Approach to tremor and parkinsonism Flashcards Preview

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Flashcards in Approach to tremor and parkinsonism Deck (14):
1

4 aspects to describe tremor by

1. distribution
2. freq
3. amplitude
4. relation to movement

2

4 aspects to topography

1. unilater/bilater
2. symetrical
3. body part
4. prox/distal

3

2 main types in relation to movement

1 resting - when body completely at rest
2. action

4

3 types of action tremor

1. postural - holding hand out
2. kinetic - doing something
3. intention - reaching for something

5

4 common etiologies of tremor

1. physiological tremor - normal, but may be enhanced
2. cerebellar
3. essential
4. idiopathic parkinsonian

6

3 drugs associated with increase physio tremor

1. sympathomimetics
2. amphetimines
3. caffeine, nicotine

7

what is essential tremor

combo postural and kinetic tremor that often gets worse with age

8

**** 2 mainstay treatment of essential tremor

1. propranolol
2. primidone - has SEs

9

4 features of parkinsonsim

TRAP
Tremor
Rigidity
Akinesia (brady)
Post instability

10

what is parkinson disease

2 of 4 caridnal features and response to L-DOPA, progressive course, no alternative cause

11

*** 3 best predictors of idiopathic PD

1. Presence of rest tremor
2. Asymmetry of signs & symptoms
3. Good response to L-dopa therapy

12

feat of PD gait

1. stooped posture
2. Reduced arm swing
3. Reduced stride length (small,
shuffling steps)
4. Difficulty turning (multiple steps,
turning “en bloc”)
5. Freezing
6. Festinating

13

Red flags for PD - refer (8)

1. early falls
2. early prominent autonomic symptoms (e.g., orthostatic
hypotension, erectile dysfunction, bowel/bladder
involvement)
3. abnormal (limited or slow) vertical eye movements
4. pyramidal (UMN) signs
5. cerebellar signs
6. cortical signs (e.g., aphasia, apraxia, cortical sensory loss)
7. symmetrical signs & symptoms
8. oor response to L-dopa

14

6 PD drugs

1. L-dopa (+ peripheral decarboxylase inhibitor)
2. dopamine agonists
3. catechol-O-methyltransferase (COMT) inhibitors
4. monoamine oxidase B inhibitors
5. anticholinergic drugs
6. amantadine

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