Parkinson's Disease Flashcards
(151 cards)
1
Q
What are the two motor systems in the body?
A
Pyramidal and Extrapyramidal
2
Q
Parkinson’s disease is a dysfunction of the midbrain?
A
Extrapyramidal
3
Q
What are the three parts of basal ganglia?
A
Corpus Striatum, Amygdala, Claustrum
4
Q
What are the structures that compose the corpus striatum?
A
Caudate nucleus, Putamen, Globus Pallidus
5
Q
What composes the Lentiform nucleus?
A
Putamen, Globus Pallidus
6
Q
What composes the Neostrium?
A
Caudate Nucleus, Putamen
7
Q
What supplies neostriatum?
A
Lenticulostriate, MCA
8
Q
What supplies globus pallidus?
A
Recurrent artery of Heubner, ACA
9
Q
What are the two primary efferents of the extrapyramidal system?
A
Substantia Nigra Pars Reticulata and Globus Pallidus Interna
10
Q
What is the primary afferent of the direct pathway?
A
Striatum
11
Q
What is the primary afferent of the indirect pathway?
A
Subthalamus
12
Q
What is the inhibitory NT of the brain?
A
GABA
13
Q
What is the excitatory NT of the brain?
A
Glutamate
14
Q
NT: Dopamine in the indirect pathway
A
Inhibitory
15
Q
NT: Dopamine in the direct pathway
A
Excitatory
16
Q
NT: ACH in the indirect pathway
A
Excitatory
17
Q
NT: ACH in the direct pathway
A
Inhibitory
18
Q
To be able to do its function, what should be the level of ACH and Dopamine in the striatum?
A
Equal
19
Q
Group of disorders with disturbances in the dopamine system of the basal ganglia
A
Parkinsonism
20
Q
Three types of parkinsonism
A
Primary PD, Secondary PD, Parkinson’s plus syndrome
21
Q
What is the diagnostic tool for PD?
A
Apomorphine Test
22
Q
Two other names of PD
A
Shaking palsy and paralysis agitans
23
Q
It is a very slowly progressive disorder on CNS with motor and non-motor symptoms
A
Parkinson’s Disease
24
Q
What gender is predominantly affected by PD?
A
M>F
25
What is the average onset of PD?
40-60 years
26
What is the onset of Young-onset?
21-40 years
27
What is the onset of Juvenile-onset?
<21 years
28
The progressive loss of dopaminergic cells that produces dopamine in substantia nigra
Primary PD
29
What are the two etiology of Primary PD?
Idiopathic and Genetic
30
The 3 genes affected in Primary PD
PPL: Pink 1, Park 1, Lark 2
31
Primary PD may be secondary to what?
Hyperactivity of cholinergic cells in the striatum
32
What diagnostic tool used in Primary PD?
MRI
33
What do you see in MRI to confirm Primary PD?
Paleness of SN
34
What is the kind of symptoms first to occur in primary PD?
Non-motor > Motor
35
Motor symptoms in primary PD occur in what percentage of destruction?
30-60%
36
What protein is absent in the BG that causes the appearance of Lewy bodies?
Synuclein protein
37
"Von economo's disease"
Post-infectious PD
38
What is the other name of Post-infectious PD?
Encephalitis Lethargica
39
What is the route of Post-infectious PD?
Viral
40
Post-traumatic PD is secondary to what MOI?
Repetitive Trauma
41
What occupation is predisposed to Post-traumatic PD?
Boxers
42
What is the other name of Post-traumatic PD?
Dementia Pugilistica
43
What toxin is the most common cause of toxic PD?
Manganese
44
What heroine is associated with Toxic PD?
1-methyl-4-phenyl-1236-tetrahydropyridine (MPTP)
45
What are the other 4 toxins associated with Toxic PD?
PCCM: Pesticides, Cyanide, Carbon Disulfide, Methanol
46
"Wilson's Disease"
Metabolic PD
47
What causes metabolic PD?
Hepatolenticular degeneration
48
What chromosome is affected by metabolic PD?
Chromosome 13
49
What is the genetic route of metabolic PD?
Autosomal Recessive
50
What causes metabolic PD?
