Parkinsons

Question 1

TRAP pneumonic for the motor symptoms of Parkinsons?

Answer 1

Tremor
Rigidity
Akinesia (bradykinesia)
Postural instability

Question 2

Autonomic changes that can arise in Parkinson’s disease?

Answer 2

Sweating issues
Constipation
Erectile dysfunction
Mood changes - depression, psychosis with hallucinations and paranoid delusions

Question 3

How is sleep effected in Parkinsons disease?

Answer 3

Vivid dreams as REM sleep effected
Nocturia
Sleep akinesia

Question 4

What kind of pain syndromes come alongside Parkinsons?

Answer 4

Frozen shoulder syndrome`

Question 5

What medium term and long term complication of Parksinons treatment do you want to be aware of?

Answer 5

Medium term - retroperitoneal fibrosis

Long term - Derangement of the dopaminergic pathways

Question 6

2 things that make up the striatum?

Answer 6

Putamen and the caudate nucleus

Question 7

Where is there characteristically cell loss in a patient with Parkinsons?

Answer 7

In the basal ganglia

Question 8

Depositions of what 2 things can sometimes be seen in Parkinsons disease?

Answer 8

Lewy bodies

Alpha-synuclein

Question 9

In young patients presenting with Parksinon’s disease what is a key differential to think about and what is the investigation of choice?

Answer 9

Wilsons disease

Copper studies

Question 10

When is a DaT scan primarily used in Parkinsons and what does it exclude?

Answer 10

Used in tremor dominant Parkinsons

Helps to exclude an essential tumour

Question 11

Side effects of levodopa?

Answer 11

Nausea, vomiting, hallucinations, constipation, dizziness, long term motor complications

Question 12

What is the mode of action of levodopa and how does it differ to that of dopamine agonists?

Answer 12

Allows conversion of Dopa to Dopamine within the brain

Dopamine agonists provide direct receptor stimulation

Question 13

Examples of 3 dopamine agonists used for treatment of Parkinsons?

Answer 13

Ropinirole
Pramipexole
Rotigotine

Question 14

What are some side effects of dopamine agonists?

Answer 14

Nausea
Vomiting
Hallucinations
Dizziness
Sleep and sedation

Question 15

2 examples of MAOB inhibitors used in Parksinons disease?

Answer 15

Rasagiline

Selegiline

Question 16

2 examples of CMOT inhibitors used to treat Parkinson’s?

Answer 16

Entacapone

Tolcapone

Question 17

What are 3 additional side effects of using COMT inhibitors as well as the usual Parkinsons drug SE?

Answer 17

Liver effects
Diarrhoea
Discolouration of urine

Question 18

What are 3 main aspects of Parkinsons and its treatment that the patient must be informed about?

Answer 18

DVLA must be informed
Drugs indice sleep so use of machinery and driving will be effected
Dopamine dysregulation syndrome - gambling and hypersexuality need to be looked out for

Question 19

What treatment of Parkinsons can be given to selected cases where there is inability to manage symptoms or motor symptoms persist despite maximal medication?

Answer 19

Bilateral subthalamic deep brain stimulation

Question 20

2 main classes of drugs that can lead to drug induced parkinsonism?

Answer 20

Antipsychotics

Antiemetics

Question 21

What is akinesia?

Answer 21

Slowing of the ability to initiate movement

Question 22

How would you describe the facial movements of those with Parkinsons?

Answer 22

Mask like and staring

Question 23

Cause of cog wheel movements in Parkinsons?

Answer 23

Mix between the rigidity of increased muscle tone and the tremor

Question 24

How would you describe the tremor in Parkinsons?

Answer 24

Tremor at rest, abolished by movement
Worse in hands
Worse on one side of the body

Question 25

WHat happens to handwritting in Parksinsons?

Answer 25

Micrographia

Question 26

How do you test a Parkinsons patient's balance and posture?

Answer 26

Push them and they will fall

Question 27

What is the gait known as in parkinsons?

Answer 27

Festinating gait!

Question 28

What occurs to secretions in parkinsons?

Answer 28

Increased sebaceous secretions and increased salivation

Question 29

If the gait disorder in Parkinsons is more pronounced than the Intellectual disorder what must be considered as a potential diagnosis?

Answer 29

Normal pressure hydrocephalus

Question 30

What enzyme metabolises L-Dopa?

Answer 30

Dopa decarboxylase

Question 31

what is given alongside L-Dopa medication?

Answer 31

Dopa decarboxylase inhibitor

Question 32

What is the purpose of prescribing a dopa decarboxylase inhibitor?

Answer 32

Stops L-Dopa break down but doesnt cross blood brain barrier so L-Dopa can still be broken down in the brain and have central effects

Question 33

What drug class are benztropine and orphenidrine?

Answer 33

Anticholinergic drugs

Question 34

What is a drug that is often used when L-Dopa is not toelrated?

Answer 34

Bromocriptine

Question 35

Recently introduced dopamine agonists that help in the fluctuating later stages of Parkinsons?

Answer 35

Pergdide | Lysuride

Question 36

What is the 'on-off' phenomena described in Parkinsons?

Answer 36

variability in patient response with L-dopa Become akinetic for periods of the day usually due to drug titres - peak or wearing off

Question 37

What is the process of skin to a pressure sore development?

Answer 37

Early erythema and oedema, erythema becomes fixed and cyanotic, blister formation, breaks down, exudate causes coagulum, skin loss, fat necrosis, muscle damage

Question 38

Type of organisms that usually infect pressure sores?

Answer 38

Gram negative

Question 39

What is the mainstay of management of deep pressure sores?

Answer 39

Debridement, cleaning, removal of eschar and slough, consider skin grafting

Question 40

Predisposing factors to the development of pressure sores?

Answer 40

Patient that is shocked or hypotensive Sensory loss or immobility Poor general health Cardiac failure, anaemia, metabolic disturbances

Question 41

What are decubitus ulcers?

Answer 41

Caused by pressure most commonly on heel

Question 42

Why do gravitational ulcers develop?

Answer 42

Insufficiency of the leg valves usually following DVT Venous hypertension is transmitted to communicating veins Tissue oedema and fibrin develop around veins leading to insufficient nutrient and gas exchange

Question 43

WHere do gravitational ulcers usually develop?

Answer 43

Around medial malleolus although may be anywhere on leg and even the whole way round

Question 44

Treatment of gravitational ulcers?

Answer 44

elevation of the leg, support bandages or hose, weight loss and regular exercise

Question 45

3 main types of ulcers?

Answer 45

Gravitational Ischaemic Decubitus