Parkinson's

Question 1

pathophysiology of parkinsons

Answer 1

degeneration of dopaminergic neurones in substantia nigra (of basal ganglia)

Question 2

quadridad of parkinsons + key feature

Answer 2

rigidity
tremor
bradykinesia
postural instability - falls

unilateral onset

Question 3

3 aspects of rigidity in parkinsons

Answer 3

leadpipe
cogwheel
festinating (shuffling) gait

Question 4

aspects of tremor in parkinsons

Answer 4

pill rolling
unilateral
resting
fine tremor

PURF

Question 5

4 aspects of bradykinesia in parkinsons

Answer 5

expressionless face
slow monotonous speech
micrographia
gait - slow, shuffling, flexed trunk

Question 6

differentials for parkinsons

Answer 6

drug-induced
lewy body dementia
MSA + PSP
corticobulbar degeneration
normal pressure hydrocephalus

Question 7

multisystem atrophy

Answer 7

cerebellar signs
prominent early autonomic problems - bowel, bladder, hypotension
symmetrical

Question 8

PSP

Answer 8

swallowing problems (pronounced)
axial rigidity
vertical gaze palsy (lose elevation + depression of eyes)
early falls

SAVE

hummingbird sign on MRI

Question 9

corticobulbar degeneration

Answer 9

apraxia
aphasia
alien limb
cortical sensory deficit
dementia

AAACD

Question 10

parkinsons - investigations

Answer 10

clinical diagnosis

MRI - rule out rare causes of parkinsonism

Question 11

1st line management of PD + indications

Answer 11

severe/elderly - levodopa + dopa decarboxylase inhibitor (co-beneldopa)
moderate - dopamine agonist (ropinirole, pramipexole)
mild - monoamine-oxidase-B-inhibitor (rasagaline, selegiline)

Question 12

dopamine agonists SEs

Answer 12

sleep attacks
confusion + hallucinations
impulse control disorders

Question 13

levodopa SEs

Answer 13

N+V
postural hypotension
over time - dyskinesias + on/off phenomena

Question 14

management of PD - add-ons to levodopa

Answer 14

monoamine oxidase B inhibitors (rasagiline)
COMT inhibitor (entacapone) - prevent end of dose deterioration of co-carelsopa (prolong effects of levodopa)
amantadine - reduces dyskinesia

Question 15

non-drug management of PD

Answer 15

physio, OT, SALT
supervised exercise
home modifications
manage dementia, depression, sleep

Question 16

6 non-motor symptoms of PD

Answer 16

dementia + depression
sleep - lashing + shouting
hypersalivation + swallowing problems
constipation + bladder

Question 17

3 features - differentiating parkinsons from other diseases

Answer 17

no weakness
unilateral
resting tremor

Question 18

causes of tremor

Answer 18

vascular
salbuatmol (fine, bilateral)
parkinsonism
essential
cerebellar
thyrotoxicosis

V-SPECT

Question 19

normal pressure hydrocephalus triad? what is absent in NPH?

Answer 19

dementia
gait disturbance
urinary incontinence

no tremor or rigidity

Question 20

drug-induced parkinsons - which drugs? key feature?

Answer 20

antipsychotics + metoclopramide

symmetrical rigidity

Question 21

lewy body dementia

Answer 21

hallucinations

Question 22

essential tremor

Answer 22

worse on movement - action tremor
familial
in jaw + legs
coarse tremor

Question 23

DANISH

Answer 23

D - dysdidadokinesia (can’t quickly flip hand) + dysmetria (past pointing)
A - ataxia (incoordination of muscles; unsteady on feet towards side of lesion, rebounding arm if pushed)
N - nystagmus + blurred vision
I - intention tremor
S - slurred speech
H - hypotonia (weakness on side of lesion)

may have UMN signs

Question 24

thyroid tremor

Answer 24

fine bilateral tremor
goitre
eye signs
tachycardia