Exam 4 Parkinson's Flashcards Preview

Q4 Clin Med III (GI) > Exam 4 Parkinson's > Flashcards

Flashcards in Exam 4 Parkinson's Deck (26):
1

Idiopathic Parkinson's is?

Progressive degeneration of nigrostriatal neurons
Apoptosis/Cell death from:
Oxidative stress
Mito dysfxn
Excitotoxicity
Inflammation

2

Idiopathic Parkinson's 4 cardinal features?

1) Resting tremor: unilateral

2) Rigidity: cog-wheel, mm stretch intact

3) Akinesia-Bradykinesia: masked face, ↓ dexterity, ↓ animation

4) Postural instability: stoop, ↓center of gravity (falls)

3

Idiopathic Parkinson's presentation: Primary motor? (4)

Tremor
Rigidity
Brady
Postural instability

4

Idiopathic Parkinson's presentation: Other motor? (5)

Slow, soft speech
Face masking
↓ blinking
Drooling
Tiny handwriting

5

Idiopathic Parkinson's presentation: Cognitive? (4)

Slow thought
Word-search
Cognitive impair
Dementia

6

Idiopathic Parkinson's presentation: Psych? (4)

Depression
Anxiety
Panic attacks
Drug-induced hallucination

7

Idiopathic Parkinson's presentation: Autonomic? (5)

Sweat
Orth HypoTN
Impotence
Constipation
Polyuria

8

Idiopathic Parkinson's presentation: Sensory? (4)

Pain
Numb
Tingle
Loss of smell

9

Idiopathic Parkinson's diagnostic criteria:

Possible?

Probable?

Definite?

Poss = 2 of 4 Group A, No Group B

Prob = 3 of 4 A, No B, 3+ yrs, sustained response to DA

Def = Possible met + histopath confirmation

10

Group A sxs? (4)

Resting tremor
Bradykinesia
Rigidity
Asymm onset

11

Group B sxs? (7)

in 1st 3 yrs:
Freezing
Postural instab
Hallucinations
Gaze palsy
Dementia before sxs in 1st yr
Focal brain lesions
Neuroleptic use

12

Drug-induced Parkinson's vs Idiopathic? (3)

U anti-nausea or anti-psych med
No resting tremor
Akathisia (restless/anxious) from med

13

Vascular dz vs Idiopathic? (4)

Gait disturb
Spasticity
Hyper-reflex
Pseudobulbar affect (uncontrolled laugh/cry)

14

Postencephalitic vs Idiopathic?

Hx of encephalitis (1917-1926) + high fever/delirium

15

Apraxia is?

Inability to do learned movements

16

Normal Pressure Hydrocephalus vs Idiopathic? (4)

Apraxia of gait
Rigidity
Cognitive impair
Urine incontinence

17

Progressive Supranuclear Palsy vs Idiopathic? (8)

Pseudobulbar affect
Gaze palsy
Slowed saccades (Normally fast eye mvmts)
Falls
Axial rigidity
No tremor
Spatic-ataxic dysarthria (mixed speech)
Poor DA response

18

Multi-system Atrophy vs Idiopathic? (8)

Falls
Axial dystonia
Respiratory stridor
Akinesia
No tremor
Dysmetria (under/over shooting)
Prominent autonomic features
Poor DA response

19

Idiopathic Parkinson's tx: Symptoms? (6)

DA
Antichol
COMT inhib
MAOI
Amantadine
Deep brain stim

20

L-Dopa/Carbidopa (Sinemet) MOA?


Doesn't help what? (3)

Block DA decarboxylase in periphery
No BBB penetration

Freezing, instability, autonomic sxs

21

L-Dopa/Carbidopa (Sinemet) benefits?

S/E? (6)

Smaller amounts of L-DA needed = less nausea

N
Dizzy
Ortho hypoTN
Sedation
Dreams/hallucination
Behaviors
On-Off episodes

22

DA Agonists indication?

< 70yo w/ normal cognition
Mild sxs
Helps dyskinesia

23

DA Agonists S/E?

N
Ortho hypoTN
Sedation
Halluc
Impulse control dis

24

MAOBI (-giline) indications?

S/E?

Mild sxs

Sleep dis
Halluc
Severe HTN w/ cheese

25

Tx for "Off"?

Tx for delayed or no "On"?

DA agonists, COMT, ↑Sinemet, ↓protein

↑Sinemet

26

Tx for freezing?

↑Sinemet, DA agonist