Neurology - Parkinson's Disease and other Hyperkinetic Movement Disorders Flashcards
patient with tremor, slow movement, postural instability and rigidity
a.parkinsons
b.huntingtons
c.guillian barre
d.stroke
e.brown sequard
a.parkinsons
tremor differentials
parkinsonism
tremor disorders - essential tremor, dystonic tremor
for a diagnosis of parkinsonian syndrome what is required alone with one of muscular rigidity, 4-6 hz rest tremor and postural instability
a.hyperreflexia
b. sensory disturbances
c.intention tremor
d.bradykinesia
for a diagnosis of parkinsonian syndrome what is required alone with one of muscular rigidity, 4-6 hz rest tremor and postural instability
a.hyperreflexia
b. sensory disturbances
c.intention tremor
d.bradykinesia
d.bradykinesia
for a diagnosis of parkinsonian syndrome bradykinesia and 1 other of rigidity , 4-6hz rest tremor and what else is required
a. postural instability
b.hyperreflexia
c.postural hypotension
d. babinski sign
a. postural instability
signs for diagnosis of parkinsonian syndrome
slow
stiff
shaky
stability
what is the core feature of parkinsonism
a.bradykinesia
b. postural instability
c.intention tremor
d.resting tremor
e.muscular rigidity
a.bradykinesia
slowness of initiation of voluntary movement with progressive reduction in speed and amplitude of repetitive movements
bradykinesia in parkinsonism
manual dexterity problems eg buttons and zips
slowing down
difficulty with repetitive movements
loss of arm swing
dragging leg
micrographia
reduced facial expression
drooling overnight
patient has hand tremor that is symmetrical in both hands and present with hands on lap no bradykinesia and normal gait . voice tremor on speaking what is the most likely diagnosis
a.parkinsons
b.huntingtons
c.guillian barre
d.stroke
e.essential tremor
f.dystonic tremor
e.essential tremor
what is a true rest tremor
a.present when hands on lap prone
b.present when walking
c.present when completing tasks only
d.present when arms raised
b.present when walking
or arms supine
rigidity (increased resistance to passive movement) occurs at which joints in parkinsonism
a.knees and ankles
b.hips and knees
c.wrist and elbow
d.elbow and shoulder
c.wrist and elbow
FROMENTS
what type of rigidity is seen in parkinsons
a.clasp knife
b.lead pipe
c.cogwheel
b.lead pipe
c.cogwheel
the rigidity in parkinsons is usually …
a.symmetrical
b.asymmetrical
b.asymmetrical
stooped posture with shuffling, arms flexed and one arm reduced swing with tremor in the stationary arm , loss of fluency when turning indicate what
a.parkinsons
b.huntingtons
c.guillian barre
d.stroke
e.essential tremor
f.dystonic tremor
a.parkinsons
MSA BROAD BASED?
the loss of arm swing in the parkinsonian gait is usually …
a.asymmetrical with tremor in stationary arm
b.asymmetrical with tremor in swinging arm
c.symmetrical with no tremor
d.symmetrical with tremor
a.asymmetrical with tremor in stationary arm
what test is done to assess for postural instability in suspected parkinsonism
a.push test
b.pull test
c.froments
d. tinnels
e.phalens
b.pull test
steps of parkinson diagnosis
1.parkinsonism syndrome
2.exclude other causes
3.supportive criteria
features of non degenerative / secondary causes of parkinsonism
repeated strokes/head injury
history of encephalitis
neuroepileptic drug exposure - metoclopramide, prochlorperazine, lithium, ccb, valporate
which of these drugs is NOT a secondary cause of parkinsonism
a.metoclopramide
b.prochloroperazine
c.ccb
d.lithium
e.valproate
f. carbimazole
f. carbimazole
patient with repeated strokes / head injury and history of encephalitis presenting with parkinsonism which type most likely
a.degenerative
b.non degenerative
b.non degenerative
secndary cause = non degenerative
neuroepilpetic drugs may..
