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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
Q

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

A

more
less

via substantia nigra

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26
Q

direct pathway […] movement

A

facilitates

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27
Q

indirect pathway […] movement

A

inhibits

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28
Q

there are […] neurons within the striatum that also modulate the basal ganglia system

A

ACh

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29
Q

hypokinetic movement disorders result from […] activity of GPi

A

too much (more inhibition)

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30
Q

hyperkinetic movement disorders result from […] activity of GPi

A

too little (less inhibition)

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31
Q

when a patient has akinetic rigid syndrome that is bilateral and mildly asymmetric with no other systems affected, the pathology is affecting the

A

substantia nigra

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32
Q

parkinson’s disease is caused by idiopathic neurodegeneration of the

A

substantia nigra

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33
Q

in Parkinson’s, there is […] dopaminergic input to the striatum, and […] output from GPi resulting in […] inhibition of thalamus

A

in Parkinson’s, there is [less] dopaminergic input to the striatum, and [more] output from GPi resulting in [more] inhibition of thalamus

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34
Q

the basal ganglia is also associated with parts of limbic system which can cause […] in Parkinson’s patients

A

apathy (amotivational)

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35
Q

the basal ganglia is also associated with parts of prefrontal cortex which can cause […] in Parkinson’s patients

A

dysexecutive symptoms

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36
Q

the basal ganglia is associated with parts of frontal eye fields which can cause […] in Parkinson’s patients

A

hypometric saccades

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37
Q

the basal ganglia is associated with the motor and premotor cortex which causes […] in Parkinson’s patients

A

akinesia

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38
Q

decreased output from the GPi can cause what affect on the limbic system?

A

hypermotivation (addiction)

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39
Q

decreased output from the GPi can cause what affect on the prefrontal cortex?

A

excessive planning (obsessive complex disorder)

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40
Q

symptomatic treatment of Parkinson’s focuses on [2]

A

repair of dopamine deficiency

modulation of basal ganglia circuits with DBS

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41
Q

can dopamine cross the BBB?

A

no, but levodopa can (precursor, converted once crosses)

42
Q

most effective agent for the treatment of Parkinson’s

A

levodopa

43
Q

what patients with Parkinson’s will have a significant benefit from levodopa?

A

all of them

(however, wears off after 10 years)

44
Q

blocks dopamine decarboxylase in the blood

A

carbidopa

45
Q

blocks comethyltransferase in the blood and brain

A

tolcapone

COMT inhibitor

46
Q

blocks monoamine oxidase B in the brain [2]

A

selegiline
rasagiline

47
Q

Sinemet is what combination of drugs?

A

carbidopa/levodopa

48
Q

dopamine agonists [2]

A

pramipexole
ropinirole

(not as effective for motor symptoms as LDOPA, but have longer half life)

49
Q

long term complications of LDOPA

A

wearing off-phenomenon
dyskinesias (chorea, dystonia)

50
Q

what is the cause of long term complications of LDOPA [2]

A

short half life

decreasing ability of nigral neurons to store dopamine

51
Q

deep brain stimulation is only effective in PD patients responsive to

A

LDOPA

52
Q

targets of DBS [2]

A

GPi
subthalamic nucleus (can adversely affect speech)

53
Q

primary feature suggesting a patient with akinetic rigid syndrome does not have Parkinson’s

A

poor response to LDOPA

54
Q

other causes of akinetic rigid syndrome (not Parkinsons)

A

encephalitis
multi-system atrophy
vascular
toxins
drug induced

55
Q

the pathology in multiple system atrophy is in the […]

A

striatum

56
Q

parkinsonian features
early postural instability
early speech difficulty
peripheral neuropathy
cerebellar signs
pyramidal tract signs

A

multiple system atrophy

57
Q

caused by ischemia to the striatum
history of HTN and strokes
MRI white matter changes

A

vascular parkinsonism

58
Q

dopamine antagonists can cause

A

drug induced Parkinsonism

59
Q

dopamine antagonists [3]

