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Neurology > Parkinson's Disease > Flashcards

Parkinson's Disease Flashcards

1
Q

What are the two motor systems in the body?

A

Pyramidal and Extrapyramidal

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2
Q

Parkinson’s disease is a dysfunction of the midbrain?

A

Extrapyramidal

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3
Q

What are the three parts of basal ganglia?

A

Corpus Striatum, Amygdala, Claustrum

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4
Q

What are the structures that compose the corpus striatum?

A

Caudate nucleus, Putamen, Globus Pallidus

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5
Q

What composes the Lentiform nucleus?

A

Putamen, Globus Pallidus

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6
Q

What composes the Neostrium?

A

Caudate Nucleus, Putamen

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7
Q

What supplies neostriatum?

A

Lenticulostriate, MCA

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8
Q

What supplies globus pallidus?

A

Recurrent artery of Heubner, ACA

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9
Q

What are the two primary efferents of the extrapyramidal system?

A

Substantia Nigra Pars Reticulata and Globus Pallidus Interna

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10
Q

What is the primary afferent of the direct pathway?

A

Striatum

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11
Q

What is the primary afferent of the indirect pathway?

A

Subthalamus

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12
Q

What is the inhibitory NT of the brain?

A

GABA

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13
Q

What is the excitatory NT of the brain?

A

Glutamate

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14
Q

NT: Dopamine in the indirect pathway

A

Inhibitory

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15
Q

NT: Dopamine in the direct pathway

A

Excitatory

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16
Q

NT: ACH in the indirect pathway

A

Excitatory

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17
Q

NT: ACH in the direct pathway

A

Inhibitory

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18
Q

To be able to do its function, what should be the level of ACH and Dopamine in the striatum?

A

Equal

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19
Q

Group of disorders with disturbances in the dopamine system of the basal ganglia

A

Parkinsonism

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20
Q

Three types of parkinsonism

A

Primary PD, Secondary PD, Parkinson’s plus syndrome

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21
Q

What is the diagnostic tool for PD?

A

Apomorphine Test

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22
Q

Two other names of PD

A

Shaking palsy and paralysis agitans

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23
Q

It is a very slowly progressive disorder on CNS with motor and non-motor symptoms

A

Parkinson’s Disease

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24
Q

What gender is predominantly affected by PD?

A

M>F

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25
Q

What is the average onset of PD?

A

40-60 years

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26
Q

What is the onset of Young-onset?

A

21-40 years

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27
Q

What is the onset of Juvenile-onset?

A

<21 years

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28
Q

The progressive loss of dopaminergic cells that produces dopamine in substantia nigra

A

Primary PD

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29
Q

What are the two etiology of Primary PD?

A

Idiopathic and Genetic

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30
Q

The 3 genes affected in Primary PD

A

PPL: Pink 1, Park 1, Lark 2

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31
Q

Primary PD may be secondary to what?

A

Hyperactivity of cholinergic cells in the striatum

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32
Q

What diagnostic tool used in Primary PD?

A

MRI

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33
Q

What do you see in MRI to confirm Primary PD?

A

Paleness of SN

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34
Q

What is the kind of symptoms first to occur in primary PD?

A

Non-motor > Motor

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35
Q

Motor symptoms in primary PD occur in what percentage of destruction?

A

30-60%

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36
Q

What protein is absent in the BG that causes the appearance of Lewy bodies?

A

Synuclein protein

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37
Q

“Von economo’s disease”

A

Post-infectious PD

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38
Q

What is the other name of Post-infectious PD?

A

Encephalitis Lethargica

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39
Q

What is the route of Post-infectious PD?

A

Viral

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40
Q

Post-traumatic PD is secondary to what MOI?

A

Repetitive Trauma

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41
Q

What occupation is predisposed to Post-traumatic PD?

A

Boxers

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42
Q

What is the other name of Post-traumatic PD?

A

Dementia Pugilistica

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43
Q

What toxin is the most common cause of toxic PD?

A

Manganese

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44
Q

What heroine is associated with Toxic PD?

A

1-methyl-4-phenyl-1236-tetrahydropyridine (MPTP)

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45
Q

What are the other 4 toxins associated with Toxic PD?

A

PCCM: Pesticides, Cyanide, Carbon Disulfide, Methanol

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46
Q

“Wilson’s Disease”

A

Metabolic PD

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47
Q

What causes metabolic PD?

A

Hepatolenticular degeneration

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48
Q

What chromosome is affected by metabolic PD?

A

Chromosome 13

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49
Q

What is the genetic route of metabolic PD?

A

Autosomal Recessive

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50
Q

What causes metabolic PD?

A

Overaccumulation of Copper

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51
Q

Three areas where coppers go?

A

Eyes, Liver, BG

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52
Q

What manifestation can be seen in the eyes if there is an overaccumulation of copper?

