Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Neurology- Clinical > Parkinson's Disease > Flashcards

Parkinson's Disease Flashcards

1
Q

PD is an example of what type of movement disorder? Is this pyramidal or extrapyramidal?

A

Hypokinetic / extrapyramidal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Which part of the brain is affected in PD?

A

Basal ganglia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What specific part of the basal ganglia is affected in PD?

A

The pars compacta region of the substantia nigra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the key pathological feature of PD?

A

Loss of dopaminergic neurones in the substantia nigra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Sections through the brainstem in a PD sufferer would show what? What does this correlate with?

A

Loss of the normally dark black pigment of the substantia nigra / correlates with dopaminergic cell loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Symptoms of PD generally do not tend to show until there is what?

A

Loss of around 60% of neurones in the substantia nigra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

The neurones which remain in the substantia nigra in PD can often accumulate what? Within where?

A

The protein alpha-synuclein within Lewy bodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are Lewy bodies?

A

Abnormal aggregates of protein that develop inside nerve cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

In terms of describing the pathophysiology of PD, the degeneration of dopaminergic neurones in the substantia nigra are associated with what? Which leads to what?

A

A decrease in dopamine levels which leads to increased basal ganglia inhibitory output and hypokinetic symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the risk factors for developing PD?

A

Increasing age, male gender, family history, other environmental/genetic factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What feature increases the probability of a genetic cause for PD?

A

Early onset, particularly < 40 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

A mutation in the PARK2 gene is responsible for causing what?

A

Typical, early onset (< 50 years) PD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

A mutation in the ATP13A2 gene is responsible for causing what?

A

Atypical, juvenile onset (children/teens) PD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Around 50% of patients with PD aged < 50 have a mutation in which gene?

A

PARK2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

LRRK2 and SNCA are both genes in which mutations can lead to PD. How are these inherited?

A

Autosomal dominant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

PARKIN and PINK1 are both genes in which mutations can lead to PD. How are these inherited?

A

Autosomal recessive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the 3 main groups of symptoms of PD?

A

Hypokinetic motor symptoms, hyperkinetic motor symptoms and non-motor symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the 3 main hypokinetic motor symptoms of PD?

A

Bradykinesia/akinesia, rigidity and postural instability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

The rigidity in PD is often described as what?

A

Cogwheeling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Rigidity is a feature of PD which can cause what?

A

A stooped posture and an expressionless ‘mask like’ face

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Which of the 3 main hypokinetic motor features of PD usually develops last? This can often lead to what?

A

Postural instability, often leads to falls

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the only hyperkinetic motor feature of PD?

A

Resting tremor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the 4 main non-motor features which can be seen in PD?

A

Hyposmia/anosmia, sleep disorders, depression/psychosis/dementia, autonomic features

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are some examples of autonomic features which may be seen in PD?

A

GI/bladder dysfunction, postural hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Motor features in PD are heterogenous, but what are the two broad subtypes?

A

Tremor dominant (with relative absence of other features) and non-tremor dominant

26
Q

What are the outcomes of tremor dominant PD when compared with non-tremor dominant PD?

A

Slower rate of progression and less functional disability

27
Q

How do the motor symptoms of PD usually start?

A

They usually start asymmetrically, often as a resting tremor in one arm

28
Q

In PD, what tends to come first - motor or non-motor symptoms?

A

Non-motor

29
Q

Essential Parkinsonism can be defined as bradykinesia and at least one of what other features?

A

Resting tremor, postural instability or rigidity

30
Q

What are some additional motor features of PD which are not included in the criteria for essential Parkinsonism?

A

Stooped, fixed or dystonic posture, hypomimia (masked face), shuffling gait

31
Q

What is cogwheel rigidity?

A

A superimposed clicking resistance, often attributed to the underlying tremor

32
Q

What is lead pipe rigidity?

A

Constant resistance throughout passive movement

33
Q

Idiopathic PD is diagnosed how?

A

It is a diagnosis of exclusion

34
Q

Idiopathic PD is a clinical diagnosis and can be confirmed with what?

A

Essential Parkinsonism, no alternative explanation for symptoms (e.g. drugs), responsiveness to Levodopa

35
Q

Before diagnosing idiopathic PD, what should you exclude?

A

Treatable causes of asthenia e.g. anaemia or hypothyroidism

36
Q

Does tremor occur in all patients with PD?

A

No, around 70%

37
Q

Patients with idiopathic PD should NOT present with what?

A

Early onset bulbar problems, dementia/hallucinations, eye movement disorder or intrusive autonomic features

38
Q

What is a useful test to do to diagnose PD and why?

A

Idiopathic PD usually responds to treatment with Levodopa, so a trial of this to see if there is an improvement in symptoms is a good test to do

39
Q

What test can be done to visualise neurodegeneration in the basal ganglia in PD?

A

MRI

40
Q

What test can be done to assess dopamine levels in the basal ganglia in PD?

A

SPECT

41
Q

In PD, symptomatic treatments are used to do what?

A

Enhance intracerebral dopamine or stimulate dopamine receptors

42
Q

What is the main symptomatic drug for PD and what is its mechanism of action?

A

Levodopa - a dopamine precursor

43
Q

What is the 2nd line symptomatic drug group for PD? What are some examples?

A

Dopamine agonists - apomorphine, ropinirole and pramipexole

44
Q

What are some last line symptomatic drug treatments for PD?

A

Monoamine oxidase type B inhibitors and amantadine

45
Q

Why is dopamine itself not used to treat PD?

A

Because it does not cross the BBB

46
Q

When should treatment for PD be initiated?

A

When symptoms are causing discomfort and disability

47
Q

Which symptoms of PD respond reliably to dopaminergic treatment in early disease?

A

Bradykinesia and rigidity

48
Q

Which symptom of PD is inconsistently responsive to dopaminergic treatment?

A

Resting tremor

49
Q

What can be an effective treatment for tremor in PD?

A

Anticholinergic agents e.g. trihexyphenidyl

50
Q

What are some non-oral therapies that can be used for PD?

A

Continuous apomorphine infusions and deep brain stimulation

51
Q

Dopamine agonists and Levodopa are associated with what side effects?

A

Nausea, daytime somnolence and oedema

52
Q

Dopamine agonists can cause what kind of disorders?

A

Impulse control disorders

53
Q

Dopamine agonists should not be prescribed in who?

A

Patients with a history of addiction/OCD/impulsive personalities and the elderly (especially with cognitive impairment)

54
Q

Which drug used to treat PD has the greatest symptomatic benefit? What are its downsides?

A

Levodopa / associated with motor complications (dyskinesias) and reduced effect after 5-10 years

55
Q

Younger patients with PD are often started on which drug first?

A

Dopamine agonists

56
Q

What are the main long term complications of dopaminergic therapies for PD?

A

Motor and non-motor fluctuations, dyskinesias, psychosis

57
Q

What are motor/non-motor fluctuations?

A

Alterations between periods of good motor/non-motor symptom control and periods of reduced motor/non-motor symptom control

58
Q

Which dyskinesias are most likely to be caused by Levodopa? They tend to occur when?

A

Involuntary chorieform or dystonic movements / when levodopa concentrations are at maximum

59
Q

What is it known as if involuntary dyskinesias occur at the beginning or the end of a levodopa dose?

A

Diphasic dyskinesia

60
Q

What type of hallucinations are most likely to occur in PD?

A

Visual

61
Q

What problems with regards to sleep can be seen in PD?

A

REM sleep disorders and restless legs

Neurology- Clinical (31 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions