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BMB Test 3 > B7-037 Parkinsons Disease > Flashcards

B7-037 Parkinsons Disease Flashcards

1
Q

[…] control systems have no direct output

A

motor

(modulate outputs through cerebellum and basal ganglia via thalamus)

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2
Q

responsible for automatic movements (habits)

A

basal ganglia

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3
Q

responsible for feed forward systems (accuracy)

A

cerebellum

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4
Q

akinetic rigid syndrome is characterized by [3]

A

slowness of movement (bradykinesia)
velocity independent increased tone (rigidity)
postural instability

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5
Q

move too little
akinetic-rigid syndrome
parkinsonism

A

hypo-kinetic movement disorders

(all synonyms)

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6
Q

move too much
abnormal involuntary movements

A

hyper-kinetic movement disorders

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7
Q

primary clinical signs of parkinsonism [3]

A

bradykinesia/akinesia
rigidity
postural instability

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8
Q

most common cause of parkinsonism

A

parkinson’s

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9
Q

what two structures make up the striatum of the basal ganglia?

A

caudate
putamen

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10
Q

what two structures make up the lenticular nucleus of the basal ganglia?

A

putamen
globus pallidus

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11
Q

parts of the basal ganglia [5]

A

caudate
putamen
globus pallidus
subthalamic nucleus
substantia nigra

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12
Q

integrate multimodal cortical information in the context of motivational information to facilitate automatic and stereotyped behaviors

A

basal ganglia

(habits: walking, driving, etc)

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13
Q

major inputs to basal ganglia system

A

cortico-striate

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14
Q

major output of the basal ganglia

A

globus pallidus internus

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15
Q

the output from the globus pallidus internus is […] to the thalamus

A

inhibitory

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16
Q

the output from the globus pallidus internus is inhibitory to the thalamus, which decreases […]

A

magnitude of movement

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17
Q

excess activity in the globus pallidus interna will result in

A

akinetic rigid syndrome

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18
Q

increased activity of the direct pathway gives […] output of GPi and […] movement

A

less
increased

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19
Q

increased activity of the indirect pathway gives […] output of GPi and […] movement

A

more
decreased

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20
Q

the inhibitory neurotransmitter in the basal ganglia system is

A

GABA

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21
Q

the excitatory neurotransmitter in the basal ganglia system is

A

glutamate

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22
Q

the direct and indirect inputs of the basal ganglia fire […]

A

simultaneously

(and both can both increase and decrease movement)

