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Year 4 Block 3-Acute medicine > 505. Parkinsons and MS and MND > Flashcards

505. Parkinsons and MS and MND Flashcards

1
Q

What is the triad of parkisonism?

A

Tremor- worst at rest pill rolling

Hypertonia- Rigidity and tremor gives cogwheel rigidity. Bets felt during pronation and supanation

Bradykinesia- Slow to intiate movement. Actions slow and decrease in amplitude with repitition

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2
Q

What causes parkinsons disease?

A

Loss of dopaminergic neurons in the substantia nigra

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3
Q

What might make you consider an alternative diagnosis to parkinsons?

A

Signs are symettrical

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4
Q

What is progressive supranuclear palsy?

A

Early postural instability

Vertical gaze palsy

Rigidity of trunk>limbs

Symmetrical

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5
Q

What is Cortico-basal degeneration

A

Akinetic rigidity involvign one limb

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6
Q

What is multi system atrophy?

A

Early autonomic features e.g. impotence, incontinence, postural reduced BP and cerebellar and pyrammidal signs

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7
Q

What are the various drugs used to treat parkinsons?

A

Levodopa- dopamine precurosor. sooner start, tolerance builds

Dopamine agonsits- helps delay levodopa starting

Apomorphine- injected subcut

Anticholinergics- Better for younger patients

MOA-B inhibitors- Alternative to dopamine agonsits. Post. Hypotension and a fib

COMT inhibitors- Hleps motor complications

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8
Q

Discuss Levodopa in more detail

A

Given combined with Co-careldopa

SE dyskinesea, painful dystonia, psychosis, N and V

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9
Q

What more can be said about dopamine agonists

A

e.g. Ropinirole. Can be given as a patch

SE- drowsiness, nausea, hallucinations

Amantadine can be used for drug induced dyskinaesia

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10
Q

COMT inhibitors. Discuss

A

Have an on time nad an off time

Monitor LFT’s

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11
Q

What anti-emetic is given in parkinsons

A

Dompiridone

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12
Q

What causes MS

A

Demylination of neurons casuing axonal loss

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13
Q

What are the sensory symtpoms of MS

A

Pins and needles

Decreased vibratin snese

Trigeminal neuralgia

Abnormal sensations

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14
Q

What are the motor symtpoms of MS

A

Spastic weakness

Myelitis

swallowing problems, constipation

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15
Q

What are the sexual/Genitourinary sypmtoms of MS?

A

Erectile dysfunciton

Anorgasmia

Urine retention

Incontinence

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16
Q

What tests can be done for MS

A

MRI- sensitive, not specific

CSF- oligoclonal IgG bands

17
Q

What are some diferentials for MS?

A

Sarcoidosis

Vasculitis

18
Q

What is the clinical diagnositc criteria for MS?

A

Attacks that are disseminated in time and space

This essentially means different attacks that happen on different occasion or there is proven degeneration over time.

This is difficult in primary progressive dimentia

19
Q

What are poor prognostic signs in MS?

A

Older, male,

early relapses

MRI lesions ( a lot of)

20
Q

What lifestyle advice is available to those with MS?

A

Exercise

Dont smoke

Avoid stress

21
Q

What disease modifying drugs are available for those who have MS?

A

Dimethyl fumarate- Relapsing and remitting

Monoclomal antibodies- relapsing and remiting

Interferon beta and glatiramer- not NICE approved

22
Q

How do you treat relapses in MS?

A

Methylpred, 3-5 day course. use sparingly

23
Q

What medications are available to treat relapses in MS

A

Spasticity- baclofen or gabapentin

Tremor- botox

Urgency/frequency- Intermittent self cathetirsation

Fatigue- Amantadine

24
Q

Discuss the follwing MS associated symtpoms:

Devics

Lhermittes

Uhthoff’s

Charles Bonnet’s

Pulfrich

Argyll robertson pupil

A

Devics- Neuromyeltis optica. Eye disease and tranverse myelitis

Lhermittes- Neck flexion causes electric shocks

Uhthoff’s- Worsenign of symptoms in heat

Charles Bonnet’s- Reduced acuity, temporary blindness, hallucinations

Pulfrich- Unequal eye latieces: straight things seemed curved

Argyll robertson pupil- pupil constrictive and unreactive to light. Reacts to accomidaiton

25
Q

What are the different types of MND?

A

ALS- UMN and LMN signs

Progressive bulbar palsy- only cranial nerves IX-XII

Progressive muscular atrophy- LMN lesions

Primary lateral sclerosis- umn signs

26
Q

What is meant by bulbar and corticobulbar palsy

A

Bulbar- diseases of CN IX and XII- tongue, muscles of talkign and swallowing, sack of worms

Corticobulbar- UMN lesions of swallowing. slow otngue, hyperreflexic jaw jerk

27
Q

What are the presenting signs of MND?

A

Never affects the eyes- distinguishable from MG

28
Q

How do you treat MND?

A

MDT

Riluzole- improves survival

Saliva- good positioning, oral care and suctioning

Alternative communication

End of life care

Year 4 Block 3-Acute medicine (85 decks)

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