKINSON DISEASE (PD)

TREATMENT

  1. What is the treatment for Mild Parkinson Disease (PD) in a patient Age < 60?
  2. What is the treatment for Mild Parkinson Disease (PD) in a patient Age > 60?
A
  1. Anticholinergic agent (Benztropine, Hydroxyzine)
  2. Amantadine (older patients develop far more AEs from anticholinergics agents. ie, worsens memory)
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6
Q

PARKINSON DISEASE (PD)

TREATMENT

What are the (2) First-Line Treatments for the Severe Symptoms of Parkinson Disease (PD)?

A
  1. Levodopa / Carbidopa
    • Advantage: Greatest Efficacy
    • Disadvantage: “On-Off” phenomena with uneven Long-Term effects and more Adverse Effects
  2. Dopamine Agonists (Pramipexole, Ropinirole, Cabergoline, Rotigotine, Apomorphine)
    • Advantage: Fewer Adverse Effects
    • Disadvantage: Less Efficacy
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7
Q

PARKINSON DISEASE (PD)

TREATMENT

What are (4) other Therapies that may be used to control the Severe Symptoms of PD if the First-Line medications cannot?

A
  1. COMT Inhibitors: Tolcapone, Entacapone (these Block Dopamine metabolism and extend the effect of Dopamine Agonists)
  2. MAO Inhibitors: Selegiline, Rasagiline, Safinamide
  3. Pimavanserin: 5HT Inhibitor (antipsychotic that does not worsen PD because its mechanism is NOT dopamine inhibition)
  4. Deep Brain Stimulation: when medical therapy does not control symptoms
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8
Q

PARKINSON DISEASE (PD)

TREATMENT

What should be added if Levodopa treatment for PD causes psychosis?

A

Quetiapine

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9
Q

PARKINSON DISEASE (PD)

TREATMENT

What medication used in PD is a Dopamine Agonist deliverable by Skin Patch?

A

Rotigotine

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10
Q

PARKINSON DISEASE (PD)

TREMOR

What is the definition for an Essential Tremor?

A

A Tremor that occurs BOTH at Rest and with Action.

  • Not associated with any other illness.
  • No specific diagnostic test.
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11
Q

PARKINSON DISEASE (PD)

TREMOR

  1. What is the Best INITIAL Therapy for Essential Tremor?
  2. What should be added after 1 -2 weeks of initial therapy if the tremor is still present?
  3. What should you switch to if the Tremor still persists?
  4. What should be done if the question describes a patient with Multiple failed medical therapies and Severe tremor that interferes with functioning?
A
  1. Beta-Blockers (especially Propranolol)
  2. Primidone (antiepileptic that controls tremor)
  3. Topiramate or Gabapentin
  4. Thalamotomy (unilateral) - using MR-focused Ultrasound to Ablate the Thalamus with local heat
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12
Q

MULTIPLE SCLEROSIS (MS)

PRESENTATION

What is the Presentation of Multiple Sclerosis (MS)?

A

Abnormalities of ANY part of the Central Nervous System (CNS):

  • Optic Neuritis - most common abnormality
  • Atonic Bladder - motor & sensory problems and defects of the bladder

The CNS abnormalities improve only to have another defect develop several months to years later.

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13
Q

MULTIPLE SCLEROSIS (MS)

PRESENTATION

Besides the eye and bladder defects, what are (4) other Common Features of Multiple Sclerosis (MS)?

A
  1. Depression
  2. Fatigue
  3. Hyperreflexia
  4. Spasticity
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14
Q

MULTIPLE SCLEROSIS (MS)

DIAGNOSIS

  1. What is the Best INITIAL & Most ACCURATE Diagnostic Test for MS?
  2. What Diagnostic Test should be performed if the most accurate test is Nondiagnostic for MS?
A
  1. MRI: no reason for CT scan since it is far less sensitive
  2. CSF (lumbar tap): Presence of Oligoclonal Bands
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15
Q

MULTIPLE SCLEROSIS (MS)

DIAGNOSIS

What is a rare Adverse Reaction to the Gadolinium contrast used in MRI for MS patients with Renal Insufficiency?

A

Nephrogenic Systemic Fibrosis

  • A systemic overreaction with increased collagen deposition in soft tissues.
  • Hardened fibrotic nodules develop in the skin, and in severe cases, the heart, lung, and liver can be involved.
  • There is no specific therapy.
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16
Q

MULTIPLE SCLEROSIS (MS)

TREATMENT

What is the Best INITIAL Therapy for Acute Exacerbations of MS to help speed resolution?

A

STEROIDS

17
Q

MULTIPLE SCLEROSIS (MS)

TREATMENT

What are (9) Disease-Modifying therapies used in the treatment of MS?

A
  1. Dalfampridine
  2. Ocrelizumab - anti-CD20 drug that decreases progression
  3. Glatiramer
  4. Fingolimod
  5. Alemtuzumab - anti-CD52 drug that inhibits lymphocytes and deters progression
  6. Natalizumab - causes PML
  7. Beta Interferon
  8. Mitoxantrone
  9. Daclizumab
18
Q

MULTIPLE SCLEROSIS (MS)

TREATMENT

  1. Which medication is used to treat the Fatigue associated with MS?
  2. Which (2) medications are used to treat the Spasticity associated with MS?
A
  1. Amantadine
  2. Baclofen or Tizanidine
19
Q

MULTIPLE SCLEROSIS (MS)

TREATMENT

What are (3) Oral Therapies for MS?

A
  1. Dimethyl Fumarate
  2. Fingolimod
  3. Teriflunomide

1.08) NEUROLOGY (4 decks)

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