Parkinson's Disease

Question 1

What is the most common neurodegenerative disorder?

Answer 1

AD

Question 2

What is the second most common neurodegenerative disorder?

Answer 2

PD

Question 3

What causes PD?

Answer 3

loss of dopamine producing neurones in the substantia nigra, causing a pigment loss which can be seen on biopsy

Question 4

What explains why there isa high incidence of depression in PD?

Answer 4

5HT-producing neurones in the brainstem are also affected

Question 5

What does degeneration of neurones cause?

Answer 5

clumps of protein called Lewy Bodies

Question 6

Strongest risk factors for PD?

Answer 6

old age/FH

Question 7

Other risk factor for PD?

Answer 7

pesticide exposure

Question 8

Protection against PD?

Answer 8

smoking, NSAIDs, high uric acid levels

Question 9

In whom with PD is there more likely to be a genetic cause?

Answer 9

early onset (below 40)

Question 10

Parkinson’s triad?

Answer 10

bradykinesia, rigidity, resting tremor

Question 11

What is bradykinesia?

Answer 11

slowness of movement, gets slower each time it is attempted

Question 12

What is hypomimia (ass with PD)?

Answer 12

decreased facial expression and blinking

Question 13

What is micrographia?

Answer 13

progressively smaller handwriting

Question 14

Is a head tremor typical for PD?

Answer 14

NO

Question 15

When is a resting tremor best observed?

Answer 15

while patient is focused on a mental task

Question 16

What is a positive Froment’s maneuvre?

Answer 16

rigidity increases in examined body segment by voluntary movement of other body parts

Question 17

What type of rigidity is felt in PD, and where is it especially noticeable?

Answer 17

cogwheel rigidity

Wrist

Question 18

Why does stooped posture occur in PD?

Answer 18

impaired postural reflexes

Question 19

What is camptocormia?

Answer 19

extreme anterior truncal flexion

Question 20

What is the typical Parkinsonian gait?

Answer 20

slow, occurs at narrow base, short shuffling steps

Question 21

What is festination?

Answer 21

very fast succession of steps and difficulties stooping

Question 22

What is the pull test?

Answer 22

pulling back on the patient while they try to maintain posture

Question 23

Name some early non motor symptoms of Parkinson’s.

Answer 23

Hyposmia, REM, constipation, depression

Question 24

What are some late non motor symptoms of PD?

Answer 24

dementia, hallucination

Question 25

In what type of PD is a resting tremor uncommon, and structural brain imaging needed for diagnosis?

Answer 25

Vascular Parkinson’s

Question 26

What should be 1st line treatment for Parkinson’s?

Answer 26

Levodopa
OR
Dopamine agonist (eg repoinorole, rotigotine, pramipexole, apomorphine)
OR
MAO B Inhibitors (eg rasagiline, selegiline)

Question 27

If an “ergot” type of Dopamine agonist is chosen to treat PD, eg pergolide or bromocriptidine, what should be done?

Answer 27

Renal function tests, ESR and CXR

Question 28

What other drugs may be used in Parkinsons but should not be first choice?

Answer 28

Beta blockers
Amantadine
Anticholinergics
Modified release levodopa

Question 29

What is the aim of treatment in Parkinson’s?

Answer 29

to treat symptoms

Question 30

What can be used to treat erectile dysfunction in PD?

Answer 30

sidenafil

Question 31

What additional drug type may be used in late PD?

Answer 31

COMT inhibitors eg entacapone, tolcapone

Question 32

When should Single photon emission computed tomography (SPECT) be used in diagnosis of Parkinson’s?

Answer 32

only where essential tremor cannot be clinically differentiated from parkinsonism.

Question 33

How is PD diagnosed?

Answer 33

CLINICALLY - MRI etc not used

Question 34

Why may D3 agonists sometimes be preferred to Levodopa?

Answer 34

in younger patients, due to Levodopa’s decreased efficacy over time

Question 35

A rare side effect of Bromocriptidine ( A D2 agonist)?

Answer 35

fibrosis

Question 36

Main side effect of dopamine agonists?

Answer 36

hallucinations

Question 37

What is selegiline?

Answer 37

MAO B inhibitor