Neurology

Question 1

Dementia comes 1 year post diagnosis of Parkinsons

Answer 1

Parkinson’s dementia

Question 2

Signs of dementia occurs first before parkinsonism

Answer 2

Lewy Body Dementia

Question 3

Parkinsons Triad?

Answer 3

Brady/Hypokinesia
Pin-rolling tremor worse at rest
Increased tone leading to lead-pipe rigidity

Question 4

Other symptoms of Parkinsons

Answer 4

Autonomic dysfunction - postural hypotension
Psychiatric - depression/dementia/visual hallucinations
Sensory: Anosmia, augesia

Question 5

What are examples of brady/hypokinesia in Parkinsons?

Answer 5

Shuffling gait.
No arm swing.
Hypomimia.
Micrographia.
Stopping at obstacles.
Slurred speech.

Question 6

How is the Parkinson’s diagnosis made usually?

Answer 6

Clinical diagnosis from bradykinesia and either tremor or rigidity.

Question 7

Is the tremor from Parkinson’s worse or better at rest?

Answer 7

Worse at rest and improves with voluntary movement.

Question 8

What drugs can cause parkinsonism?

Answer 8

Anti-psychotics and metoclopramide

Question 9

What anti-emetic can you use in parkinsons? and what cant you use?

Answer 9

cant use metoclopramide

can use domperidone.

Question 10

What are features of Lewy Body Dementia?
Timing wise?
What goes?

Answer 10

Dementia first, then parkinsonism.
Progressive nature.
Visual hallucination.
Inattention + executive functioning before memory.

Question 11

What medication can you use to treat LBD?

Answer 11

Memantine and acetylcholinesterase inhibitors (donepezil, rivastigmine)

Question 12

why cant you give antipsychotics in LBD?

Answer 12

worsens parkinsonism

Question 13

what drug do you give w levodopa and why?

Answer 13

decarboxylase inhibitor (carbidopa or benserizide) to prevent peripheral breakdown of levodopa into dopamine

Question 14

What is the features of progressive supranuclear palsy?

Answer 14

Vertical gaze is impaired (downward gaze worse than upward so hard to read and go down stairs)
Parkinsonism
Falls
slurring of speech 
cognitive impairment

Question 15

Progressive supranuclear palsy responds to levodopa?

Answer 15

No, PSP has poor response to levodopa.

Question 16

Side effects of metoclopramide:

Answer 16

Parkinsonism
extrapyramidal side effects - oculogyric crisis
Tardive dyskinesia
hyperprolactinaemia

Question 17

What are the Parkinson plus syndromes?

Answer 17

Lewy body dementia, progressive supranuclear palsy,

multiple system atrophy

Question 18

What are the features of multiple system atrophy?

Answer 18

Parkinsonism & cerebellar

Autonomic dysfunction: erectile dysfunction, postural hypotension, atonic bladder

Question 19

After a patient started taking anti-psychotics, (hours - days) she started developing fever/pyrexia, muscle rigidity and is agi + confused.
Blood pressure raised, breathing rate raised, pulse rate raised.
what the heck is going on?

Answer 19

Neuroleptic Malignant Syndrome caused by the anti-psychotics.

Question 20

In neuroleptic malignant syndrome, what would you see in blood investigations?
think FBC and renal

Answer 20

Leukocytosis

Creatine Kinase raised

Question 21

What meds do you give for severe neuroleptic syndrome?

Answer 21

Dantrolene