Geriatric's Medical Potpourri 2 Flashcards Preview

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Flashcards in Geriatric's Medical Potpourri 2 Deck (24):

Parkinson's Dz
1. What is it? 3

2. PP?

1. An idiopathic, slowly progressive degenerative CNS disorder characterized by:
-Tremor (usually resting)
-Muscular rigidity

2. Striatal dopamine is deficient and dopaminergic neurons are lost in the substansia nigra


Some patients will develop what from this?

Some patients develop dementia


How should we Dx parkinson's Dz?

1. By history and physical exam
2. Diagnosed clinically if 2 of the 3 cardinal features (tremor, rigidity, bradykinesia) are present


1. Symptoms & signs in PD typically begin where and move where?

2. Symptoms reported by patients can include the following:

1. one extremity or one side but eventually involve other limbs and trunk

-Stiffness & slowed movements
-Tremor or shaking at rest
-Difficulty getting out of chair or rolling in bed
-Frequent falls or tripping
-Difficulty walking
-Memory loss
-Speech changes (whispering, rapid speech)
-Small handwriting
-Slowness in performing activities of daily living


Physical findings in Parkinson’s disease
What is initially affected and what does it move to?

Hands initially affected but legs, chin and head are involved with advanced disease.


Physical findings in Parkinson’s disease:

1. Muscle rigidity, cog wheeling type
2. Bradykinesia
3. Postural instability , assumes a stooped forward posture
4. Decreased arm swinging in ambulatory activity
5. Resting tremor / pill-rolling tremor
6. Masked facies
7. Micrographia
8. Dysarthria, hypokinetic, monotonous low volume
9. Painful dystonia
10. Dementia
11. Depression up to 50%
12. Akathisia inability to sit still
13. Seborrheic dermatitis face & scalp
14. Autonomic dysfunction e.g. orthostatic hypotension


Initial Treatment for Parkinson's

Initial drug treatment includes carbidopa/levodopa or dopamine agonists
-After 2 to 5 years levodopa becomes less effective


Other options include: Parkinson's?

1. monoamine oxidase type B inhibitors
2. Catechol-O-methyltransferase inhibitors
3. Amantadine
4. Deep brain stimulation (electrodes placed in subthalamic nucleus connected to a pacemaker) for drug resistant tremor or levodopa induced motor complications


What is a common problem in this?

How should it be managed?

Constipation is common and should be

prevented or relieved with dietary fiber, fruit juices, sometimes laxatives


Parkinson’s-end of life issues

1. Many patients eventually become severely impaired and immobile and are at risk for aspiration

2. Eating may become impossible

3. Dementia

4. Discuss end-of-life care issues early

5. Advise patient to appoint a surrogate to make medical care decisions if they become incapacitated


Polymyalgia Rheumatica characterized by what?

characterised by
1. severe bilateral pain and
2. morning stiffness of the

shoulder, neck and pelvic girdle.



Polymyalgia Rheumatica:
1. There is an increased incidence of the disorder where?

2. Women are more frequently affected than men with a M:F ratio of approximately what?

1. At higher latitudes

2. 1:3.


1. Polymyalgia Rheumatica: What genes is it linked to?

2. What else has been linked to? 5

1. HLA-DRBI*04 and *01 alleles

-antibodies to respiratory syncitial virus and
-adenovirus in PMR and the association between the increased incidence of the disorder and epidemics of
-Mycoplasma pneumoniae,
-chlamydia pneumoniae and
-Parvovirus B19.


Polymyalgia Rheumatica: Other symptoms and signs may include?

1. Pain on active and passive movement of joints ( shoulders 70-95%, hips and neck 50-70%)
2. Morning stiffness of more than one hour and also after periods of rest.
3. Myositis
4. Lethargy
5. Loss of weight
6. Depression
7. Fever
8. Joint effusions


Polymyalgia Rheumatica: May or may not see symptoms of what?

± Asymmetric peripheral arthritis ( mainly knee and wrist)
± Carpal tunnel syndrome
± edema of hands, wrists, ankles and feet


Polymyalgia Rheumatica: Labs?
3 (whats the most important test)

1. ESR…the most useful laboratory test -
although up to 20% of patients may have a normal ESR at diagnosis. Plasma Viscosity can be used instead of ESR.

2. C-reactive protein
3. IL-6 levels

4. CBC –
5. Rheumatoid and ANA
6. LFTs


What levels of ESR?

raised to a level of at least 40 mm/hour and often 100 mm/hour


How are the following changed in Polymyalgia Rheumatica:
1. IL-6 levels?
2. CBC?
3. Rheumatoid and ANA?
4. LFTs?

1. usually raised, and a useful marker of disease activity

2. normochromic, normocytic anemia

3. not elevated!!

4. mildly elevated in 1/3 of patients


Polymyalgia Rheumatica Associated Dzs?

Giant cell arteritis co-exists in about 30% of patients with PMR and shares many features of the disease


Polymyalgia Rheumatica:
Advise people with PMR to seek medical attention if they developed any symptoms of GCA. Such as? 3

1. any new headache,
2. jaw claudication or
3. visual disturbances.


Polymyalgia Rheumatica:
Monitor response to treatment by assessing changes in clinical features and inflammatory markers– Such as? 2

1. ESR
2. CRP


DOC for PMR?

Prednisone remains the drug of choice for treating PMR.
-Treatment is generally initiated at 15mg/day per day


What should be given to all PMR patients who are receiving doses of prednisone (or equivalent)>5mg daily for >6 months?

1. Bisphosphonates, or
2. if they are not tolerated, Calcium and vitamin D supplementation


1. PMR occurs in patients who on average are > how old?

2. Cardinal symptoms are what?

3. Clinicians must be alert to mimics, including what? 4

4. What is usually raised at disease onset?

5. ___________ is present in about 30% of patients

6. PMR is treated with what?

1. 70 years of age.

2. shoulder & hip girdle pain with pronounced stiffness lasting at least one hour.

-metabolic bone disease, and
-elderly onset rheumatoid arthritis.

4. ESR or CRP , or both,

5. Giant cell arteritis

6. oral glucocorticoids.