Parkinsons

Question 1

Athetosis Chorea Hemiballius lesions

Answer 1

A= (GAP) — GLOBUS PALLIDUS

C= CAUDATE NUCLEUS

Hb (Always U/L) = STN C/L**

Question 2

Chorea causes

CHOREA

Answer 2

Chorea gravidarum

Huntingtons

OCP***

Rheumatoid—Sydenhams

Endocrine—Thyrotoxicosis

Mcc= SLE***

Atherosclerotic—Senile

Question 3

MC neuro degenerative do

Answer 3

ALZHEIMER»PD

Question 4

Pathology PD

Answer 4

Atrophy + Hypopigmentation of SNPC

Lewy Body deposition (a-synuclein)

Nigrostriatal pathway impairment

(STRIATUM= Putamen + CN)

Question 5

D1 and D2 receptors function

Answer 5

D1= Stimulate stimulatory

D2 = Stimulate inhibitory

Question 6

DA decrease features

Answer 6

BRADYKINESIA—> PD

Rx DA+

Question 7

DA increase features

Answer 7

CHOREA

Rx DA-

Question 8

DA functions

Answer 8

Behaviour (Depression)

Movement regulation (EPS)

Question 9

EPS list

NAAT

Answer 9

NMS
Akathisia
Acute Muscle Dystonia
TD

Question 10

Etiology PD

DTTGSE

Answer 10

Drugs (Antags and Depletors)

Toxins ( Hexane/ CO / Mn / Methanol)

Trauma (Alzheimer»PD)

Genetic (Parkin &laquo_space;LRRK)—5%

Sporadic (mc)

Enzyme deficiency (Ty Hydroxylase— Rate limiting in DA formation)

Question 11

DA depletors

Answer 11

Methyl dopa
Reserpine
Tetrabenzene
Lithium
Amiodarone

Question 12

DA antags

Answer 12

Metoclop
Typical Antipsychotics

Flunarizine
Cinnarizine. (CCBs)

Question 13

Parkin LRRK features

Answer 13

P= AR—Early onset—Chr12

L= AD—>40y—Chr 6

Question 14

Cf Pd

TRAP

Answer 14

Tremors (Resting/4-6Hz/ UL>LL / Unilat / dec with sleep)

Rigidity (Cogwheel-UL / leadpipe-LL)

Akinesia

Postural instability (Akathisia)

(LEAD PIPE rigidity is usually seen in EPS but tremors + LPR= cogwheel rigidity)

Question 15

Gait in PD

Answer 15

Festinating/ Shuffling

KINESIA PARADOXA***
Increased acceleration while running

Question 16

Postural instability features

Answer 16

Loss of postural reflexes—PULL TEST+

Last symptom to occur

Question 17

Rx PD

Aim is to decrease Ach and increase DA—fall in even 30% DA leads to Pd

Answer 17

Levodopa

Carbidopa/Benserazide (Do-decarboxy)

Selagiline/ Rasagiline (MAO-Bx)
(RASAGILINE IS NEUROPROTECTIVE**)

Capones (COMT x)

AMANTADINE***
(Anti-Dyskinesia : Uncontrolled muscle movement)

Ropirinole/Pramipexole/ Rotigotin (DA+)
(ROTIGOTIN IS AVAILABLE AS A PATCH*)

APOMORPHINE(DA+)
(Faster acting/ inj / emetic++)
(USED IN RESCUE THERAPY)

Trihexyphenidyl/Biperidine/ Benzopteopine (Central Ach inhibitors)
(DOC DRUG INDUCED PD)

Question 18

Surgeries in Parkinsons indication and procedure

Answer 18

Intractable tremors— STN(mc) DBS

Drug induced dyskinesia—-GPi DBS

(Deep brain stimulation)

Question 19

What is wheelchair sign of QUINN

Answer 19

PD patients are very much mobile till death—If early wheelchair use—R/o. pD)

RED FLAG SIGN

Question 20

Restless leg syndrome aggravation and relief

Answer 20

Agg on rest and night

Relief on movement

Question 21

NON MOTOR FEATURES OF PD

5M

Answer 21

Depression/ Anxiety / Sleep disturbance

Cognitive impairment

Autonomic disturbance

ANOSMIA*** - Lewy body deposition

MICROGRAPHIA**

Monotonous speech ( hypophonia )

Hypomimia (Mask like face)

MEYERSONS SIGN (Sustained blinking with tapping on forehead—Otherwise decreased blinking overall)

DeMentia (AFTER 1 year)

Question 22

Earliest/ Disabling symptoms of Pd

Answer 22

Tremors. Bradykinesia.

