4th Year PD

Question 1

two types of ataxia

Answer 1

1. sensory

2. cerebellar

Question 2

what is sensory ataxia?

Answer 2

loss of proprioceptive sense

Question 3

how to test for sensory ataxia

Answer 3

Romberg’s test

Question 4

what is cerebellar ataxia?

Answer 4

cerebellum coordinating movement problem

Question 5

what are the four parkinson-plus syndromes?

Answer 5

multiple system atrophy (MSA)
Dementia with Lewy Bodies (DLB)
progressive supranuclear palsy (PSP)
corticobasal degeneration (CBD)

Question 6

what is MSA?

Answer 6

there is degeneration of many parts of the brain including the basal ganglia and cerebellum

Question 7

presentation of MSA

Answer 7

TRAP
autonomic dysfunction (postural hypotension, constipation, abnormal sweating, sexual dysfunction)
cerebellar ataxia

Question 8

presentation of PSP

Answer 8

early postural instability
vertical gaze palsy
falls
rigidity of trunk
symmetrical
swallowing problems

Question 9

presentation of corticobasal degeneration (CBD)

Answer 9

akinetic rigidity
alien hand syndrome
sensory loss
apraxia

Question 10

examples of combination drugs used in PD

Answer 10

co-benyldopa

co-careldopa

Question 11

what is in co-benyldopa?

Answer 11

levodopa

benserazide

Question 12

what is in co-careldopa?

Answer 12

levodopa

carbidopa

Question 13

what does excessive dopamine cause?

Answer 13

excessive motor activity (dyskinesia) with dystonia, chorea, athetosis

Question 14

what happens to the response to levodopa over time?

Answer 14

it reduces so consider starting late

Question 15

what does MSA affect?

Answer 15

central and autonomic nerves

Question 16

two types of MSA?

Answer 16

1. cerebellar

2. parkinsonian (most common)

Question 17

how to differentiate PD from MSA?

Answer 17

MSA won’t respond to Parkinson drugs

Question 18

what does PSP have difficulties with?

Answer 18

eye movements (looking down)
balance

rare to have a tremor

Question 19

what causes PSP?

Answer 19

build up of TAU protein

Question 20

what does CBD present with?

Answer 20

difficulties from one side of the body

Question 21

examination points for PD

Answer 21

writing
finger tapping
distraction - tap other leg when testing rigidity or count months of the year backwards

Question 22

does PD tend to be symmetrical or asymmetrical?

Answer 22

starts asymmetrical then becomes bilateral

Question 23

management of benign essential tremor

Answer 23

propranolol

primidone

Question 24

four types of tremor

Answer 24

1. intention tremor
2. rest tremor
3. postural tremor
4. re-emergent tremor

Question 25

which part of the brain is affected with intention tremor?

Answer 25

cerebellum

Question 26

when is an intention tremor worse?

Answer 26

at the end of purposeful movements

Question 27

what is affected in rest tremor?

Answer 27

extra-pyramidal

Question 28

what disease is rest tremor seen in?

Answer 28

PD

Question 29

what disease is postural tremor seen in?

Answer 29

benign essential tremor

Question 30

causes of postural tremor

Answer 30

beta agonists
anxiety
thyrotoxicosis

Question 31

what is re-emergent tremor?

Answer 31

tremor when >10seconds of postural

Question 32

when is re-emergent tremor seen?

Answer 32

PD

Question 33

define athetosis

Answer 33

slow purposeless movements

Question 34

define dystonia

Answer 34

prolonged muscle contraction

Question 35

what can rivastigmine and donepezil in AD cause?

Answer 35

exacerbate peptic ulcer disease and heart block