Neurology

Question 1

What is the pathophysiology of Parkinson’s disease?

Answer 1

Degeneration of dopaminergic neurones in the substantia nigra leads to reduced dopamine, causing Parkinsonian symptoms.

Question 2

What is the triad of clinical features in Parkinson’s?

Answer 2

Tremor
Rigidity
Bradykinesia

Question 3

What type of tremor occurs in Parkinson’s?

Answer 3

Pill-rolling tremor, it is a resting tremor which diminishes with movement, looks like someone is rolling a pill between their fingers.

Question 4

What type of rigidity do you get in Parkinson’s?

Answer 4

Cogwheel rigidity - series of catches/stalls as a person’s limb is moved by someone else.

Question 5

What is bradykinesia?

Answer 5

Slow movement, a clinical feature of Parkinson’s disease.

Question 6

What kind of gait would a patient with Parkinson’s have?

Answer 6

Shuffling gait

Question 7

What type of tremor do you get in cerebellar disease?

Answer 7

Action/intention tremor, tremor gets worse with movement.

Question 8

What is the most common treatment for Parkinson’s disease?

Answer 8

Levodopa - can cross the blood brain barrier and is then converted to dopamine by dopa decarboxylase. Increase the amount of dopamine in the nigrostriatum. (Carbidopa prevents the conversion of levodopa to dopamine in the periphery, but it cannot cross the blood brain barrier).

Question 9

What other medication do you need to give with Levodopa in Parkinson’s treatment?

Answer 9

Carbidopa, because it inhibits peripheral dopa decarboxylase, preventing L-DOPA being converted to dopamine in the periphery. Carbidopa can’t cross the blood brain barrier so this effect doesn’t occur in the brain.

Question 10

What is xanthchromia?

Answer 10

Yellow staining of CSF due to bilirubin, can indicate a previous SAH, can occur >12 hours after a bleed.

Question 11

What type of scan is needed urgently for a suspected stroke?

Answer 11

Non-contrast CT head scan.