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Parkinson Dx Flashcards

1
Q

What is Parkinsonism?

A

Parkinsonism is a clinical syndrome characterized by bradykinesia, rigidity, tremor, and/or postural instability.

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2
Q

What is the pathological hallmark of Parkinson’s disease?

A

The presence of Lewy bodies (eosinophilic inclusion bodies) in the substantia nigra.

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3
Q

What are the primary motor symptoms of Parkinson’s disease?

A

Bradykinesia, rigidity, resting tremor, and postural instability.

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4
Q

What is the estimated global prevalence of Parkinson’s disease?

A

Approximately 6.1 million people worldwide.

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5
Q

At what age does Parkinson’s disease typically onset?

A

Between 50 and 65 years of age.

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6
Q

What are the main risk factors for Parkinson’s disease?

A

Age, male sex, genetic predisposition, environmental exposures, and certain medical comorbidities.

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7
Q

What environmental exposures increase the risk of Parkinson’s disease?

A

Pesticides, air pollution, well water use, and heavy metal exposure (Cu, Mn, Pb).

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8
Q

Which genetic mutation is commonly associated with Parkinson’s disease?

A

Mutations in the glucocerebrosidase 1 (GBA1) gene.

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9
Q

What is the main neurotransmitter deficiency in Parkinson’s disease?

A

Dopamine deficiency due to degeneration of dopaminergic neurons in the substantia nigra.

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10
Q

Which neurotransmitter imbalance is responsible for motor symptoms in Parkinson’s disease?

A

An imbalance between dopamine (inhibitory) and acetylcholine (excitatory).

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11
Q

What is the ‘classic triad’ of Parkinson’s disease?

A

Bradykinesia, rigidity, and resting tremor.

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12
Q

What is the characteristic tremor in Parkinson’s disease?

A

A resting tremor, often described as ‘pill-rolling’.

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13
Q

What is festination?

A

A tendency to take progressively quicker and smaller steps while walking.

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14
Q

What is micrographia?

A

Progressively smaller handwriting seen in Parkinson’s disease.

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15
Q

What are the common non-motor symptoms of Parkinson’s disease?

A

Depression, cognitive dysfunction, sleep disturbances, postural hypotension, constipation, and sexual dysfunction.

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16
Q

What is cogwheel rigidity?

A

A type of rigidity with a ratchet-like resistance to passive movement.

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17
Q

What is the pull test used for?

A

Assessing postural instability by pulling the patient backward and observing their ability to regain balance.

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18
Q

What is the first-line pharmacologic treatment for Parkinson’s disease?

A

Levodopa combined with a decarboxylase inhibitor (carbidopa or benserazide).

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19
Q

What is the primary limitation of long-term levodopa use?

A

Motor fluctuations and levodopa-induced dyskinesia.

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20
Q

What are dopamine agonists used for in Parkinson’s disease?

A

To stimulate dopamine receptors and delay the need for levodopa.

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21
Q

What are examples of dopamine agonists?

A

Pramipexole, ropinirole, bromocriptine, cabergoline.

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22
Q

What are common side effects of dopamine agonists?

A

Nausea, hallucinations, impulse control disorders (e.g., gambling, hypersexuality).

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23
Q

What is the mechanism of action of MAO-B inhibitors in Parkinson’s disease?

A

They prevent dopamine breakdown by inhibiting monoamine oxidase-B (MAO-B).

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24
Q

What are examples of MAO-B inhibitors?

A

Rasagiline, selegiline.

