Parkinson's Disease

Question 1

What is the triad of parkinsonism?

Answer 1

rigidity
bradykinesia
resting tremor

Question 2

What is ballismus?

Answer 2

increased amplitude chorea

Question 3

What is chorea?

Answer 3

fragments of movements flow irregularly from one body segment to another causing a dance-like appearance

Question 4

What structures make up the basal ganglia?

Answer 4

caudate nucleus 
putamen 
globus pallidus 
sub thalamic nucleus 
substantia nigra

Question 5

What are the 2 broad subtypes of Parkinson’s?

Answer 5

Tremor dominant

non-tremor dominant

Question 6

Which subtype of parkinsons has a better prognosis?

Answer 6

tremor-dominant

Question 7

Which symptoms tend to come first, motor or non-motor?

Answer 7

non-motor

Question 8

What are some examples of non-motor features?

Answer 8

olfactory dysfunction 
cognitive impairment 
psychiatric symptoms 
sleep disorders 
autonomic dysfunction 
pain and fatigue

Question 9

How is rapid eye movement sleep behaviour disorder treated?

Answer 9

clonazepam/melatonin at bedtime

Question 10

What is the pathological hallmark of parkinson’s disease?

Answer 10

loss of dopaminergic neurones in the substantia nigra

Question 11

What protein forms Lewy Bodies?

Answer 11

alpha-synuclein

Question 12

what is the greatest risk factor for PD?

Answer 12

Age

Question 13

Is there a genetic component to PD?

Answer 13

Yes

Question 14

Which drug cures parkinsons disease?

Answer 14

No cure!!

Question 15

Which drugs can be effective in treating tremor?

Answer 15

anticholinergic agents
trihexyphenidyl
clozapine

Question 16

What adverse effect are associated with dopamine agonists and levadopa?

Answer 16

nausea
daytime somnolence
oedema
psychosis

Question 17

What is an example of a dopamine agonist?

Answer 17

bromocriptine

Question 18

What is the difference between dopamine agonists and levadopa?

Answer 18

levodopa is converted into dopamine in the brain, dopamine agonists mimic the effect of dopamine without needing to be converted

Question 19

Which patients should not receive dopamine agonists?

Answer 19

gamblers, binge eating, compulsive spenders

elderly with cognitive impairment

addition/OCD

Question 20

At what point during treatment do dyskinesias tend to occur?

Answer 20

maximum dose of levodopa

Question 21

Can dopaminergic therapies cause psychosis?

Answer 21

yes - drug induced psychosis

Question 22

What drugs are used to manage PD psychosis?

Answer 22

clozapine

quetiapine

Question 23

What is rivastigmine?

Answer 23

cholinesterase inhibitor

helps reduce visual hallucinations and delusions in PD patients

Question 24

what surgical treatments are available for PD?

Answer 24

deep brain stimulation of the sub thalamic nucleus or globus pallidus internus

Question 25

What is bradykinesia?

Answer 25

slowness of movement with progressive loss of amplitude/speed

Question 26

What movements assess bradykinesia?

Answer 26

opening and closing hand foot tapping

Question 27

What other motor symptoms are seen in PD?

Answer 27

hypomimia hypophonia micrographia

Question 28

What kind of tremor is seen in PD?

Answer 28

resting tremor commonly "pill-rolling"

Question 29

What features are seen in Parkinsonian gate?

Answer 29

``` stooped posture slow, shuffling decreased arm swing slow turning with many steps freezing festination ```

Question 30

What are common premotor symptoms?

Answer 30

sleep disorder loss of smell constipation

Question 31

Parkinson's disease is typically symmetrical - T/F?

Answer 31

False

Question 32

What is a DAT scan?

Answer 32

dopamine transporter imaging to assess dopaminergic function

Question 33

What will be seen on a DAT scan in a patient with essential tremor?

Answer 33

nothing

Question 34

What is drug induced parkinsonism?

Answer 34

emergence of parkinsonism after specific drug treatment

Question 35

What are distinguishing features of essential tremor?

Answer 35

autosomal dominant inheritance | responsive to alcohol

Question 36

what features are seen in multi-system atrophy?

Answer 36

dysautonomia cerebellar features parkinsonism

Question 37

What is progressive supra nuclear palsy?

Answer 37

symmetrical akinetic rigid syndrome with predominantly axial involvement

Question 38

which facial muscle is continuously activated in patients with PSP?

Answer 38

frontalis