A

Kayser-fleischer ring

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53
Q

Where specific area of BG is affected in metabolic PD?

A

Lentiform nucleus

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54
Q

What manifestation can be seen in the liver if there is an overaccumulation of copper?

A

It becoms firm and large

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55
Q

What are the three drugs associated with Drug-induced PD?

A

Anti-depressant, anti-hypertension, anti-psychotic

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56
Q

What PD is resulted in the lesion of blood supply?

A

Vascular PD

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57
Q

What are the 6 types of secondary PD?

A

Post-infectious, Post-traumatic, Toxic, Metabolic, Drug-induced, Vascular

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58
Q

What is the most common presenting symptom of PD?

A

Resting Tremor

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59
Q

5 sites of resting tremor

A

Hand, FA, Postural tremor, Jaw & Tongue, LE

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60
Q

It is the rapid extension-flexion of the index finger and thumb

A

Pill-rolling

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61
Q

What are the 3 frequencies of Pill-rolling?

A

3-5 Hz, 4-6 Hz, 4-7 Hz

62
Q

What type of tremor is seen in advanced stage PD?

A

Action tremor

63
Q

What is induces resting tremor?

A

Stress

64
Q

When does the resting tremor disappear?

A

During sleep

65
Q

Velocity-independent resistance to passive movement

A

Rigidity

66
Q

Two types of rigidity

A

Lead pipe and Cogwheel

67
Q

Type of rigidity that is uniform, sustained, resistance

A

Lead Pipe

68
Q

Type of rigidity that is intermittent, jerky-racthet like resistance

A

Cogwheel

69
Q

What is the other name of lead pipe?

A

Plastic

70
Q

Cogwheel is secondary to what?

A

Superimposed tremors

71
Q

Most disabling symptom of PD

A

Bradykinesia

72
Q

(+) delayed initiation

A

Akinesia

73
Q

(+) decrease amplitude of movement

A

Hypokinesia

74
Q

Masked face

A

Hypomimia

75
Q

(+) small handwriting

A

Micrographia

76
Q

(+) slowness of movement

A

Bradykinesia

77
Q

(+) decrease thought process

A

Bradyphrenia

78
Q

What is the symptom that is last to occur in PD?

A

Postural Instability

79
Q

Postural Instability is indicative of what stage of PD?

A

Advanced stage

80
Q

Patients with Postural Instability have a risk for ____?

A

Falls

81
Q

What posture is predominant in flexor muscles?

A

Simian Posture

82
Q

6 components of simian posture

A

Forward head, Protracted shoulder, shoulder ADIR, elbow flexion, hip flexion, knee flexion

83
Q

3 components of a striatal hand

A

FA pronation, wrist & MCP flexion, IP extension

84
Q

3 components of a striatal foot

A

DIB: DF, Inversion, Big toe extension

85
Q

What is the cardinal sign of PD?

A

TRAP: Tremor, Rigidity, Akinesia, Postural Instability

86
Q

Four gait difficulty is seen in PD patients

A

Shuffling, Festinating, Freezing, Fear of Falling

87
Q

Typical gait pattern in PD

A

Shuffling gait

88
Q

Gait with small steps with increased speed

A

Festinating Gait

89
Q

Gait due to the start of an off-state phenomenon

A

Freezing gait

90
Q

Cautious gait

A

Fear of falling

91
Q

Features of shuffling gait

A

Decrease step length, stride length, BOS, velocity

92
Q

Festinating gait is secondary to what factors?

A

Displaced COG and Advance stage PD

93
Q

What are the 6 other manifestations of PD?

A

PBSACB: Pain, Bulbar dysfunction, Sleep disorder, Autonomic Dysfunction, Cognitive Impairments, Behavioral changes

94
Q

What is the most common source of pain in PD?

A

Limb rigidity

95
Q

What are the two syndrome causes of pain in PD?

A

Postural stress and Restless leg

96
Q

What is the CN affected in PD?

A

CN 3, 7, 9, 1

97
Q

Excessive drooling

A

Sialorrhea

98
Q

What is the most common speech problem in PD?

A

Hypokinetic dysarthria

99
Q

What is the most common speech problem in advanced-stage PD?

A

Mutism

100
Q

Three features of sleep disorder in PD

A

Insomnia, Excessive day time sleeping, REM sleep behavior disorder

101
Q

Six features of Automatic dysfunction in PD

A

Erectile dysfunction, urinary incontinence, excessive sweating, seborrhea, OH, constipation

102
Q

What are the two cognitive and behavioral changes were seen in PD?

A

Dementia and Depression

103
Q

Three positive prognosticating factors of PD

A

Tremor, Rigidity, Family History

104
Q

Six negative prognosticating factors of PD

A

Bradykinesia, Akinesia, Gait difficulty, Cognitive impairments, Postural instability, Late age onset

105
Q

Modified HY: Unilateral disability

A

1

106
Q

Modified HY: Confined to bed or wheelchair

A

5

107
Q

Modified HY: Bilateral disability with a balance problem

A

3

108
Q

Modified HY: Unilateral disability + axial involvement

A

1.5

109
Q

Modified HY: Bilateral disability

A

2

110
Q

Modified HY: All s/sx is present and severe

A

4

111
Q

Modified HY: Bilateral disability with the recovery of pull-test

A

2.5

112
Q

Modified HY: Unsteadiness but the patient can live independently

A

3

113
Q

Modified HY: Standing and walking are only possible with assistance

A

4

114
Q

Three consideration with pharmacologic therapy in PD

A

Time, Low Protein Diet, and Peak Dose

115
Q

Time consideration: PD medications take effect

A

1 hr before or after a meal

116
Q

Why do PD patients should have a low protein diet?

A

High protein level inhibits the absorption of levodopa

117
Q

What is the time effective to conduct a rehab for PD patients?

A

1 hour after taking levodopa

118
Q

The precursor of dopamine

A

Levodopa

119
Q

The drug that prevents the early conversion of levodopa

A

Carbidopa

120
Q

The gold standard drug for PD

A

Sinemet

121
Q

Two phases of pharmacologic therapy in PD

A

Honeymoon period and Wearing off phase

122
Q

The phase where optimal effects of medication occur

A

Honeymoon period

123
Q

The phase where effects of medication start to wear off

A

Wearing off phase

124
Q

How long does the Honeymoon period last?

A

7-8 years

125
Q

What do physicians prescribe when the patient is already experiencing the wearing-off phase?

A

Increase dosage of levodopa

126
Q

9 adverse effect of increased dosage of levodopa

A

VPDMDNDMO: Visual hallucination, Peak dose dyskinesia, Dystonia, Motor fluctuations, Dysuria, Nausea, Dryness of mouth, Mood/sleep disorders, OH

127
Q

What is the most common adverse effect experienced by patients?

A

Visual hallucination

128
Q

What are the two involuntary movements seen experienced by patients?

A

Grimacing of face and limb choreoathetosis

129
Q

What is the most common site of dystonia in PD?

A

Foot = clawing of toes

130
Q

What is the most common site of dystonia in the body?

A

Neck

131
Q

Feeling of restlessness

A

Akathisia

132
Q

Motor fluctuations are caused by?

A

End dose deterioration, On-off phenomenon

133
Q

Difficulty in urination

A

Dysuria

134
Q

What are the two medications administered together with Sinemet to prevent adverse effects?

A

Dopamine agonist and anticholinergic

135
Q

7 dopamine agonist

A

Bromocriptine, premipexole, ropinerole, pergolide, cabergolide, amantadine, apomorphine

136
Q

2 anticholinergic

A

Trihexyphenidyl, Bentropine

137
Q

What substance inhibits NT in the brain including dopamine?

A

MAO: Mono-amine oxidase

138
Q

2 MAO-inhibitors

A

Rasagiline, Selegiline

139
Q

Four types of Parkinson plus syndrome

A

Progressive Supranuclear palsy, Corticobasal ganglionic degeneration, Multi-system Atrophy, PD with early dementia

140
Q

Parkinson plus syndrome due to (-) tau protein in the midbrain

A

Progressive Supranuclear palsy

141
Q

Parkinson plus syndrome due to (-) tau protein in the cortex

A

Corticobasal ganglionic degeneration

142
Q

Parkinson plus syndrome due to (-) synuclein protein

A

Multi-system Atrophy

143
Q

What are the PD-like symptoms seen in Progressive Supranuclear palsy?

A

Shuffling gait and Difficulty in performing vertical gaze

144
Q

What are the PD-like symptoms seen in Corticobasal ganglionic degeneration?

A

Asymmetric, akinetic rigid syndrome; Apraxia; Alien hand syndrome

145
Q

Sites affected in Multi-system Atrophy

A

Basal ganglia, cerebellum, autonomic system

146
Q

Another name of Multi-system Atrophy - Basal ganglia

A

Striatonigral degeneration (MSA-P)

147
Q

Another name of Multi-system Atrophy - Cerebellum

A

Olivopontocerebellar Atrophy (MSA-C)

148
Q

Another name of Multi-system Atrophy - Autonomic system

A

Shy-dager syndrome (MSA-A)

149
Q

What is the most common cause of dementia?

A

Alzheimer’s disease

150
Q

Dementia due to cycad seed toxicity

A

Guamanian ALS

151
Q

Dementia due to (-) synuclein protein

A

Diffuse cortico lewy bodies

Neurology (14 decks)

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