Case 20 overview Flashcards
what makes up the triad for Lewy body dementia
dementia
Parkinsonism
visual hallucinations
which deficit is more profound in Lewy body dementia than in Parkinson’s
a.muscarinic
b.dopaminergic
c.cholinergic
d.serotinegric
e.GABA
c.cholinergic
myoclonus
response to. cholinesterase therapies often marked
neuroleptic drugs can exacerbate Parkinsonism
in which part of the brain is affected in Lewy body dementia
a.substancia nigra
b.caudate nucleus
c.cerebral cortex
d.cerebellum
e.striatum
c.cerebral cortex
atypical Parkinsonism conditions
multiple system atrophy
progressive supranuclear palsy
corticobasal syndrome
what distinguishes atypical Parkinsonism from Parkinson’s
Parkinsonism AND additional features which distinguish then from PD
in which atypical Parkinsonism is there autonomic failure, leading to postural hypotension, erectile dysfunction, urinary incontinence and involuntary forward flexion of neck (antecollis) on auscultation there is stridor
a.MSA
b.PSP
c.CBS
a.MSA
at what age is the onset of MSA
a.55-66 yrs
b.22-33 yrs
c.77-88 yrs
a.55-66 yrs
what is the usual presentation for MSA
erectile dysfunction
urinary symptoms
features of PD
poor balance
progresses more rapidly than Parkinson’s so prognosis of 6-9 years
what protein causes MSA
a.alpha synuclein
b.beta synuclein
c.amyloid
d.colloid
a.alpha synuclein
in which atypical Parkinsonism is there early falls, severe neck stiffness and inability to move eyes vertically , slurred speech and facial weakness and frontal type dementia (change in personality and emotion)
a.MSA
b.PSP
c.CBS
b.PSP
inability to move eyes vertically - supranuclear gaze palsy
what is the onset age for PSP
a.55-66 yrs
c. 63 years
d.40 years
e.80 years
c. 63 years
what protein causes progressive supranuclear palsy
A.amyloid
b.a synuclein
c.tau
d.colloid
c.tau
in which atypical Parkinsonism is there Parkinsonism, frontal dementia - changed personality and language difficulties , myoclonus and dystonia in affected limbs and inability to control that limb (alien limb phenomenon)
a.MSA
b.PSP
C.CBS
C.CBS
less common
onset age 63 years
which protein causes corticobasal syndrome
A.amyloid
b.a synuclein
c.tau
d.colloid
c.tau
an abnormal DAT scan suggests a diagnosis of what
a.parkinsons disease
b.MSA
c.nigrostriatal neurodegenerative parkinsonian syndrome
d.parkinsonism
c.nigrostriatal neurodegenerative parkinsonian syndrome
Lewy bodies are pink intracytoplasmic inclusions in neurones they are composed of abnormal deposits of which protein
A.amyloid
b.a synuclein
c.tau
d.colloid
b.a synuclein
which of these drugs is a directly acting dopamine antagonist that is given daily sc and is the best method for smoothing out fluctuations or managing troublesome dyskinesias in PD
a.levodopa
b.MAOi
c. apomorphine
d.duodopa
c. apomorphine
which of these drugs is used to smooth out fluctuations and manage dyskinesias in advanced PD
a.levodopa
b.MAOi
c. apomorphine
d.duodopa
c. apomorphine
what are the main side effects of apomorphine
nausea, confusion, hypotension
which of these drugs is made up of levodopa contnuously and directly administered into the small intestine via PEJ tube for rapid uptake into the bloodstream
a.levodopa
b.MAOi
c. apomorphine
d.duodopa
d.duodopa
failure of apomorphine and lack of indication for deep brain stimulation are indications for which Parkinson’s drug
a.levodopa
b.MAOi
c. apomorphine
d.duodopa
d.duodopa
what is the target of deep brain stimulation in Parkinson’s disease
a.subthalmic nucelus
b.substancia nigra
c.caudate nucleus
d.cerebral cortex
a.subthalmic nucelus
which part of the brain is stimulated by deep brain stimulation in tremor and dyskinesias
a.subthalmic nucelus
b.substancia nigra
c.caudate nucleus
d.cerebral cortex
e.pallidum
e.pallidum
implantation of a device that sends electrical impulses to parts of the Brian that control movements
deep brain stimulation
lesioning - electrical probe placed in the targeted region (usually globes pallidus interns) heated to destroy cells in that area
may relive symptoms and is most often effective at treating disabling dyskinesias
pallidotomy
rarely performed compared to dbs surgery
medication side effects with developing Parkinson’s disease
wearing off phenomenon
on off effect quicker
dyskinesias
dose failures
slowing, gait, speech, thought
falls
a perception in the absence of adequate peripheral stimulus
a.hallucination
b.delirium
c.delusions
d.psychosis
a.hallucination
an acute fluctuating disturbance of attention and awareness accompanied by impairment in cognition
a.hallucination
b.delirium
c.delusions
d.psychosis
b.delirium
fixed false beliefs not amendable tp reason eg held despite evidence to the contrary
a.hallucination
b.delirium
c.delusions
d.psychosis
c.delusions
presence of delusions, hallucinations , formal though disorder or abnormal psychomotor behaviour not explained by another psychiatric / medical condition or substance misuse
a.hallucination
b.delirium
c.delusions
d.psychosis
d.psychosis