unmask pre clinical PD or be a secondary cause of parkinsonism
red flags for degenerative atypical parkinsonian disorders
poor levodopa response
early recurrent falls
prominent early speech/swallowing difficulty
early cognitive decline
cerebellar , pyrimidal, dyspraxia signs
supranuclear gaze palsy
prominent early autonomic dysfunction
absence of rest tremor/ dyskinesia
APPLAUSE SIGN
SUPRANUCLEAR GAZE
a high pitched quivering dysarthria is characteristic of what
a.Multiple system atrophy (MSA)
b.Progressive supranuclear palsy (PSP)
a.Multiple system atrophy (MSA)
a low pitched growl dysarthria is characteristic of what
a.Multiple system atrophy (MSA)
b.Progressive supranuclear palsy (PSP)
b.Progressive supranuclear palsy (PSP)
what scan shows integrity of dopaminergic nigrostriatal pathways
a.CT
b.CAT
c.DAT
d.MRI
e.EEG
c.DAT
how will an essential tremor appear on a DAT scan
a. normal
b.abnormal
a. normal
how will an drug induced parkinsonsim on a DAT scan
a. normal
b.abnormal
a. normal
how will a dystonic tremor appear on a DAT scan
a. normal
b.abnormal
a. normal
how will a vascular parkinsonism appear on a DAT scan
a. normal
b.abnormal
a. normal
except if basal ganglia infarct - moth eaten appearance
how will dopa responsive dystonia appear on a DAT scan
a. normal
b.abnormal
a. normal
how will alzheimers appear on a DAT scan
a. normal
b.abnormal
a. normal
how will FXTAS appear on a DAT scan
a. normal
b.abnormal
a. normal
how will parkinsons disease appear on a DAT scan
a. normal
b.abnormal
b.abnormal
how will MSA appear on a DAT scan
a. normal
b.abnormal
b.abnormal
how will PSP appear on a DAT scan
a. normal
b.abnormal
b.abnormal
how will dementia with lewy bodies appear on a DAT scan
a. normal
b.abnormal
b.abnormal
how will Corticobasal degeneration appear on a DAT scan
a. normal
b.abnormal
b.abnormal
how will wilsons appear on a DAT scan
a. normal
b.abnormal
b.abnormal
how will spinocerebellar ataxia 2, 3 appear on a DAT scan
a. normal
b.abnormal
b.abnormal
supportive criteria for parkinsons
unilateral onset
persistent asymmetry
rest tremor
progressive
excellent levodopa response
visual hallucinations
clinical course more than 10 yrs
types of parkinsons drugs
dopaminergic medications
-levodopa
- dopamine agonists
dopamine degradation inhibitors
-MAO b inhibitors
–COMT inhibitors
which drugs are most effective at alleviating parkinsonism
a.levodopa
b.dopamine agonists
c. MAO b inhibitors
d. COMT inhibitors
a.levodopa
which drugs are useful for overnight/ early morning symptoms
a.levodopa
b.dopamine agonists
c. MAO b inhibitors
d. COMT inhibitors
b.dopamine agonists
which drugs are least likely to cause psychotic symtpoms
a.levodopa
b.dopamine agonists
c. MAO b inhibitors
d. COMT inhibitors
b.dopamine agonists
impusle control??
first line drug for parkinsons
no universal 1 line
take into account clinical and lifestyle characteristics
patient preference and expectations
which parkinsons drug has a short half life and competes for absorption with other amino acids with delayed gastric emptying as a side effect
a.levodopa
b.dopamine agonists
c. MAO b inhibitors
d. COMT inhibitors
a.levodopa
can also cause psychosis
non oral treatments
deep brain stimulation
duodopa
apomorphine sc
gambling, shopping, binge eating and hypersexuality are all….
impulse control disorders
young males with a history or family history of substance abuse, prominent dyskinesia and bipolar are most at risk of whoich dose related effect of dopaminergic antagonists
a. delayed gastric emptying
b.psychosis
c.impulse control disorders
c.impulse control disorders
dopamine disregulation syndrome is a side effect usually seen with which parkinsons drug
a.levodopa
b.dopamine agonists
c. MAO b inhibitors
d. COMT inhibitors
a.levodopa
impulse control disorders are mostly associated with which parkinsons drug
a.levodopa
b.dopamine agonists
c. MAO b inhibitors
d. COMT inhibitors
b.dopamine agonists
non motor PD symptoms
depression
REM sleep behaviour disorder
constipation
olfactory disturbance
swallowing difficulties are more common and a more significant problem in ..
a.parkinsons
b.msa and psp
b.msa and psp
swallowing difficulties are……….. to dopaminergic medications
a.responsive
b.irresponsive
b.irresponsive
inability to swallow PD medication is ..
A MEDICAL EMERGENCY
what happens with abrupt withdrawal of PD medication
life threatening syndrome similar to neuroleptic malignant syndrome
if patient has sawllowing difficulties and cannot swallow PD medication what should be done
nasogastric tube
nil by mouth
admitted to hospital
liase with consultant
