Delirium and Parkinsons Flashcards

1
Q

mean age of onset of parkinsons?

A

60

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2
Q

is parkinsons more common in males or females?

A

males

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3
Q

what is associated with increased risk of parkinsons?

A
higher risk if first degree relative affected
drinking well water
pesticide exposure
farming
rural dwelling
smoking reduces risk
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4
Q

criteria for parkinsons diagnosis?

A

bradykinesia + 1 out of

  • muscular rigidity
  • resting tremor (4-6Hz)
  • postural instability (not caused by visual, cerebellar, vestibular or proprioceptive dysfunction)
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5
Q

what is bradykinesia?

A

slowing and fatiguing of movement and reduced amplitude of movement
eg: slow shuffling gait, reduced arm swing, slow turning, fine movement like tapping finger gets v easily fatigued

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6
Q

type of rigidity in parkinsons?

A
lead pipe rigidity (sustained resistance to movement throughout whole range of motion)
cogwheel rigidity (jerky resistance to movement as muscles tense and relax)
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7
Q

what criteria excludes parkinsons?

A

repeated strokes and stepwise progression
repeated head injury
history of definite encephalitis
oculogyric crisis
neuroleptic treatment at onset
more than one affected relative (think about direct genetic cause)
sustained remission (parkinsons is progressive)

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8
Q

what symptoms might help exclude parkinsons?

A
strictly unilateral symptoms after 3 years
supranuclear gaze palsy
cerebellar signs
early severe autonomic involvement
early severe dementia
babinski sign (upgoing plantar indicating UMN problem)
cerebral tumour or hydrocephalus
negative response to levodopa
MPTP
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9
Q

what criteria would support a diagnosis of parkinsons?

A
unilateral onset
resting tremor
progressive disorder
persistent asymmetry affecting site of onset most
excellent response to levodopa
severe levodopa induced chorea
levodopa response lasting 5+ years
clinical course of 10+ years
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10
Q

types of tremor?

A

essential tremor
dystonic tremor
cerebellar tumour
functional tremor

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11
Q

what is essential tremor?

A

often AD inheritance
bilateral, postural tremor (tremor while maintaining a position against gravity like holding arms outstretched)
worsens over time
alcohol reduces tremor

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12
Q

what is dystonic tremor?

A
large variable, jerky tremor
asymmetrical
dystonia often present (sustained muscle contraction)
worse in particular positions or tasks
little response to propanalol
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13
Q

what is a cerebellar tremor?

A

slow, high amplitude intention tremor which can be caused by:
- demyelination
- ischaemia
- toxins (drugs and alcohol)
- paraneoplastic
- spinocerebellar ataxia
(intention tremor = shaking towards end of movement eg if going to press a button person will have upper limb tremor the closer they get to the button)

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14
Q

examples of parkinson plus syndromes (atypical parkinsonism)?

A

progressive supranuclear palsy
multiple systems atrophy
lewy body dementia

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15
Q

what is progressive supranuclear palsy?

A

rare condition causing loss of nerve cells in the brain

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16
Q

main features of progressive supranuclear palsy?

A
usually symmetrical with no tremor
neck dystonia, retrocollis (sustained neck extension)
levator inhibition and frontalis overactivity
vertical gaze palsy
postural instability and early falls
dementia
dysarthria and dysphagia 
lack of levodopa response
17
Q

what is multiple systems atrophy?

A

degenerative condition affecting autonomic functions

18
Q

main features of multiple systems atrophy?

A
parkinsonism with poor response to levodopa
autonomic failure
early falls and postural instability 
orofacial dystonia 
dysarthria 
myoclonus 
stridor/sleep apnoea
raynauds
inappropriate laughing and crying
19
Q

features of lewy body dementia?

A

early cognitive problems
fluctuating course
hallucinations
exaggerated and bad response to antipsychotics

20
Q

facial signs in parkinsons?

A
reduced facial expression
reduced blinking
drooling
difficult eye movements
quiet, monotomous speech
loss of sense of smell
swallow problems
21
Q

handwriting in parkinsons?

A

micrographia (difficulty with fine finger movements)

22
Q

what drugs are available for parkinsons?

A
levodopa
dopamine agonist
MAO-B inhibitor
COMT inhibitor
apomorphine (s/cut)
duodopa
23
Q

non-medical treatment of parkinsons?

A

deep brain stimulation

24
Q

phases of parkinsons disease progression?

A

diagnostic
maintenance
complex
palliative

25
Q

how is parkinsons managed in acute setting?

A

do not stop parkinsons meds

early referral to parkinsons nurse (can advise on meds)

26
Q

why shouldnt you stop parkinsons drugs in acute setting?

A

(risk of parkinsonism hyperpyrexia syndrome, loss of function and may take long time to regain function after stopping)

27
Q

..

A

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