Neuro - Chronic Disorders

Question 1

what triad of symptoms makes up parkinsonism?

Answer 1

rigidity
tremor
bradykinesia

Question 2

risk factors for parkinson’s?

Answer 2

age
FHx
head injury
drugs

Question 3

what drugs can cause parkinsonism?

Answer 3

typical antipsychotics (older)
legal highs
anti emetics (dopamine antagonist e.g prochloperazine)

Question 4

features of parkinson’s?

Answer 4

pill rolling tremor at rest
cog wheel
shuffling gait 
postural instability
lack of arm swing 
hypomimia
reduced blink rate
micrographia

Question 5

systemic features of parkinson’s?

Answer 5

anosmia
REM sleep disorders
retention/constipation
depression
hallucination 
postural hypotension

Question 6

how can drug induced parkinson’s present?

Answer 6

symmetrical
tardive dyskinesia
akathasia
orolingual dyskinesia

Question 7

pathology or parkinson’s?

Answer 7

loss of dopaminergic neurons in the substantia nigra of the basal ganglia

Question 8

Ix for parkinson’s?

Answer 8

clinical (improves with L dopa use)
MRI
DAT scan (reduced uptake in basal ganglia)

Question 9

Tx for parkinson’s?

Answer 9

L dopa + COMT inhibitor (e.g carbidopa)

dopamine agonist e.g pramipexole, bromocriptine

MAO B inhibitor e.g selegeline

Question 10

complications of dopaminergic therapy?

Answer 10

dyskinesias (‘freezes’ as drug stops working then excess movement)

compulsive behaviour
nausea
hypotension
arrythmias

Question 11

is smoking good or bad for parkinson’s?

Answer 11

good

Question 12

what are parkinson’s plus syndromes?

Answer 12

have the core features of parkinsonism but can be distinguished

Question 13

how to distinguish multi system atrophy from parkinson’s?

Answer 13

impotence

urinary retention/incontinence

Question 14

how to distinguish progressive supranuclear palsy from parkinson’s?

Answer 14

difficulty moving eyes vertically

loss of balance

Question 15

how to distinguish corticobasal degen from parkinson’s?

Answer 15

movement disorder is worse

Question 16

what are LMN signs?

Answer 16

weakness
fasciculations
atrophy
hyporeflexia

Question 17

what features MND NOT have?

Answer 17

sensory loss
sphincter disturbance
eye movement changes

Question 18

most common type of MND? what signs are there?

Answer 18

ALS

UMN + LMN

Question 19

what does progressive bulbar palsy affect?

Answer 19

CN IX-XII

progresses to ALS

Question 20

what does progressive muscular atrophy affect?

Answer 20

LMN
distal then proximal muscles
best prognosis

Question 21

what does primary lateral sclerosis affect?

Answer 21

UMN

Question 22

in MND, where can there be a loss of neurone?

Answer 22

pre central gyrus
motor CNs
anterior horn cells

Question 23

Tx for MND?

Answer 23

MDT approach
riluzone
baclofen
antidepressants

Question 24

what happens in myasthenia gravis?

Answer 24

antibodes to acetyl choline receptors attack

destroy post synaptic membrane of the NMJ

reduced muscle fibre action potentials

Question 25

features of myasthenia gravis?

Answer 25

``` muscle weakness worse at end of day proximal weakness ptosis diplopia dysphagia dysarthria facial weakness SOB normal reflexes ```

Question 26

Ix for myasthenia gravis?

Answer 26

serum AChR Abs MuSK Abs pulmonary function tests (FVC)

Question 27

Tx for myasthenia gravis?

Answer 27

pyridogstimine pred IV Igs/plasma in crisis

Question 28

in a myasthenia gravis crisis, what changes can occur on PFTs?

Answer 28

low FVC | low NIF

Question 29

what are those with myasthenia gravis at higher risk of developing?

Answer 29

thymoma