Parkinson's

Question 1

what is parkinsonism?

Answer 1

clinical syndrome that encompasses variety of diseases

Question 2

what makes up the triad seen in parkinsonism?

Answer 2

Akinesia (brady/hypo)

Restign tremor

Rigidity

Question 3

what is bradykineasia and hypokinesia?

Answer 3

bradykinesia = slowing of movements

hypokinesia = difficulty initiating movement

Question 4

what kind of disorder is parkinsonism?

Answer 4

progressive neurodegenerative movement disorder

Question 5

which tract is affected in parkinsons?

Answer 5

extra-pyramidal

Question 6

which neurons are affected in parkinsons?

Answer 6

dopaminergic neurons are lost

Question 7

which area of the brain is primarily affected in parkinsons?

Answer 7

pars compacta of the substantia nigrans

(causes disturbance in dopaminergic pathway)

Question 8

how is a diagnosis of parkinsons made?

Answer 8

clinically- look at age, symtpoms

there is no diagnostic test

Question 9

what is classically seen histologyically in parkinsons?

Answer 9

lewy bodies

(abnormal aggregates of protein)

Question 10

what kind of onset is seen in parkinsons?

Answer 10

gradual onset

Question 11

at what age will people typically develop parkinsons?

Answer 11

>55yrs

risk increases w age

Question 12

what clinical features can be seen in parkinsons?

Answer 12

parkinsonism triad

shuffling gait

masked facies: loss of facial expressions

Question 13

which later features concerning posture are seen in parkinsons?

Answer 13

flexed posture and postural instability

Question 14

what are the non-motor symtpoms of parkinsons?

Answer 14

constipation

REM sleep behaviour disorder

depression

dementia

Question 15

what drugs are used to manage parkinsons?

Answer 15

levodopa

monoamine oxidase B inhibitors

dopamine agonists

Question 16

what is the MoA of levodopa?

Answer 16

dopamine precursor that crosses the BBB

Question 17

what are the side effects of levodopa?

Answer 17

hypotension

nausea

dyskinesia

Question 18

what is the MoA of Monoamine oxidase B inhibitors?

Answer 18

inhibits monoamine oxidase B: an enzyme reponsible for catabolising dopamine to homovanillic acid

Question 19

what are the side effects of monoamine oxidase B inhibitors?

Answer 19

hypertensive crisis when consuming tyramine rich foods

Question 20

what is the MoA of dopamine agonsits?

Answer 20

stimulate dopamine receptors directly

Question 21

what aree the side effects of dopamine agonists?

Answer 21

hypotension

nausea

ankle swelling

hallucinations

Question 22

who is likely to be prescribed dopamine agonists?

Answer 22

younger pateints (<70) due to high risk of dyskinesia in younger patients using levodopa

Question 23

what is the one majot side effect seen when using levodopa?

Answer 23

‘overshoot’ from akinesia to dyskinesia

kwown as wearing off of the doses

Question 24

what is drug induced parkinsonism?

Answer 24

onset of parkinsonian features after strarting or raising dose of some meds or after withdrawal of anti-parkinsonian agent

Question 25

how soon is the onset of drug induced parkinsonism?

Answer 25

few weeks

Question 26

how is drug induced parkinsonism treated?

Answer 26

cessation of causitive drug

Question 27

what are some drugs that can cause drug induced parkinsonism?

Answer 27

chorpromazine

haloperidol

lithium

Question 28

which has a lower risk of extrapyramidal symptoms, typical or atypical antipschotics?

Answer 28

atypical antipsychotics

if someoen on typical cannot stop their medication they will be switched to atypical instead

Question 29

what can be used as an add in for symtpomatic relief in drug induced parkinsonism?

Answer 29

anticholinergics i.e. benztropine and procyclidine

Question 30

dementia starting more than 1 year after onset of parkinsonism is called?

Answer 30

parkinsons disease dementia

Question 31

dementia or cognitive symtpoms occuring before or at the same time as parkinsonism is termed?

Answer 31

Lewy Body Dementia

Question 32

what are the three core features of lewy body dementia?

Answer 32

dementia

recurrent visual hallucinations

features of parkinsonism

Question 33

what is multiple system atrophy?

Answer 33

parkinsonism along with autonomic dysfunction and/or cerebellar dysfunction

Question 34

what autonomic features are seen in multiple system atrophy?

Answer 34

postural hypotension

erectile dysfunction

urinary urgency

Question 35

what is seen on MRI in multiple system atrophy?

Answer 35

putaminal atrophy

‘hot cross bun’ appearance in pons in an axial section

Question 36

putaminal atrophy on MRI is seen in what condition?

Answer 36

multiple system atrophy

Question 37

‘hummingbird’ sign seen on MRI is classical of which condition?

Answer 37

progressive supranuclear palsy

Question 38

what is seen in progressive supranuclear palsy?

Answer 38

axial akinesia and rigidity

loss of balance and unexplained falls, forgetfullness

loss of eye movements

Question 39

what is the name for the loss of eye movements in progressive supranuclear palsy?

Answer 39

supranuclear gaze palsy

(especially on vertical plane)

Question 40

atrophy of which area of the brain is seen in progressive supranuclear palsy?

Answer 40

midbrain atrophy

Question 41

what is the cause of vascular parkinsonism?

Answer 41

mulitple small strokes or infarcts

Question 42

people with vascular parkinsonism tend to have problems with gait or tremor?

Answer 42

gait

have more problems in lower body

Question 43

does vascular parkinsonism progress more slowly or more rapidly in comparison to other types of parkinsonism?

Answer 43

progresses a lot slower

poor response to levodopa

Question 44

what imaging is used to differentiate vascular dementia from other parkinsonian syndromes?

Answer 44

SPECT

(single photon emission computed tomography)