Exam 4 Parkinson's

Question 1

Idiopathic Parkinson’s is?

Answer 1

Progressive degeneration of nigrostriatal neurons
Apoptosis/Cell death from:
Oxidative stress
Mito dysfxn
Excitotoxicity
Inflammation

Question 2

Idiopathic Parkinson’s 4 cardinal features?

Answer 2

1) Resting tremor: unilateral
2) Rigidity: cog-wheel, mm stretch intact
3) Akinesia-Bradykinesia: masked face, ↓ dexterity, ↓ animation
4) Postural instability: stoop, ↓center of gravity (falls)

Question 3

Idiopathic Parkinson’s presentation: Primary motor? (4)

Answer 3

Tremor
Rigidity
Brady
Postural instability

Question 4

Idiopathic Parkinson’s presentation: Other motor? (5)

Answer 4

Slow, soft speech
Face masking
↓ blinking
Drooling
Tiny handwriting

Question 5

Idiopathic Parkinson’s presentation: Cognitive? (4)

Answer 5

Slow thought
Word-search
Cognitive impair
Dementia

Question 6

Idiopathic Parkinson’s presentation: Psych? (4)

Answer 6

Depression
Anxiety
Panic attacks
Drug-induced hallucination

Question 7

Idiopathic Parkinson’s presentation: Autonomic? (5)

Answer 7

Sweat
Orth HypoTN
Impotence
Constipation
Polyuria

Question 8

Idiopathic Parkinson’s presentation: Sensory? (4)

Answer 8

Pain
Numb
Tingle
Loss of smell

Question 9

Idiopathic Parkinson’s diagnostic criteria:

Possible?

Probable?

Definite?

Answer 9

Poss = 2 of 4 Group A, No Group B

Prob = 3 of 4 A, No B, 3+ yrs, sustained response to DA

Def = Possible met + histopath confirmation

Question 10

Group A sxs? (4)

Answer 10

Resting tremor
Bradykinesia
Rigidity
Asymm onset

Question 11

Group B sxs? (7)

Answer 11

in 1st 3 yrs:
Freezing
Postural instab
Hallucinations
Gaze palsy
Dementia before sxs in 1st yr
Focal brain lesions
Neuroleptic use

Question 12

Drug-induced Parkinson’s vs Idiopathic? (3)

Answer 12

U anti-nausea or anti-psych med
No resting tremor
Akathisia (restless/anxious) from med

Question 13

Vascular dz vs Idiopathic? (4)

Answer 13

Gait disturb
Spasticity
Hyper-reflex
Pseudobulbar affect (uncontrolled laugh/cry)

Question 14

Postencephalitic vs Idiopathic?

Answer 14

Hx of encephalitis (1917-1926) + high fever/delirium

Question 15

Apraxia is?

Answer 15

Inability to do learned movements

Question 16

Normal Pressure Hydrocephalus vs Idiopathic? (4)

Answer 16

Apraxia of gait
Rigidity
Cognitive impair
Urine incontinence

Question 17

Progressive Supranuclear Palsy vs Idiopathic? (8)

Answer 17

Pseudobulbar affect
Gaze palsy
Slowed saccades (Normally fast eye mvmts)
Falls
Axial rigidity
No tremor
Spatic-ataxic dysarthria (mixed speech)
Poor DA response

Question 18

Multi-system Atrophy vs Idiopathic? (8)

Answer 18

Falls
Axial dystonia
Respiratory stridor
Akinesia
No tremor
Dysmetria (under/over shooting)
Prominent autonomic features
Poor DA response

Question 19

Idiopathic Parkinson’s tx: Symptoms? (6)

Answer 19

DA
Antichol
COMT inhib
MAOI
Amantadine
Deep brain stim

Question 20

L-Dopa/Carbidopa (Sinemet) MOA?

Doesn’t help what? (3)

Answer 20

Block DA decarboxylase in periphery
No BBB penetration

Freezing, instability, autonomic sxs

Question 21

L-Dopa/Carbidopa (Sinemet) benefits?

S/E? (6)

Answer 21

Smaller amounts of L-DA needed = less nausea

N
Dizzy
Ortho hypoTN
Sedation
Dreams/hallucination
Behaviors
On-Off episodes

Question 22

DA Agonists indication?

Answer 22

< 70yo w/ normal cognition
Mild sxs
Helps dyskinesia

Question 23

DA Agonists S/E?

Answer 23

N
Ortho hypoTN
Sedation
Halluc
Impulse control dis

Question 24

MAOBI (-giline) indications?

S/E?

Answer 24

Mild sxs

Sleep dis
Halluc
Severe HTN w/ cheese

Question 25

Tx for “Off”?

Tx for delayed or no “On”?

Answer 25

DA agonists, COMT, ↑Sinemet, ↓protein

↑Sinemet

Question 26

Tx for freezing?

Answer 26

↑Sinemet, DA agonist