Parkinsons Disease

Question 1

Which type of movement disorder is it?

Answer 1

Hypokinetic

Question 2

Definition

Answer 2

Motor and non motor difficulties arising from brain dysfunction through the reduced production of dopamine

Question 3

There is increased/decreased production of dopamine

Answer 3

Decreased

Question 4

It affects a specific part of the brain. True or false?

Answer 4

False

- it affects the whole brain

Question 5

Are there any diagnostic tests available at an early/prodromal state?

Answer 5

No

- b the time motor features are detected, the disease is well advanced

Question 6

Pathogenesis

Answer 6

Degeneration of substantia nigra

Substantial loss of dopaminergic neurones in the substantial nigra pars compacta

Question 7

What would a cross section through the brain stem show

Answer 7

Loss of normally black pigment in the substantial nigra

Locus coeruleus

Question 8

Pigment loss in the substantial nigra correlates with ?

Answer 8

Loss of domaminergic cells

Question 9

What pathological feature may remaining neurones show?

Answer 9

Lewy bodies

Question 10

What are lewy bodies?

Answer 10

Eosinophilic alpha-syunclein containingg inclusion granules

Question 11

What do lewy bodies look like?

Answer 11

Dense core with a surrounding halo

Question 12

Cause

Answer 12

Unknown

Question 13

More common in males/females

Answer 13

Males

Question 14

More common in younger/older population?

Answer 14

Older population

Question 15

What is parkinsonism

Answer 15

Symptoms that are compatible with parkinson disease but the underlying cause may be different

Question 16

Which symptoms tend to arise first - motor symptoms or non motor symptoms?

Answer 16

Non-motor symptoms

Question 17

Non motor features

Answer 17

Sleep disorders 
Hallucinations
Constipation
Fatigue 
Depression
Cognitive impairment 
Anosmia
Pain
Bladder problems 
Loss of facial expression (hypomimia)
Soft speech (hypophonia)

Question 18

Motor features

Answer 18

Resting tremor 
Rigidity
Bradykinesia
Gait abnormalities 
Postural instability

Question 19

Motor features - resting tremor

Answer 19

When patient is relaxed and sits down there is a pill rolling tremor
- opposing circular movements of the thumb and index finger

Question 20

Motor features - the resting tremor is symmetrical. True or false?

Answer 20

False

- asymmetrical

Question 21

Motor features - the resting tremor vanishes with active movement. True or false?

Answer 21

True

Question 22

Motor features - rigidity. There is increased/decreased muscle tone?

Answer 22

Increased

Question 23

Motor features - movements are stiff. True or false?

Answer 23

True

Question 24

Motor features - bradykinesia

Answer 24

Slowness of movements

Difficulty initiating movements

Question 25

How can you assess bradykinesia?

Answer 25

Ask the patient to perform some repetitive movements as quickly as possible

Question 26

Motor features - gait abnormalities

Answer 26

``` Shuffling gait short stepped gait slow gait absence of swinging arms whilst walking slow turning with multiple steps ```

Question 27

Motor features - postural instability

Answer 27

Pull the patient back slightly and they fall backwards

Question 28

Cerebellar signs should be present/absent?

Answer 28

Absent

Question 29

Diagnostic tests are required to confirm the diagnosis. True or false?

Answer 29

False | - clinical diagnostic test and diagnostic tests are not usually required

Question 30

Confirmation of diagnosis

Answer 30

``` Parkinsonism - bradykinesia - resting tremor - rigidity - gait abnormality No alternative explanation for presentation Dopamine responsiveness ```

Question 31

When should treatment be initiated?

Answer 31

When symptoms cause disability or discomfort

Question 32

Management

Answer 32

Drugs that increase dopamine concentration or directly stimulate dopamine receptors - levodopa - dopamine agonists - monoamine oxidase type B inhibitors

Question 33

Side effects of dopamine stimulating drugs

Answer 33

Nausea Daytime somnolence Impulse control disorders (pathological gambling) Drug induced psychosis

Question 34

Levodopa crosses the BBB. True or false?

Answer 34

True

Question 35

What is levodopa converted to in the brain?

Answer 35

Dopamine

Question 36

Name 3 examples of dopamine agonists

Answer 36

Pramipexole Ropinirole Bromocriptine

Question 37

Individuals with parkinsons disease have a decreased life span. True or false?

Answer 37

True

Question 38

Vascular parkinsonism predominantly affects which part of the body?

Answer 38

Lower limbs

Question 39

How does drug induced parkinsonism arise?

Answer 39

Caused by any drug that blocks the action of dopamine

Question 40

``` Which 2 of the following medications should be avoided in patients with Parkinson’s disease? Domperidone Quetiapine Haloperidol Metochlopramide ```

Answer 40

Haloperidol | Metochlopramide