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25
What is the role of COMT inhibitors in Parkinson’s disease?
They prolong the effect of levodopa by inhibiting catechol-O-methyltransferase (COMT).
26
What are examples of COMT inhibitors?
Entacapone, tolcapone.
27
What is the role of amantadine in Parkinson’s disease?
It enhances dopamine release, inhibits reuptake, and has NMDA antagonist properties.
28
What are anticholinergic drugs used for in Parkinson’s disease?
They help control tremor, especially in younger patients.
29
What are examples of anticholinergic drugs used in Parkinson’s disease?
Benztropine, trihexyphenidyl.
30
What are the major complications of levodopa therapy?
Motor fluctuations ('on-off' phenomena), dyskinesias, and wearing-off effects.
31
What is peak-dose dyskinesia?
Involuntary movements occurring when levodopa levels are highest.
32
What is 'wearing off' in Parkinson’s disease?
Re-emergence of symptoms as levodopa effects diminish before the next dose.
33
What is freezing of gait (FOG)?
A sudden inability to move forward, often occurring at doorways or turns.
34
What is deep brain stimulation (DBS)?
A surgical procedure that involves implanting electrodes in the brain to modulate neural activity.
35
Which brain regions are targeted in deep brain stimulation for Parkinson’s disease?
The subthalamic nucleus (STN) or globus pallidus internus (GPi).
36
What are red flags that suggest an alternative diagnosis rather than Parkinson’s disease?
Early falls, autonomic failure, absence of response to levodopa, or rapid disease progression.
37
What is multiple system atrophy (MSA)?
Atypical parkinsonism with autonomic dysfunction and cerebellar signs.
38
What is progressive supranuclear palsy (PSP)?
A disorder characterized by early falls and vertical gaze palsy.
39
What is corticobasal degeneration (CBD)?
A parkinsonian syndrome with asymmetric rigidity, apraxia, and alien limb phenomenon.
40
What is dementia with Lewy bodies (DLB)?
A condition with Parkinsonism, fluctuating cognition, and visual hallucinations.
41
What imaging can help differentiate Parkinson’s disease from other parkinsonian syndromes?
Dopamine transporter (DaT) SPECT scan or MRI.
42
What is the gold standard for diagnosing Parkinson’s disease?
Clinical diagnosis based on motor symptoms and response to dopaminergic therapy.
43
What lifestyle modifications can help manage Parkinson’s disease?
Regular exercise, physical therapy, speech therapy, and fall prevention strategies.
44
What dietary considerations should be made for Parkinson’s disease patients?
Protein intake should be spaced apart from levodopa dosing to optimize absorption.
45
What is the significance of olfactory loss in Parkinson’s disease?
Early loss of smell (anosmia) is a common non-motor symptom and may precede motor symptoms.
46
What are the common causes of secondary parkinsonism?
Drug-induced (e.g., antipsychotics, metoclopramide), vascular disease, infections, trauma.
47
What is vascular parkinsonism?
A form of Parkinsonism caused by multiple small vessel strokes affecting basal ganglia pathways.
48
What is the effect of smoking on Parkinson’s disease risk?
Smoking appears to be protective due to nicotine’s dopaminergic effects.
49
How does caffeine consumption affect Parkinson’s disease risk?
Caffeine is associated with a reduced risk of developing Parkinson’s disease.
50
What is the role of genetic testing in Parkinson’s disease?
Genetic testing is useful in familial or early-onset cases but not routinely recommended.
51
Which non-motor symptoms can precede motor symptoms in Parkinson’s disease?
Olfactory loss, REM sleep behavior disorder, constipation, depression.
52
What is REM sleep behavior disorder (RBD) in Parkinson’s disease?
A condition where patients act out their dreams due to loss of muscle atonia during REM sleep.
53
What is Parkinsonism?
Parkinsonism is a clinical syndrome characterized by bradykinesia, rigidity, tremor, and/or postural instability.
54
What is the pathological hallmark of Parkinson’s disease?
The presence of Lewy bodies (eosinophilic inclusion bodies) in the substantia nigra.
55
What are the primary motor symptoms of Parkinson’s disease?
Bradykinesia, rigidity, resting tremor, and postural instability.
56
What is the estimated global prevalence of Parkinson’s disease?
Approximately 6.1 million people worldwide.
57
At what age does Parkinson’s disease typically onset?
Between 50 and 65 years of age.
58
What are the main risk factors for Parkinson’s disease?
Age, male sex, genetic predisposition, environmental exposures, and certain medical comorbidities.
59
What environmental exposures increase the risk of Parkinson’s disease?
Pesticides, air pollution, well water use, and heavy metal exposure (Cu, Mn, Pb).
60
Which genetic mutation is commonly associated with Parkinson’s disease?
Mutations in the glucocerebrosidase 1 (GBA1) gene.
61
What is the main neurotransmitter deficiency in Parkinson’s disease?
Dopamine deficiency due to degeneration of dopaminergic neurons in the substantia nigra.
62
Which neurotransmitter imbalance is responsible for motor symptoms in Parkinson’s disease?
An imbalance between dopamine (inhibitory) and acetylcholine (excitatory).
63
What is the 'classic triad' of Parkinson’s disease?
Bradykinesia, rigidity, and resting tremor.
64
What is the characteristic tremor in Parkinson’s disease?