A

phenothiazines
metoclopramide
thioxanthenes

60
Q

drug induced Parkinsonism can take up to […] to reverse

A

6 months

61
Q

in […] postural tremor is greater than resting tremor

A

drug induced Parkinsonism

62
Q

rhythmic abnormal involuntary movement

A

tremor

63
Q

most common tremor

A

essential

64
Q

treatment of tremor [3]

A

primidone
propanolol
focused US targeting thalamus

65
Q

abnormal involuntary movement that the patient can voluntarily suppress but still have an urge to move

A

tic

66
Q

common diseases causing tics [2]

A

Tourette’s
adult-onset Tic disorder

67
Q

treatment of tic

A

neuroleptics
pimozide
cognitive behavioral therapy

68
Q

sustained abnormal involuntary movements

A

dystonia

69
Q

common diseases causing focal dystonia

A

torticollis
writer’s cramp

70
Q

treatment of dystonia

A

botulinum toxin (focal)
anticholinergics (generalized, hard to treat)

71
Q

non-sustained, arrhythmic ballistic movement

A

chorea

72
Q

involves an agonist, antagonist, agonist

A

ballistic movement

73
Q

hemi-ballismus can result from […] stroke

A

subthalamic

74
Q

chorea is seen in […] disease

A

Huntington’s

75
Q

treatment of chorea

A

dopamine antagonists

76
Q

contralateral hemiballismus indicates lesion in the

A

subthalamic nucleus

77
Q

brief, shock like movement of simulatenous agonist/antagonist

A

myoclonus

78
Q

common diseases causing myoclonus

A

primary generalized epilepsy
post anoxic

79
Q

treatment of myoclonus

A

valproic acid
long-acting benzos

80
Q

abnormal involuntary movements after the use of a dopamine blocking unit

(often an antipsychotic)

A

tardive dyskinesia

81
Q

dystonia and chorea of the tongue, mouth, and mandible are commonly seen in

A

tardive dyskinesia

82
Q

[…] prevent tardive dyskinesia

A

anticholinergics

83
Q

treatment of tardive dyskinesia

A

valbenazine

84
Q

akinetic rigid syndrome is a synonym for

A

Parkinsons/parkinsonism

85
Q

if a patient with akinetic rigid syndrome does not respond to levodopa, what diagnosis do they have?

A

Parkinsonism

86
Q

cause of Parkinson’s disease

A

degeneration of the substantia nigra

87
Q

cardinal features of akinetic rigid syndrome [3]

A

bradykinesia
rigidity
postural instability

88
Q

velocity independent increased tone

A

rigidity

89
Q

MOA-B inhibitors prevent the breakdown of

A

dopamine

90
Q

carbidopa prevents the breakdown of

A

L-DOPA

91
Q

the major output of the basal ganglia is via the

A

globus pallidus interna

92
Q

the GPi inhibits the

A

ventral lateral thalamus

93
Q

decreasing the activity of the GPi would […] the ventrolateral thalamus

A

disinhibit

94
Q

do basal ganglia have direct motor outputs?

A

no,

they modulate the output of the corticospinal and corticobulbar

95
Q

precursor to dopamine

A

L-DOPA

96
Q

inhibits the peripheral metabolism of levodopa

A

carbidopa

97
Q

[…]inhibitors prevent the breakdown of dopamine [2]

A

MOA inhibitors
COMT inhibitors

98
Q

damage to the […] results in decreased inhibitory output from the basal ganglia to the motor thalamus

A

subthalamic nucleus

99
Q

atrophy of the globus pallidus would result in

A

dystonia

100
Q

non-sustained arrhythmic ballistic movements affecting one extremity

A

hemiballismus

(i.e. arm flings out uncontrollably, striking people or objects)

101
Q

classically hemiballismus is related to damage in the

A

subthalamic nucleus

(but can be any part of the basal ganglia)

BMB Test 3 (18 decks)

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