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Hugh's MD2 Core Conditions and Presentations > Parkinson Disease > Flashcards

Parkinson Disease Flashcards

1
Q

What are some causes of sudden declines in PD symptoms?

A

Not taking meds

Intercurrent illness - eg UTI

Dehydration

Poor nutrition

Deconditioning

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2
Q

What are the advanced therapies for PD?

A

Apomorphine infusion (dopamine agonist)

Deep brain stimulation - stimulate the globus pallidus or subthalamic nucleus

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3
Q

What is the main difference between dementia with Lewy bodies and Parkinson disease?

A

The dementia preceeds the movement disorder in DLB, in Parkinson disease the movement disorder occurs first

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4
Q

What is restless legs?

A

Deep noring pain in the legs at night that is relieved by movement

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5
Q

What is the purpose of a decarboxylase inhibitor?

A

Stops metabolism of levedopa in the periphery to prevent side effects

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6
Q

What happens to the eyes in PD?

A

Reduced blink rate

Hypometric saccades

Saccadic intrusion into smooth pursuit

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7
Q

What the incidence of Parkinson disease?

A

100-200 per 100,000 over 40 years

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8
Q

How long might anosmia preceed the movement symptoms?

A

15-20 years

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9
Q

What is the pathology of PD?

A

Loss of dopaminergic neuron in the substantia nigra, therefore dopamine production, in the basal ganglia

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10
Q

What are some causes of PD or PD like syndrome?

A

Genetic

Brain injury

Pesticide exposure

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11
Q

What does a festinating gait look like?

A

Difficult to initiate walking

Increasing speed of steps

+/- Fall

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12
Q

How does the levodopa regimen change with the progression of the disease?

A

Increase dose frequency as endogenous dopamine production decreases so they have exogenous dopamine most of the time

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13
Q

What is the ratio of male to female in the incidence of Parkinson disease?

A

3:2

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14
Q

What is the first line therapy for PD?

A

Levedopa

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15
Q

What are some nocturnal symptoms of PD?

A

Enacting their dreams in bed

Restless legs

Reduced turning in bed

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16
Q

What does tremor predominant PD refer to? What are the implications?

A

Predominance of tremor at presentation, usually slower progression of disease

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17
Q

What is the Hoen-Yhaer staging?

A

Staging for PD severity

Uses the pull test

18
Q

What anti-emetic is levodopa accompanied with?

A

Domperidone

19
Q

Can PD be diagnosed without a tremor?

A

Yes

20
Q

What does asymmetry of motor sign indicate?

A

More likely PD than an other cause of Parkinsonism

21
Q

What is the side effect of levodopa?

A

Dyskinesia

Nausea

22
Q

What is the most effective intervention for improved walking and falls prevention?

A

Physio

Exercises requiring balance

23
Q

What is the name of the facial affect PD patient might exhibit?

A

Hypomimia

Blank face

24
Q

What is madopar?

A

Levodopa and benserazide

25
Q

What are some other PD medications?

A

COMT inhibitors

Selective monoamine oxidase type B inhibitors

Dopamine agonists (pramipexole)

Anticholinergic

Amantadine

26
Q

What are the cardinal feature of PD?

A

Tremor

Rigidity

Bradykinesia

Postural instability

27
Q

What is the mean age of diagnosis?

A

Around 70

28
Q

What is the main symptomatic relief provided by levodopa?

A

Reduced bradykinesia

29
Q

What causes acute akinesia in PD?

A

Not taking their medication

Intercurrent illness

30
Q

How does speech change in PD?

A

Lower volume

31
Q

What is dystonia?

A

Involuntary muscle contraction involving abnormal movements and postures

32
Q

What is dystonia is the setting of PD likely due to?

A

Drugs

33
Q

What is the difference between GEM and Fast track?

A

GEM is slow stream for the less motivated patient

Fast track is for the highly motivated patient

34
Q

What are the features of a PD gait?

A

Shuffling +/- festinating/freezing

Brady and hypokinetic

Camptocormia (stooped posture)

Loss of arm swing

Increase in tremor

Difficult crossing threshold

Slow turning

35
Q

What is the pull test?

A

When the patient is pulled back they take multiple steps (instead of one)

36
Q

What are the most troubesome non-motor features of PD?

A

Orthostatic hypotension

Urinary frequency

Constipation

37
Q

What are the side effects of dopamine agonists?

A

Hypersexuality

Gambling

Binge eating

Shopping

38
Q

An increase in tremor when walking indicates what?

A

PD is most likely over other movement disorders

39
Q

How does dementia develop in PD?

A

It develops after movement symptoms in all PD patients

40
Q

What is the prevalence of depression in PD patients? How it is treated?

A

40%

Treat with SSRI

41
Q
A
42
Q

What is on-off syndrome?

A

Episodes of decreased mobility despite medications

Can prepitate failure to turn “on” if for a prolonged period

Hugh's MD2 Core Conditions and Presentations (67 decks)

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