A resting tremor, often described as 'pill-rolling'.
65
What is festination?
A tendency to take progressively quicker and smaller steps while walking.
66
What is micrographia?
Progressively smaller handwriting seen in Parkinson’s disease.
67
What are the common non-motor symptoms of Parkinson’s disease?
Depression, cognitive dysfunction, sleep disturbances, postural hypotension, constipation, and sexual dysfunction.
68
What is cogwheel rigidity?
A type of rigidity with a ratchet-like resistance to passive movement.
69
What is the pull test used for?
Assessing postural instability by pulling the patient backward and observing their ability to regain balance.
70
What is the first-line pharmacologic treatment for Parkinson’s disease?
Levodopa combined with a decarboxylase inhibitor (carbidopa or benserazide).
71
What is the primary limitation of long-term levodopa use?
Motor fluctuations and levodopa-induced dyskinesia.
72
What are dopamine agonists used for in Parkinson’s disease?
To stimulate dopamine receptors and delay the need for levodopa.
73
What are examples of dopamine agonists?
Pramipexole, ropinirole, bromocriptine, cabergoline.
74
What are common side effects of dopamine agonists?
Nausea, hallucinations, impulse control disorders (e.g., gambling, hypersexuality).
75
What is the mechanism of action of MAO-B inhibitors in Parkinson’s disease?
They prevent dopamine breakdown by inhibiting monoamine oxidase-B (MAO-B).
76
What are examples of MAO-B inhibitors?
Rasagiline, selegiline.
77
What is the role of COMT inhibitors in Parkinson’s disease?
They prolong the effect of levodopa by inhibiting catechol-O-methyltransferase (COMT).
78
What are examples of COMT inhibitors?
Entacapone, tolcapone.
79
What is the role of amantadine in Parkinson’s disease?
It enhances dopamine release, inhibits reuptake, and has NMDA antagonist properties.
80
What are anticholinergic drugs used for in Parkinson’s disease?
They help control tremor, especially in younger patients.
81
What are examples of anticholinergic drugs used in Parkinson’s disease?
Benztropine, trihexyphenidyl.
82
What are the major complications of levodopa therapy?
Motor fluctuations ('on-off' phenomena), dyskinesias, and wearing-off effects.
83
What is peak-dose dyskinesia?
Involuntary movements occurring when levodopa levels are highest.
84
What is 'wearing off' in Parkinson’s disease?
Re-emergence of symptoms as levodopa effects diminish before the next dose.
85
What is freezing of gait (FOG)?
A sudden inability to move forward, often occurring at doorways or turns.
86
What is deep brain stimulation (DBS)?
A surgical procedure that involves implanting electrodes in the brain to modulate neural activity.
87
Which brain regions are targeted in deep brain stimulation for Parkinson’s disease?
The subthalamic nucleus (STN) or globus pallidus internus (GPi).
88
What are red flags that suggest an alternative diagnosis rather than Parkinson’s disease?
Early falls, autonomic failure, absence of response to levodopa, or rapid disease progression.
89
What is multiple system atrophy (MSA)?
Atypical parkinsonism with autonomic dysfunction and cerebellar signs.
90
What is progressive supranuclear palsy (PSP)?
A disorder characterized by early falls and vertical gaze palsy.
91
What is corticobasal degeneration (CBD)?
A parkinsonian syndrome with asymmetric rigidity, apraxia, and alien limb phenomenon.
92
What is dementia with Lewy bodies (DLB)?
A condition with Parkinsonism, fluctuating cognition, and visual hallucinations.
93
What imaging can help differentiate Parkinson’s disease from other parkinsonian syndromes?
Dopamine transporter (DaT) SPECT scan or MRI.
94
What is the gold standard for diagnosing Parkinson’s disease?
Clinical diagnosis based on motor symptoms and response to dopaminergic therapy.
95
What lifestyle modifications can help manage Parkinson’s disease?
Regular exercise, physical therapy, speech therapy, and fall prevention strategies.
96
What dietary considerations should be made for Parkinson’s disease patients?
Protein intake should be spaced apart from levodopa dosing to optimize absorption.
97
What is the significance of olfactory loss in Parkinson’s disease?
Early loss of smell (anosmia) is a common non-motor symptom and may precede motor symptoms.
98
What are the common causes of secondary parkinsonism?
Drug-induced (e.g., antipsychotics, metoclopramide), vascular disease, infections, trauma.
99
What is vascular parkinsonism?
A form of Parkinsonism caused by multiple small vessel strokes affecting basal ganglia pathways.
100
What is the effect of smoking on Parkinson’s disease risk?
Smoking appears to be protective due to nicotine’s dopaminergic effects.
101
How does caffeine consumption affect Parkinson’s disease risk?
Caffeine is associated with a reduced risk of developing Parkinson’s disease.
102
What is the role of genetic testing in Parkinson’s disease?
Genetic testing is useful in familial or early-onset cases but not routinely recommended.
103
Which non-motor symptoms can precede motor symptoms in Parkinson’s disease?
Olfactory loss, REM sleep behavior disorder, constipation, depression.
104
What is REM sleep behavior disorder (RBD) in Parkinson’s disease?
A condition where patients act out their dreams due to loss of muscle atonia during REM sleep.

Neurology Medicine (14 decks)

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