Approach to tremor and parkinsonism Flashcards
1
Q
4 aspects to describe tremor by
A
- distribution
- freq
- amplitude
- relation to movement
2
Q
4 aspects to topography
A
- unilater/bilater
- symetrical
- body part
- prox/distal
3
Q
2 main types in relation to movement
A
1 resting - when body completely at rest
2. action
4
Q
3 types of action tremor
A
- postural - holding hand out
- kinetic - doing something
- intention - reaching for something
5
Q
4 common etiologies of tremor
A
- physiological tremor - normal, but may be enhanced
- cerebellar
- essential
- idiopathic parkinsonian
6
Q
3 drugs associated with increase physio tremor
A
- sympathomimetics
- amphetimines
- caffeine, nicotine
7
Q
what is essential tremor
A
combo postural and kinetic tremor that often gets worse with age
8
Q
** 2 mainstay treatment of essential tremor
A
- propranolol
2. primidone - has SEs
9
Q
4 features of parkinsonsim
A
TRAP Tremor Rigidity Akinesia (brady) Post instability
10
Q
what is parkinson disease
A
2 of 4 caridnal features and response to L-DOPA, progressive course, no alternative cause
11
Q
*** 3 best predictors of idiopathic PD
A
- Presence of rest tremor
- Asymmetry of signs & symptoms
- Good response to L-dopa therapy
12
Q
feat of PD gait
A
- stooped posture
- Reduced arm swing
- Reduced stride length (small,
shuffling steps) - Difficulty turning (multiple steps,
turning “en bloc”) - Freezing
- Festinating
13
Q
Red flags for PD - refer (8)
A
- early falls
- early prominent autonomic symptoms (e.g., orthostatic
hypotension, erectile dysfunction, bowel/bladder
involvement) - abnormal (limited or slow) vertical eye movements
- pyramidal (UMN) signs
- cerebellar signs
- cortical signs (e.g., aphasia, apraxia, cortical sensory loss)
- symmetrical signs & symptoms
- oor response to L-dopa
14
Q
6 PD drugs
A
- L-dopa (+ peripheral decarboxylase inhibitor)
- dopamine agonists
- catechol-O-methyltransferase (COMT) inhibitors
- monoamine oxidase B inhibitors
- anticholinergic drugs
- amantadine
