Parkinsons Disease Flashcards Preview

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Flashcards in Parkinsons Disease Deck (25):
1

Underlying pathology of PD

Loss of dopaminergic neurones in the substantia negra of the midbrain

2

Describe the genetic aetiology of PD

Multifactorial and genetically heterogeneous

3

Possible risk factors for PD (2)

Positive family history, environmental toxins

4

Three potential cause of secondary PD

Vascular insult (e.g. basal ganglia infarct)
Repeated head injury (e.g. boxing)
Post-encephalitis

5

Four cardinal symptoms of PD

Bradykinesia
Rest tremor
Rigidity
Postural and gait impairment

6

Classical tremor seen in hands of PD patients

Pill-rolling tremor

7

Features of muscle tone seen in PD (2)

"Lead pipe" rigidity
Superimposed tremor- "cogwheel rigidity" particularly seen in pronation of wrist

8

Classical description of gait in PD

Stooped, "simian", shuffling gait

9

Hypomimia

Decreased facial expression

10

Hypophonia

Soft monotonous voice

11

Micrographia

Progressively smaller writing

12

How is tremor best observed in clinical practice?

Distraction- ask the patient to focus on a particular mental task

13

Positive Froment's manouevre

Rigidity increases in body segment when other body segments are being moved voluntarily

14

Early non-motor symptoms (3)

Hyposmia
Constipation
Depression

15

Late nonmotor symptoms (2)

Dementia
Hallucinations

16

Diagnosis of PD (2)

Mainly clinical
Levodopa trial may be useful

17

Features which might suggest a vascular cause of parkinsonism rather than classic PD (5)

Lower body predominately affected
Poor levodopa response
Lack of rest tremor
Dementia prominent or early
Occurs in people older than 70

18

Feature which might suggest drug-induced parkinsonism

Emergence of symptoms after exposure; resolution after withdrawal

19

Distinguish between essential tremor and PD?

ET tends to be symmetrical, usually not at rest
Improves with alcohol
Has a mean onset of about 15 years

20

Imaging modality which can be used as an aid to clinical diagnosis?

SPECT (commonly known as DAT-SCAN) which looks for dopamine-releasing cells in the brain

21

Treatment for daytime somnolence in PD?

Modafinil

22

Autonomic failure + parkinsonism + pyramidal signs + ataxia

Multi-system atrophy (Shy-Drager syndrome)

23

Up and down gaze palsy + axial rigidity and falls + dysarythria and dysphagia

Progressive supranuclear palsy

24

Drugs which can induce parkinsonism?

Neuroleptics e.g. haloperidol
Anti-emetics e.g. metoclopramide

25

Most appropriate anti-emetic to prescribe in Parkinson's, and why?

Domperidone
Does not cross blood brain barrier