Parkinson's

Question 1

What causes Parkinson’s disease

Answer 1

degeneration of dopaminergic neurons in the substantia nigra

Question 2

Classic triad of features in Parkinson’s

Answer 2

radykinesia, tremor and rigidity

Typically asymmetrical

Question 3

Epidemiology of Parkinson’s

Answer 3

More likely in older men

Question 4

Features of bradykinesia in Parkinson’s

Answer 4

poverty of movement also seen, sometimes referred to as hypokinesia
short, shuffling steps with reduced arm swinging
difficulty in initiating movement

Question 5

Features of tremor in Parkinson’s

Answer 5

most marked at rest, 3-5 Hz
worse when stressed or tired, improves with voluntary movement
typically ‘pill-rolling’, i.e. in the thumb and index finger

Question 6

Other characteristic features of Parkinson’s

Answer 6

mask-like facies
flexed posture
micrographia
drooling of saliva
Impaired olfaction 
Fatigue

Question 7

Main autonomic dysfunction in Parkinson’s

Answer 7

Postural hypotension

Question 8

Psychiatric features of Parkinson’s

Answer 8

depression is the most common feature (affects about 40%); dementia, psychosis and sleep disturbances may also occur

Question 9

How might drug-induced Parkinsonism present in comparison to Parkinson’s disease

Answer 9

motor symptoms are generally rapid onset and bilateral
rigidity and rest tremor are uncommon
(in drug-induced)

Question 10

Diagnosis of Parkinson’s

Answer 10

Usually clinical

123I‑FP‑CIT single photon emission computed tomography (SPECT) if difficulty in diagnosis

Question 11

1st line treatment of Parkinson’s disease - if motor symptoms

Answer 11

if the motor symptoms are affecting the patient’s quality of life: levodopa

Question 12

1st line treatment of Parkinson’s disease if motor symptoms not affecting QOL

Answer 12

Dopamine agonist (non-ergot derived), levodopa or monoamine oxidase B (MAO‑B) inhibitor

Question 13

NICE advice for treatment if resistant to levodopa

Answer 13

addition of a dopamine agonist, MAO‑B inhibitor or catechol‑O‑methyl transferase (COMT) inhibitor as an adjunct

Question 14

Risks if Parkinson’s medication is not taken/absorbed

Answer 14

Acute akinesia
NMS

(Risk if drug holiday or gastroenteritis resulting in reduced absorption)

Question 15

Key side effect of Parkinson’s disease medication

Answer 15

Impulse control disorders more likely with:

dopamine agonist therapy
a history of previous impulsive behaviours
a history of alcohol consumption and/or smoking

Question 16

Management of excessive daytime sleepiness in Parkinson’s disease therapy

Answer 16

avoid driving

Medication should be adjusted to control symptoms. Modafinil can be considered if alternative strategies fail

Question 17

Mx of orthostatic hypotension in Parkinson’s disease

Answer 17

Medication review

Midodrine(acts on peripheral alpha-adrenergic receptors to increase arterial resistance)

Question 18

Mx of drooling of saliva in Parkinson’s disease

Answer 18

glycopyrronium bromide

Question 19

Side effects of levodopa

Answer 19

Dyskinesia
‘On-Off’ effect
Dry mouth
Anorexia

Palpitations
Psychosis
Postural hypotension

Question 20

What can be given if a person with Parkinson’s disease is admitted to hospital and medication has not been taken

Answer 20

Dopamine agonist patch as rescue medication to prevent acute dystonia

Question 21

What have ergot-derived dopamine receptor agonists been associated with(bromocriptine, cabergoline)

Answer 21

pulmonary, retroperitoneal and cardiac fibrosis

Echo, ESR, creatinine and CXR recommended prior

Question 22

Use of antimuscarinics in Parkinson’s management(procyclidine)

Answer 22

block cholinergic receptors
now used more to treat drug-induced parkinsonism rather than idiopathic Parkinson’s disease

Help tremor and rigidity

Question 23

Drugs associated with Parkinsonism

Answer 23

Antipsychotics

Metoclopramide

Question 24

Causes of Parkinsonism

Answer 24

Progressive supra nuclear palsy
Multiple system atrophy
Wilson’s disease
Carbox monoxide

Question 25

Gait associated with Parkinson’s disease

Answer 25

Shuffling gait
Hesitant
Festinating gait
Lack of arm swing(early sign)

Question 26

features of multiple system atrophy

Answer 26

Parkinsonism
Autonomic disturbance(erectile dysfunction, postural hypotension, atonic bladder)
Cerebellar signs