Parkinson's

Question 1

general definition of PD

Answer 1

chronic progressive disorder affecting BG c motor and non-motor sx

insidious and slow progression - yrs

Question 2

cardinal features

Answer 2

TRAP

tremors - resting
rigidity
akinesia/brady
postural instab

Question 3

what are the types of PD based on etiology

Answer 3

primary parkinsonism

secondary parkinsonism

parkinson plus

Question 4

discuss primary parkinsonism

Answer 4

most common type - true PD

unknown or idopathic

paralysis agitans

Question 5

what are the 2 groups in primary PD

Answer 5

2 groups:

tremor predominant - most common; early

PIGD - most severe; later

Question 6

discuss secondary parkinsonism

Answer 6

d/t toxins, drugs and vriuses

1. post-encephalitic
2. toxic PD
3. drug-induced
4. metabolic

Question 7

discuss post-encephalitic PD

Answer 7

slow virus attacking the brain

Question 8

discuss toxic PD

Answer 8

exposure to toxins

manganese - most common; inhalation

pesticides
carbon monoxide/disulfide
cyanide
MPTP - synthetic heroine

Question 9

discuss drug-induced PD

Answer 9

drugs that produce extrapyramidal sx; mimics PD

neuroleptic drugs - for schizophrenia since it will dec dopamine

anti-depressant
anti-hypertensive

Question 10

discuss metabolic PD

Answer 10

problem in calcium metabolism kaya mag calcify BG - substantia nigra

Question 11

discuss parkinson plus syndromes

Answer 11

neurodegenerative disease that mimics PD since affect nila substantia nigra

mimic but will also present other signs:
- progressive supranuclear palsy
- cortico-basal ganglionic degeneration

(-) apomorphine test

Question 12

types of parkinson plus syndrome

Answer 12

basta yung dmo alam na name

Question 13

anatomic structures of BG

Answer 13

caudate, putamen, globus pallidus

Question 14

physiologic structures of BG

Answer 14

substantia nigra and subthalamic nucleus

nasa midbrain sila

Question 15

which structures release GABA

Answer 15

all except:

SN pars compacta: dopamine

STN: glutamate

Question 16

lentiform nucleus

Answer 16

putamen and globus pallidus

Question 17

neostriatum

Answer 17

caudate and putamen

Question 18

corpus striatum

Answer 18

caudate, putamen, globus pallidus

Question 19

overactivity of D1 and under of D2

Answer 19

resting tremors and rigidity

Question 20

overactivity of D2 and under of D1

Answer 20

bradykinesia and postural instab

Question 21

discuss the pathophysiology of PD

Answer 21

degeneretion of dopaminergic neurons in SNRP = no dopamine

signs of BG degeneration - 30-60% kaya late na lagi pag nag manifest ssx

hallmark: lewy bodies

Question 22

discuss tremors in PD

Answer 22

most common and initial symptom; 4-6 Hz

resting tremor: present at rest and mawala with movement

pill rolling muna then postural tremor: distal to proximal and uni to bilat

supine: inc in LE

no stress: lesser
sressed: inc

Question 23

what are the different types of tremors

Answer 23

intention - present at movement
senile - at rest and movement so old age kc MSK prob
resting - at rest

Question 24

discuss rigidity in PD

Answer 24

early: assym and proximal
later: symm and distal

slow movement lang when testing

cogwheel: ratchet like

lead pipe: fixed or magalaw mo pero matigas throughout

Question 25

discuss bradykinesia in PD

Answer 25

slowness of movement - most disabling d/t: weakness, tremor, rigidity

Question 26

differentiate bradykinesia, akinesia and hypokinesia

Answer 26

bradykinesia: slowness akinesia: absent hypokinesia: reduce amplitude

Question 27

discuss postural instab in PD

Answer 27

most disabling d/t high risk of falls least specific bcs can be from other diseases or old age di sha na ttreat ng drugs phantom pillow posture - supine and head remains flexed

Question 28

significance of drugs before tx

Answer 28

painom para di super rigid ng pt

Question 29

motor planning other clinical pres

Answer 29

start hesitation micrographia freezing episodes hypomimia uniplanar movements lng not rotatory

Question 30

motor learning other clinical pres

Answer 30

hirap sa step by step learning intact declarative

Question 31

gait other clinical pres

Answer 31

festinating - anterorepulsive shuffling gait

Question 32

sensation other clinical pres

Answer 32

proprio deficits intermittent paresthesia and pain postural stress syndrome akathisia

Question 33

speech, voice and swallowing other clinical pres

Answer 33

dysphagia sialorrhea mutism hypokinetic dysarthria

Question 34

cognitive and behavior other clinical pres

Answer 34

depression dysthymic behavior dementia bradyphrenia

Question 35

ANS other clinical pres

Answer 35

seborrhea seborrheic dermatitis constipation sexual impotence

Question 36

cardiopulmo other clinical pres

Answer 36

orthostatic hypotension airway obstruction restricted lung dysfunction

Question 37

deformities other clinical pres

Answer 37

striatal hand striatal toe

Question 38

CN affectation other clinical pres

Answer 38

CN 3, 7, 9 marcus gunn pupil argyll-robertson pupil blepharospasm blepharoclonus hypomimia

Question 39

critera for PD dx

Answer 39

2/4 of cardinal signs and resting tremor should be present (+) apomorphine lewy bodies at least 10 yrs of clinical course

Question 40

hoehn-yahr stage 1

Answer 40

unilateral or minimal/absent

Question 41

hoehn-yahr stage 2

Answer 41

bilat or midline balance not impaired

Question 42

hoehn-yahr stage 3

Answer 42

indep but impaired balance na pero kaya pa hirap lanf

Question 43

hoehn-yahr stage 4

Answer 43

all sx and severe stand and walk c assist

Question 44

hoehn-yahr stage 5

Answer 44

confined to bed and w/c

Question 45

drastic initial functional improvements

Answer 45

honeymoon period

Question 46

worsening of sx during expected time of medication effectiveness

Answer 46

wearing-off state

Question 47

medical management of PD

Answer 47

sinemet - carbidopa and levidopa