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Neurology > Parkinson's > Flashcards

Parkinson's Flashcards

1
Q

What is the pathology in PD?

A

Loss of dark pigment in substantial nigra (in basal ganglia)

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2
Q

Which type of cell loss causes the pigment loss?

A

Dopaminergic

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3
Q

What is the histological finding in PD?

A

Lewy bodies

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4
Q

What are the motor features in PD?

A

Tremor
Bradykinesia
Rigidity
Postural instability

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5
Q

What are the non motor features in PD?

A 
Sleep disorders
Hallucinations
GI dysfunction
Depression
Dementia (late disease)
Anosmia
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6
Q

What are the essential criteria for diagnosis of PD?

A

Bradykinesia + one or more of:

  • resting tremor (pill-rolling)
  • rigidity (cogwheel or lead pipe)
  • postural instability
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7
Q

Is onset of PD unilateral or bilateral?

A

Unilateral

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8
Q

What might be observed in a parkinsonian gait?

A

Stooped, fixed posture
Reduced arm swing
Shuffling, short stepped gait
Slow turning

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9
Q

What might be observed in the face of someone with PD?

A

Hypomimia (reduced expression –> masked face)

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10
Q

How is PD diagnosed?

A

Clinically

structural imaging and SPECT may be helpful

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11
Q

Which factors are thought to increase the risk of developing PD?

A 
Pesticides
Head injury
Rural living
Beta-Blockers 
Agricultural occupation
Well water drinking
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12
Q

Which factors are thought to decrease the risk of developing PD?

A 
Tobacco smoking
Coffee
NSAID use
Calcium channel blockers 
Alcohol consumption
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13
Q

Name 2 genes linked to PD

A

LRRK2

PARKIN

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14
Q

What is the role of treatment in PD?

A

Symptomatic treatment by increasing intracerebral dopamine or stimulating dopamine receptors
No neuroprotective of disease modifying drugs for PD

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15
Q

When should treatment with levodopa be initiated?

A

When symptoms cause disability

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16
Q

What is the problem with one term levodopa use?

A

Motor complications including:

  • dyskinesias (involuntary movements)
  • painful dystonias
  • fluctuations in response –> “off freezing”
17
Q

How does levodopa work?

A

It is converted to dopamine in the brain

18
Q

What are the non motor side effects of levodopa?

A

Nausea and vomiting
Tolerance (increased dose required to elicit same effect)
Psychosis
Visual hallucinations

19
Q

Which type of drug can be given to delay starting levodopa in early disease? Give two examples

A

Dopamine agonists

  • ropinirole
  • pramipexole
20
Q

What are the side effects of dopamine agonists?

A 
Nausea 
Daytime sleepiness
Oedema
Gambling and hyper sexuality
Hallucinations
21
Q

Which patients should not be given dopamine agonists?

A

Patients with history of addiction/OCD

Elderly (hallucinations)

22
Q

Which other class of drugs can be used in PD? Give 2 examples

A

Monoamine oxidase (MAO-B) inhibitors

  • rasagiline
  • selegiline
23
Q

Which drug can be given for drooling of saliva in PD?

A

Glycopyrronium bromide

24
Q

Which drug should be given for orthostatic hypotension in PD?

A

Midodrine

25
Q

Which drug can be given for dementia in PD and which class of drugs does it belong to?

A

Rivastigmine

- cholinesterase inhibitor

26
Q

How should hallucinations/delusions in PD be managed?

A

Reduce meds that may be causative

Quetiapine or clozapine

27
Q

How should you manage daytime sleepiness in PD?

A

Inform the DVLA

Modafinil if can’t be reversed

28
Q

How can you treat REM sleep behaviour disorder and restless leg syndrome in PD?

A

Clonazepam or melatonin

29
Q

What are the differentials for PD?

A 
Vascular Parkinsonism
Drug induced Parkinsonism
Tremor disorders
Multisytem atrophy
Progressive supra nuclear palsy
Fragile X tremor ataxia syndrome
30
Q

Which drugs can cause parkinsonism?

A

Any drugs that block action of dopamine

Neuroleptics:

  • chlorpromazine
  • haloperidol
  • olanzapine
  • respiridone
  • metoclopramide
  • prochlorperazine

Neurology (16 decks)

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