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23
Q

dopaminergic modulation of the basal ganglia system occurs through

A

substantia nigra

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24
Q

more dopaminergic activity […] output from GPi, […] movement

A

less
more

via substantia nigra

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25
less dopaminergic activity [...] output from GPi, [...] movement
more less via substantia nigra
26
direct pathway [...] movement
facilitates
27
indirect pathway [...] movement
inhibits
28
there are [...] neurons within the striatum that also modulate the basal ganglia system
ACh
29
hypokinetic movement disorders result from [...] activity of GPi
too much (more inhibition)
30
hyperkinetic movement disorders result from [...] activity of GPi
too little (less inhibition)
31
when a patient has akinetic rigid syndrome that is bilateral and mildly asymmetric with no other systems affected, the pathology is affecting the
substantia nigra
32
parkinson's disease is caused by idiopathic neurodegeneration of the
substantia nigra
33
in Parkinson's, there is [...] dopaminergic input to the striatum, and [...] output from GPi resulting in [...] inhibition of thalamus
in Parkinson's, there is [less] dopaminergic input to the striatum, and [more] output from GPi resulting in [more] inhibition of thalamus
34
the basal ganglia is also associated with parts of limbic system which can cause [...] in Parkinson's patients
apathy (amotivational)
35
the basal ganglia is also associated with parts of prefrontal cortex which can cause [...] in Parkinson's patients
dysexecutive symptoms
36
the basal ganglia is associated with parts of frontal eye fields which can cause [...] in Parkinson's patients
hypometric saccades
37
the basal ganglia is associated with the motor and premotor cortex which causes [...] in Parkinson's patients
akinesia
38
decreased output from the GPi can cause what affect on the limbic system?
hypermotivation (addiction)
39
decreased output from the GPi can cause what affect on the prefrontal cortex?
excessive planning (obsessive complex disorder)
40
symptomatic treatment of Parkinson's focuses on [2]
repair of dopamine deficiency modulation of basal ganglia circuits with DBS
41
can dopamine cross the BBB?
no, but levodopa can (precursor, converted once crosses)
42
most effective agent for the treatment of Parkinson's
levodopa
43
what patients with Parkinson's will have a significant benefit from levodopa?
all of them (however, wears off after 10 years)
44
blocks dopamine decarboxylase in the blood
carbidopa
45
blocks comethyltransferase in the blood and brain
tolcapone | COMT inhibitor
46
blocks monoamine oxidase B in the brain [2]
selegiline rasagiline
47
Sinemet is what combination of drugs?
carbidopa/levodopa
48
dopamine agonists [2]
pramipexole ropinirole (not as effective for motor symptoms as LDOPA, but have longer half life)
49
long term complications of LDOPA
wearing off-phenomenon dyskinesias (chorea, dystonia)
50
what is the cause of long term complications of LDOPA [2]
short half life decreasing ability of nigral neurons to store dopamine
51
deep brain stimulation is only effective in PD patients responsive to
LDOPA
52
targets of DBS [2]
GPi subthalamic nucleus (can adversely affect speech)
53
primary feature suggesting a patient with akinetic rigid syndrome does not have Parkinson's
poor response to LDOPA
54
other causes of akinetic rigid syndrome (not Parkinsons)
encephalitis multi-system atrophy vascular toxins drug induced
55
the pathology in multiple system atrophy is in the [...]
striatum
56
parkinsonian features early postural instability early speech difficulty peripheral neuropathy cerebellar signs pyramidal tract signs
multiple system atrophy
57
caused by ischemia to the striatum history of HTN and strokes MRI white matter changes
vascular parkinsonism
58
dopamine antagonists can cause
drug induced Parkinsonism
59
dopamine antagonists [3]
phenothiazines metoclopramide thioxanthenes
60
drug induced Parkinsonism can take up to [...] to reverse
6 months
61
in [...] postural tremor is greater than resting tremor
drug induced Parkinsonism
62
rhythmic abnormal involuntary movement
tremor
63
most common tremor
essential
64
treatment of tremor [3]
primidone propanolol focused US targeting thalamus
65
abnormal involuntary movement that the patient can voluntarily suppress but still have an urge to move
tic
66
common diseases causing tics [2]
Tourette's adult-onset Tic disorder
67
treatment of tic
neuroleptics pimozide cognitive behavioral therapy
68
sustained abnormal involuntary movements
dystonia
69
common diseases causing focal dystonia
torticollis writer's cramp
70
treatment of dystonia
botulinum toxin (focal) anticholinergics (generalized, hard to treat)
71
non-sustained, arrhythmic ballistic movement
chorea
72
involves an agonist, antagonist, agonist
ballistic movement
73
hemi-ballismus can result from [...] stroke
subthalamic
74
chorea is seen in [...] disease
Huntington's
75
treatment of chorea
dopamine antagonists
76
contralateral hemiballismus indicates lesion in the
subthalamic nucleus
77
brief, shock like movement of simulatenous agonist/antagonist
myoclonus
78
common diseases causing myoclonus
primary generalized epilepsy post anoxic
79
treatment of myoclonus
valproic acid long-acting benzos
80
abnormal involuntary movements after the use of a dopamine blocking unit (often an antipsychotic)
tardive dyskinesia
81
dystonia and chorea of the tongue, mouth, and mandible are commonly seen in
tardive dyskinesia
82
[...] prevent tardive dyskinesia
anticholinergics
83
treatment of tardive dyskinesia
valbenazine
84
akinetic rigid syndrome is a synonym for
Parkinsons/parkinsonism
85
if a patient with akinetic rigid syndrome does not respond to levodopa, what diagnosis do they have?
Parkinsonism
86
cause of Parkinson's disease
degeneration of the substantia nigra
87
cardinal features of akinetic rigid syndrome [3]
bradykinesia rigidity postural instability
88
velocity independent increased tone
rigidity
89
MOA-B inhibitors prevent the breakdown of
dopamine
90
carbidopa prevents the breakdown of
L-DOPA
91
the major output of the basal ganglia is via the
globus pallidus interna
92
the GPi inhibits the
ventral lateral thalamus
93
decreasing the activity of the GPi would [...] the ventrolateral thalamus
disinhibit
94
do basal ganglia have direct motor outputs?
no, they modulate the output of the corticospinal and corticobulbar
95
precursor to dopamine
L-DOPA
96
inhibits the peripheral metabolism of levodopa
carbidopa
97
[...]inhibitors prevent the breakdown of dopamine [2]
MOA inhibitors COMT inhibitors
98
damage to the [...] results in decreased inhibitory output from the basal ganglia to the motor thalamus
subthalamic nucleus
99
atrophy of the globus pallidus would result in
dystonia
100
non-sustained arrhythmic ballistic movements affecting one extremity
hemiballismus (i.e. arm flings out uncontrollably, striking people or objects)
101
classically hemiballismus is related to damage in the
subthalamic nucleus (but can be any part of the basal ganglia)

BMB Test 3 (18 decks)

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