Parkinsons

Question 1

Parkinson’s is classified as a movement disorder. Which one of the following is NOT categorised as a movement disorder?
a. Tremors
b. Tonic-clonic seizures
c. Tics
d. Dystonia

Answer 1

Answer: b
Tonic-clonic seizures are classified as a type of generalised seizure under the category of epilepsy.

• Tremors = Idiopathic Parkinson’s disease (IPD) cardinal feature.
• Tics = abrupt, transient, repetitive, stereotypical, co-ordinated movements which vary in intensity and occur at irregular intervals. (p.g.22)
• Dystonia = sustained muscle contractions which frequently cause twisting and repetitive movements or abnormal postures. (p.g.18)

Question 2

Which one of the following statements regarding Parkinson’s disease is NOT correct?
a. The majority of cases are familial.
b. It is presumed to be the result of a combination of genetic and environmental factors.
c. Mean age of onset is between 50 and 60 years of age.
d. It is a degenerative disease involving the basal ganglia.

Answer 2

Answer: a
“Very few cases - familial” (p.g.4 - Parkinson’s)

Question 3

Which of the following is NOT regarded as a cardinal feature of idiopathic Parkinson’s?
a. Bradykinesia.
b. Difficulties with balance.
c. ‘Pill-rolling’ is noted at rest, particularly during sleep.
d. Tremor measured at 4-6 cycles per second.

Answer 3

Answer: c
‘Pill-rolling’ is a sign of Parkinson’s but not a cardinal feature + tremors are NOT present during sleep.
Parkinsonian tremors = Resting tremors (occur when the muscles are relaxed and the person is AWAKE but not voluntarily moving)

IPD cardinal features:
* Tremor
* Rigidity
* Bradykinesia
* Disturbance in posture or equilibrium

Question 4

Which one of the following statements regarding rigidity in idiopathic Parkinson’s is NOT correct?
a. There is increased tone in both flexor and extensor muscle groups.
b. Rigidity is elicited during slow passive movement.
c. It is typically described as being ‘clap-knife’ in nature.
d. Voluntary activity on one side of the body may increase rigidity in the contralateral limb.

Answer 4

Answer: c
Cog-wheel type
(Not velocity dependent - uniform resistance with ratchet like interruptions during passive movement of a limb)

• ‘Clap-knife’ type of rigidity = Upper motor neuron lesions (e.g. stroke, cerebral palsy) - Muscle tone increase is velocity dependent

Question 5

Which one of the following statements regarding gait in idiopathic Parkinson’s is NOT correct?
a. There is decreased arm swing.
b. Stride is shortened.
c. Posture is usually stooped.
d. It is described as ‘high-stepping’ gait.

Answer 5

Answer: d
Shuffling gait
(underlying problem: bradykinesia and rigidity due to basal ganglia dysfunction)

• ‘High-stepping’ gait = commonly caused by Foot drop - person lifts the leg excessively high with each step to avoid dragging the foot.