Parkinson's disease and Parkinsonism Flashcards Preview

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Flashcards in Parkinson's disease and Parkinsonism Deck (50)
1

The symptoms of dystonia, tick, myoclonus, chorea and tremor are due to a problem in what part of the motor system?

Basal ganglia

2

Spasticity is due to a problem in what part of the motor system?

Corticospinal tract

3

Ataxia is due to a problem is which part of the motor system?

Cerebellum

4

What are the three components of the parkinsonian syndrome?

Rigidity
Akinesia/Bradykinesis
Resting tremore

5

What is chorea?

Uncontrolled writhing movements, sometimes described as "dancing"

6

What is ballismus?

Large chorea movements

7

What two places do you get atrophy in parkinson's disease?

Substantia nigra
Locus coeruleus

8

What does the locus coeruleus produce?

Noradrenaline

9

Where is the locus coeruleus?

A nucleus in the pons

10

What is the main neurohistological hallmark in parkinson's disease?

Lewy bodies

11

What are the four motor symptoms of parkinson's disease?

Bradykinesia
Resting tremor
Rigidity
Postural and gait impairment

12

What word describes decreased facial expression and eye blinking?

Hypomimia

13

What work describes a quiet voice?

Hypophonia

14

What word describes progressively smaller handwriting?

Micrographia

15

What clinical examinations would you perform to assess bradykinesia?

Askinf patients to perform repetitive movements as quickly and widely as possible eg;
- Opening and closing the hand
- Tapping the foot

16

What kind of tremor is seen in parkinson's disease?

Resting tremor

17

When is it best to observe a tremor in parkinson's disease?

When the patient is concentrating on a mental tae (eg counting backwards from 100)

18

Does a resting tremor get better or worse on movement?

Usually vanishes on active movement

19

What differentiates rigidity from spasticity?

Rigidity: Felt through full range of movememt "lead pipe"
Spasticity: Velocity dependant "clasp knife"

20

What is cog wheel rigidity?

Resting tremor + lead pipe rigidity. It is jerky rigidity most clearly felt at the wrist.

21

What is a parkinsonian gait?

Slow, narrow based with short shuffling steps. Also festination

22

What is festination?

very fast succession of steps and difficulty stopping, often seen in parkinsons

23

List the non motor symptoms of parkinson's disease?

Early:
Hyposmia,
REM,
constipation,
depression
Late:
Dementia
Hallucinations

24

In someone with parkinson's disease what happens when you give them a course of levodopa?

Rapid relief of symptoms (this isn't permanent)

25

Give two examples of dopamine functional imaging tests

- PET scan with fluoro dopa
- Dopamine transporter imagine with single photon emission

26

List some red flags of parkinsons disease?

– Symmetrical symptoms
– Severe axial or lower limb involvement*
– Frequent falls*
– Fast disease progression
– Eye movement
disorder
- Other movement disorders such as tics, myoclonus and chorea
- Pyramidal or cerebellar dysfunction
- Bulbar or pseudobulbar features
- Parietal associative sensory disturbances
- Apraxia
- Severe cognitive deterioration or psychosis
- Marked autonomic dysfunction
- Negative levodopa challenge

27

A 77 year old man presents with lower body rigidity. He has no resting tremor and poor response to levodopa.

Vascular parkinsonism

28

How would you confirm a diagnosis of vascular parkinsonism?

Structural brain imaging

29

What class of drugs causes parkinsonian symptoms?

Any block that blocks the action of dopamine (especially neuroepileptic drugs)

30

What kind of tremor is most common with drug induced parkinsonism?

Postural tremor

31

Do the symptoms in drug induced parkinsonism tend to be symmetrical or asymmetrical?

Symmetrical

32

A 75 year old women presents with her family as she keeps getting lost and running away. She has profound memory loss and also talks off hallucinations.

Dementia with lewy bodies

33

What disease encompasses a triad of autonomic dysfunction, cerebellar features and parkinsonism?

Multi system atrophy

34

A 72 year old lady presents with a constipation, jerky postural tremor and clumsiness. On examination she walks with a wide based gait and she has generalized hyperflexia and extensor plantar responses.

Multi system atrophy

35

What will the MRI scan most likely show in multi - system atrophy?

Cerebellar and pontine atrophy
OR
Hyperintense rim surrounding the putamen in T2 weighted scan.

36

A 69 year old women presents with falls, slurred speech and a stiff neck. On examination her neck is tilted backwards and her eyes appear to be staring. You do a levodopa challenge test and there is no response.

Progressive supranuclear palsy

37

What is the genetic problem is fragile X ataxia syndrome?

Abnormal number of CGG repeats in the FMR1 gene

38

A 67 year old female comes to your clinic. She has cerebellar gait ataxia, an intention tremor and complains of constipation. She has a disabled son.

Fragile X tremor ataxia syndrome

39

What drug would you give to treat erectile dysfunction is patient with parkinsons disease?

Sidenfil

40

What is the initial management for a patient newly diagnosed with parkinson's disease?

50mg levodopa 3 x daily

41

What are the main side effects of levodopa?

"Peak dose dyskenesias" = involuntary movemnts such as tics & corea
Wearing off
Sudden off states

42

What drug should levodopa be combined with to increase its peripheral action?

Peripheral dopa decarboxylase inhibitor (Carbidopa)

43

What other drugs (aside from levodopa) are used in the treatment of the motor symptoms of parkinson's disease?

- Dopamine agonists eg bromocriptine and peroglide
- Catechol - 0 - methyltransferase inhibitors eg entacapone, tolcapone
- Amantadine

44

What non drug treatment is useful in selected cases of parkinson's disease?

Deep brain stimulation

45

Are the symptoms in parkinson's disease usually symmetrical or asymmetrical?

Asymmetrical

46

What are the four most important motor symptoms of parkinsons disease?

Resting tremor
Rigidity
Bradykinesia
Postural instability

47

Name a drug that is contraindicated in parkinsons disease? Why?

Haloperidol. It blocks dopamine so will worsen the symptoms of parkinsons.

48

What are the three cardinal symptoms of parkinsons disease?

Resting Tremor
Dysdiadokinesis
Rigidity

49

What medicine is prescribes alongside L Dopa in parkinsons disease?

DOPA decarboxylase inhibitor (cabidopa)
This prevents the peripheral metabolism of L Dopa

50

What is the locus correlus?

Nucleus in the pons involved with physiological responses to stress and panic.
Principal site for brain synthesis of noradrenaline.