ic16 parkinsons disease (general)

Question 1

what are the 4 characteristic features of PD and diagnosis

Answer 1

1) cogwheel rigidity - muscle rigidity
2) pill rolling - tremors at rest
3) bradykinesia/akinesia (slowness/poverty of movement)
4) postural instability (and gait disturbances)

first three are the cardinal features of which ≥2 of the 3 must be present for diagnosis

Question 2

pathophysiology of PD

Answer 2

misfolded alpha-synuclein = formation of lewy bodies

= decreased DA neurotransmission
= functional mitochondrial failure
= neuroinflammation > activation of microglia

Question 3

initial presentation of idiopathic PD

Answer 3

usually postural instabiltiy and falls not present
asymmetric
less rapid progression
no autonomic dysfunction

impaired olfaction(?)

Question 4

methods and kinds of differential diagnosis for PD

Answer 4

MRI: only to differentiate from other parkinsonian syndromes

SPECT (single photon emission computed tomography) AND DAT SCAN (dopamine transporter imaging)
- differential essential tremors and other non-dopamine deficiency etiologies

Question 5

disease progression for idiopathic PqD

Answer 5

unable to perform basic ADL = mobility, feeding self, grooming, toileting, showering.. hygiene stuff

CHOKING

PNEUMONIA, specifically aspiration pneumonia

FALLS

Question 6

non motor symptoms of PD?

Answer 6

CNS: depression, psychosis, DEMENTIA?

Autonomic:
= constipation
= GI motility
= orthostatic hypotension
= sialorrhoea

FATIGUE

Question 7

presentation of early or young onset PD

Answer 7

usually less cognitive decline and more early onset of motor complications

dystonia is more common initial presentation VS falls/freezing in late onset

Question 8

presentation of drug-induced Parkinsonism

Answer 8

usually bilateral, acute onset (vs graudal in IPD)
uncommon to see tremors, more orofacial dyskinesia, akathisia…
more often in elderly (vs 60s in IPD)

withdrawal should lead to improvement in 80% of patients in 8 weeks.

Question 9

drugs that might cause DIP?

Answer 9

d2 receptor blockers = antipsychotics
dopamine depleters: tetrabenazine, reserpine
dopamine synthesis blockers: alpha methyldopa
calcium channel antaognists (P-channel) = flunarizine, cinnarizine

others
CCB l channel: diltiazem, verapamil
antiepileptics: valproate, phenytoin, levetiracetam
lithium
antiemetic: metoclopramide, prochloperazine

Question 10

non phx management of PD?

Answer 10

PHYSIOTHERAPY
OCCUPATIONAL THERAPY
SPEECH THERAPY

for advanced PD: DEEP BRAIN STIMULATION