Question 23

Good improvement of which symptoms with drugs?

BART

Answer 23

Bradykinesia

Tremors

Rigidity

Abnormal posture

Question 24

Poor response to rx with drugs inPD

CHAP

Answer 24

Cognitive symptoms

Hypophonia

Autonomic dysfunction

Postural instability

Question 25

Types of Atypical PDs | PLMC

Answer 25

All have symmetric presentation (PD= unsymmetrical) and all are unresponsive to LDOPA PSP (PSPp/ PSPr) Lewy Body dementia MSA (MSAa / MSAc) CBD

Question 26

Types of NDGenerative disorders

Answer 26

Synucleopathies (lewy body) - PD - LBD - MSA Tau-pathies - AD - PSP - CBD - FTD

Question 27

PSP other name and features

Answer 27

STEEL RICHARDSON SYNDROME Defective Horizontal and vertical gaze Extended posture— Early and freq falls** Dementia++ NO TREMORS

Question 28

PSP types and differences

Answer 28

``` PSPp PSPr (Parkinson). (Richardson) ~ pD Doesnt resemble LDopa+. No response Wheelchair sign++ ```

Question 29

Microscopy PSP feature

Answer 29

Globose tangles

Question 30

IxOC PsP

Answer 30

MRI—ATROPHY OF MIDBRAIN**

Question 31

LBD features

Answer 31

Visual hallucinations Parkinsonism EARLY ONSET DEMENTIA (within 1 year)

Question 32

MSA (Multisystem atrophy) features and types

Answer 32

``` MSAa. MSAc. PD. PD +. + Autonomic Cerebellar symp instability ``` Postural Hypotension

Question 33

MSAa is also called as

Answer 33

SHY DRAGGER SYNDROME

Question 34

CBD- Cortico basillar degeneration features

Answer 34

ALIEN LIMB PHENOMENON** Dystonia Myoclonus Parkinsonism

Question 35

Types of tremors | RIFFE

Answer 35

Resting—PD Intentional (On approaching object)—CEREBELLAR LESION Flapping (Asterixis) (-ve Myoclonus)— decrease in muscle tone.. Myoclonus= increase in muscle tone. UREMIC ENCAPH HEPATIC ENCAPH CO2 NARCOSIS Fine- Thyrotoxicosis Essential Tremors

Question 36

ET features

Answer 36

Increases with Anxiety Decreases with alcohol AD inheritance 4-8Hz LARGE HANDWRITING** B/L and symmetrical Origin= Cerebellum UL>>Head>>Voice>>LL Rx= Propanalol—Primidone—-DBS (Ventero-intmd nucleus of THALAMUS)—DBS cortex

Question 37

Type of spasticity in UMN

Answer 37

CLASP KNIFE

Question 38

Rigidity vs Spasticity | resistance to passive movement

Answer 38

F= E. F easy E difficult Bidirectn. Unidirection Velocity. Increased Independent. Resistance c velocity

Question 39

Types of Gaits | CWLBHSSS

Answer 39

CIRCUMDUCTION - HEMIPARESIS / Distal>>Proximal myopathy + spasticity (this is benificial to maintain balance) WADDLING- Prox muscle myopathy LURCHING- Polio (AHC lesion) BROAD BASE- Cerebellar lesions (tendency to fall on one side) HIGH STEP- Foot drop (Peroneal nerve) / DC lesion STAMPING-Posterior column lesion (to get a sense of vibration and proprioception) SHUFFLING- PD SCISSORING - Spastic Cerebral Palsy— flex at knee, plantar flex at ankles (Decorticate= above Midbrain Decerebrate= below midbrain)