Overaccumulation of Copper
51
Three areas where coppers go?
Eyes, Liver, BG
52
What manifestation can be seen in the eyes if there is an overaccumulation of copper?
Kayser-fleischer ring
53
Where specific area of BG is affected in metabolic PD?
Lentiform nucleus
54
What manifestation can be seen in the liver if there is an overaccumulation of copper?
It becoms firm and large
55
What are the three drugs associated with Drug-induced PD?
Anti-depressant, anti-hypertension, anti-psychotic
56
What PD is resulted in the lesion of blood supply?
Vascular PD
57
What are the 6 types of secondary PD?
Post-infectious, Post-traumatic, Toxic, Metabolic, Drug-induced, Vascular
58
What is the most common presenting symptom of PD?
Resting Tremor
59
5 sites of resting tremor
Hand, FA, Postural tremor, Jaw & Tongue, LE
60
It is the rapid extension-flexion of the index finger and thumb
Pill-rolling
61
What are the 3 frequencies of Pill-rolling?
3-5 Hz, 4-6 Hz, 4-7 Hz
62
What type of tremor is seen in advanced stage PD?
Action tremor
63
What is induces resting tremor?
Stress
64
When does the resting tremor disappear?
During sleep
65
Velocity-independent resistance to passive movement
Rigidity
66
Two types of rigidity
Lead pipe and Cogwheel
67
Type of rigidity that is uniform, sustained, resistance
Lead Pipe
68
Type of rigidity that is intermittent, jerky-racthet like resistance
Cogwheel
69
What is the other name of lead pipe?
Plastic
70
Cogwheel is secondary to what?
Superimposed tremors
71
Most disabling symptom of PD
Bradykinesia
72
(+) delayed initiation
Akinesia
73
(+) decrease amplitude of movement
Hypokinesia
74
Masked face
Hypomimia
75
(+) small handwriting
Micrographia
76
(+) slowness of movement
Bradykinesia
77
(+) decrease thought process
Bradyphrenia
78
What is the symptom that is last to occur in PD?
Postural Instability
79
Postural Instability is indicative of what stage of PD?
Advanced stage
80
Patients with Postural Instability have a risk for ____?
Falls
81
What posture is predominant in flexor muscles?
Simian Posture
82
6 components of simian posture
Forward head, Protracted shoulder, shoulder ADIR, elbow flexion, hip flexion, knee flexion
83
3 components of a striatal hand
FA pronation, wrist & MCP flexion, IP extension
84
3 components of a striatal foot
DIB: DF, Inversion, Big toe extension
85
What is the cardinal sign of PD?
TRAP: Tremor, Rigidity, Akinesia, Postural Instability
86
Four gait difficulty is seen in PD patients
Shuffling, Festinating, Freezing, Fear of Falling
87
Typical gait pattern in PD
Shuffling gait
88
Gait with small steps with increased speed
Festinating Gait
89
Gait due to the start of an off-state phenomenon
Freezing gait
90
Cautious gait
Fear of falling
91
Features of shuffling gait
Decrease step length, stride length, BOS, velocity
92
Festinating gait is secondary to what factors?
Displaced COG and Advance stage PD
93
What are the 6 other manifestations of PD?
PBSACB: Pain, Bulbar dysfunction, Sleep disorder, Autonomic Dysfunction, Cognitive Impairments, Behavioral changes
94
What is the most common source of pain in PD?
Limb rigidity
95
What are the two syndrome causes of pain in PD?
Postural stress and Restless leg
96
What is the CN affected in PD?
CN 3, 7, 9, 1
97
Excessive drooling
Sialorrhea
98
What is the most common speech problem in PD?
Hypokinetic dysarthria
99
What is the most common speech problem in advanced-stage PD?
Mutism
100
Three features of sleep disorder in PD
Insomnia, Excessive day time sleeping, REM sleep behavior disorder
101
Six features of Automatic dysfunction in PD
Erectile dysfunction, urinary incontinence, excessive sweating, seborrhea, OH, constipation
102
What are the two cognitive and behavioral changes were seen in PD?
