Parksinsons

Question 1

Age of presentation of Parkinson’s ?

Answer 1

45-60

Question 2

Parkinsonism triad?

Answer 2

Bradykinesia, tremor, rigidity. Usually bilateral but can start unilateral

Question 3

What happens to tremor in Parkinson’s ?

Answer 3

Disappears with activity

Question 4

What is rigidity?

Answer 4

Increased resistance to passive movement

Question 5

What is rigidity like throughout the range of movement ?

Answer 5

Equal throughout

Question 6

Gait in Parkinson’s ?

Answer 6

Show, shuffling gait

Question 7

Arms and posture during walking ?

Answer 7

Stopped posture and reduced arm swing

Question 8

What is speech like ?

Answer 8

may be slow and monotonous. In late stage disease may be slurred, or even lost

Question 9

Power and sensory loss?

Answer 9

Power remains normal and there is no sensory loss

Question 10

What other psychiatric conditions associated with Parkinson’s ?

Answer 10

Dementia and depression

Question 11

Why do you get hallucinations.

Answer 11

A combination of the disease and the drugs used. Often they are not unpleasant

Question 12

What are kayser fleisher rings seen in?

Answer 12

Wilson’s disease (copper)

Question 13

Which drugs can cause Parkinsonism?

Answer 13

Drugs (usually dopamine antagonsists)–e.g. prochlorperazine, metoclopramide (antiemetics) phenozanthines, butyrophenones (neuroleptics)

Question 14

pathological hallmark of parkinsons disease

Answer 14

prominent dopaminergic neurone loss in the substantial nigra with alphasyneuclein containing lewey bodies and lewey neurites

Question 15

which part of the brain is the substantial nigra found?

Answer 15

basal ganglia

Question 16

what are upper motor neurone features?

Answer 16

pyramidal weakness and spasticity

Question 17

triad of parkinsonianism?

Answer 17

bradykinesia, resting tremor and rigidity

Question 18

Fragments of movements flow irregularly from one body segment to another causing a dance-like appearance?

Answer 18

chorea

Question 19

what does PD present with?

Answer 19

PD presents with tremor, muscular rigidity, akinesia, rest tremor, and gait and postural impairment

Question 20

which subtype has the slower rate of progression ?

Answer 20

tremor dominant

Question 21

non motor features of PD?

Answer 21

olfactory dysfunction, cognitive impairment, psychiatric symptoms, sleep disorders, autonomic dysfuncLon, pain, and faLgue.

Question 22

when does diagnosis occur in PD?

Answer 22

with the onset of motor symptoms

Question 23

what is progression of PD characterised by?

Answer 23

progression of motor symptoms

Question 24

Neuronal loss in PD occurs in many other regions including?

Answer 24

ocus ceruleus, nucleus basalis Meynert, pedunculoponLne and raphe nuclei, dorsal motor nucleus of vagus, amygdala, hyopthalamus

Question 25

how are lewey bodies formed?

Answer 25

Misfolded α-synuclein,which is insoluble and aggreagated, forms intracellular inclusions (Lewy bodies)

Question 26

Prolonged muscle spasms and abnormal postures

Answer 26

dystonia

Question 27

Fragments of movements flow irregularly from one body segment to another causing a dance-like appearance

Answer 27

chorea

Question 28

a parasomnia characterized by abnormal or disrupLve behaviours (such as talking, laughing, shouLng, gesturing, grabbing, punching, kicking,, sirng up in bed)

Answer 28

Rapid eye movement sleep behaviour

Question 29

treatment of rapid eye movement sleep disorder?

Answer 29

clonazepam or malatonin

Question 30

what is the frequency of the rest tremor in parkinsons?

Answer 30

4-6Hz

Question 31

where are lewey bodies found in parkinsons?

Answer 31

not confined to the brain, they are also present in spinal cord and peripheral nervous system

Question 32

what are lewey bodies?

Answer 32

misfolded alpha sinuclein, which is insoluble and aggregated. These form intracellular inclusions

Question 33

what does pigment loss correlate with?

Answer 33

dopaminergic cell loss

Question 34

greatest risk factor of parkinsons?