Dementia and Depression
103
Three positive prognosticating factors of PD
Tremor, Rigidity, Family History
104
Six negative prognosticating factors of PD
Bradykinesia, Akinesia, Gait difficulty, Cognitive impairments, Postural instability, Late age onset
105
Modified HY: Unilateral disability
1
106
Modified HY: Confined to bed or wheelchair
5
107
Modified HY: Bilateral disability with a balance problem
3
108
Modified HY: Unilateral disability + axial involvement
1.5
109
Modified HY: Bilateral disability
2
110
Modified HY: All s/sx is present and severe
4
111
Modified HY: Bilateral disability with the recovery of pull-test
2.5
112
Modified HY: Unsteadiness but the patient can live independently
3
113
Modified HY: Standing and walking are only possible with assistance
4
114
Three consideration with pharmacologic therapy in PD
Time, Low Protein Diet, and Peak Dose
115
Time consideration: PD medications take effect
1 hr before or after a meal
116
Why do PD patients should have a low protein diet?
High protein level inhibits the absorption of levodopa
117
What is the time effective to conduct a rehab for PD patients?
1 hour after taking levodopa
118
The precursor of dopamine
Levodopa
119
The drug that prevents the early conversion of levodopa
Carbidopa
120
The gold standard drug for PD
Sinemet
121
Two phases of pharmacologic therapy in PD
Honeymoon period and Wearing off phase
122
The phase where optimal effects of medication occur
Honeymoon period
123
The phase where effects of medication start to wear off
Wearing off phase
124
How long does the Honeymoon period last?
7-8 years
125
What do physicians prescribe when the patient is already experiencing the wearing-off phase?
Increase dosage of levodopa
126
9 adverse effect of increased dosage of levodopa
VPDMDNDMO: Visual hallucination, Peak dose dyskinesia, Dystonia, Motor fluctuations, Dysuria, Nausea, Dryness of mouth, Mood/sleep disorders, OH
127
What is the most common adverse effect experienced by patients?
Visual hallucination
128
What are the two involuntary movements seen experienced by patients?
Grimacing of face and limb choreoathetosis
129
What is the most common site of dystonia in PD?
Foot = clawing of toes
130
What is the most common site of dystonia in the body?
Neck
131
Feeling of restlessness
Akathisia
132
Motor fluctuations are caused by?
End dose deterioration, On-off phenomenon
133
Difficulty in urination
Dysuria
134
What are the two medications administered together with Sinemet to prevent adverse effects?
Dopamine agonist and anticholinergic
135
7 dopamine agonist
Bromocriptine, premipexole, ropinerole, pergolide, cabergolide, amantadine, apomorphine
136
2 anticholinergic
Trihexyphenidyl, Bentropine
137
What substance inhibits NT in the brain including dopamine?
MAO: Mono-amine oxidase
138
2 MAO-inhibitors
Rasagiline, Selegiline
139
Four types of Parkinson plus syndrome
Progressive Supranuclear palsy, Corticobasal ganglionic degeneration, Multi-system Atrophy, PD with early dementia
140
Parkinson plus syndrome due to (-) tau protein in the midbrain
Progressive Supranuclear palsy
141
Parkinson plus syndrome due to (-) tau protein in the cortex
Corticobasal ganglionic degeneration
142
Parkinson plus syndrome due to (-) synuclein protein
Multi-system Atrophy
143
What are the PD-like symptoms seen in Progressive Supranuclear palsy?
Shuffling gait and Difficulty in performing vertical gaze
144
What are the PD-like symptoms seen in Corticobasal ganglionic degeneration?
Asymmetric, akinetic rigid syndrome; Apraxia; Alien hand syndrome
145
Sites affected in Multi-system Atrophy
Basal ganglia, cerebellum, autonomic system
146
Another name of Multi-system Atrophy - Basal ganglia
Striatonigral degeneration (MSA-P)
147
Another name of Multi-system Atrophy - Cerebellum
Olivopontocerebellar Atrophy (MSA-C)
148
Another name of Multi-system Atrophy - Autonomic system
Shy-dager syndrome (MSA-A)
149
What is the most common cause of dementia?
Alzheimer's disease
150
Dementia due to cycad seed toxicity
Guamanian ALS
151
Dementia due to (-) synuclein protein
Diffuse cortico lewy bodies