Answer 34

age

Question 35

male to female?

Answer 35

more common in males

Question 36

greatest genetic risk factor for PD

Answer 36

mutations in GBA

Question 37

what is treatment in PD aimed at doing ?

Answer 37

enhancing intracerebral dopamine concentrations or stimulate dopamine receptors

Question 38

which drug class associated with oedema?

Answer 38

dopamine agonists

Question 39

which drug associated with dyskinesia? (writhing movements)

Answer 39

levodopa

Question 40

what is the "on-off effect" of levodopa

Answer 40

alterations between periods of good motor symptom control and periods of reduced motor symptom control

Question 41

PsyChosis in PD is most efficiently managed with

Answer 41

Clozapine

Question 42

motor symptoms in PD?

Answer 42

bradykinesia rest tremor rigidity postural and gait impairment (stooped posture and show, shuffling gait with reduced arm swing)

Question 43

Slowness of movement with progressive loss of amplitude or speed during aWempted rapid alternaLng movement of body segments

Answer 43

BRADYKINESIA

Question 44

how can you assess bradykinesia?

Answer 44

can be assessed by asking the patient to perform some repetitive movements as quickly and wisely as possible

Question 45

decreased facial expression and eye blinking ?

Answer 45

hypomimia

Question 46

what happens to rhythmic oscillatory tremor on voluntary active movement

Answer 46

disappears

Question 47

what is re emerging tremor?

Answer 47

tremor reappears after hands held out

Question 48

is head tremor typical for PD?

Answer 48

no

Question 49

what is cog wheel rigidity

Answer 49

"Cogwheel" rigidity occurs when there is also a tremor and is characterized by a "stop and go" effect during a range of motion maneuver. Felt especially at the wrist

Question 50

why do you get a stooped posture?

Answer 50

impaired postural reflexes

Question 51

what is the parkinsonian gait like ?

Answer 51

slow, shuffling gait with a narrow base

Question 52

what is hyposmia?

Answer 52

reduced ability to smell (hypnosemia)

Question 53

what are premotor symptoms to ask about?

Answer 53

REM sleep behaviour, loss of smell, constipation

Question 54

exposure to what can be a risk factor for parkinsons?

Answer 54

manganese, pesticides

Question 55

do you get dementia early in the disease course?

Answer 55

no

Question 56

investigations for parkinsons?

Answer 56

``` structural brain imaging possibly structural brain imaging dopamine functional imaging is unable to distnguish PD from other causes of degeneratve Parkinsonism, but should be normal in essenLal tremor, dystonic tremor, psychogenic parkinsonism. positive levodopa challenge genetic testing where appropriate ```

Question 57

what is vascular parkinsonism?

Answer 57

parkinsonism affects mainly the lower limbs. rest tremor is uncommon. get a poor levodopa response

Question 58

does parkinsonism tend to be symmetrical or assymetrical?

Answer 58

symmetrical, although can start unilateral

Question 59

what drugs can cause parkinsonism?

Answer 59

any drugs that block the action of dopamine (especially neuroleptic drugs)

Question 60

what improves essential tremor?

Answer 60

alcohol and beta blockers

Question 61

frequency of essential tremor?

Answer 61

higher frequency (12Hz)

Question 62

inheritnace pattern of essential tremor?

Answer 62

autosomal dominant

Question 63

typical onset of essential tremor?

Answer 63

15 years

Question 64

common cause of degenerative parkinsonism, hot cross bun sign on MRI?

Answer 64

multi system atrophy O+

Question 65

Symmetric akineLc-rigid syndrome with predominantly axial involvement. Vertical gaze supra nuclear palsy?

Answer 65

progressive supranuclear palsy

Question 66

Core symptoms include cerebellar gait ataxia, postural / intenLon tremor, variably Parkinsonism, dysautonomia, cogniLve decline of frontal type, and peripheral neuropathy

Answer 66

fragile x tremor ataxia syndrome

Question 67

useful for managing tremor in drug induced parkinsonism?

Answer 67

procyclidine

Question 68

which features of parkinsons disease are uncommon in drug induced parkinsonism?

Answer 68

Rigidity and resting tremor