Parkinsonism

Question 1

key Parkinsonian features

Answer 1

(TRAP)

• Tremor
• Rigidity
• Akinesia / bradykinesia
• Postural instability

Question 2

differential of tremor

Answer 2

• essential tremor
• hyperthyroidism
• drug induced (beta agonist)
• cerebellar disorder

Question 3

management of Parkinson’s disease

Answer 3

• immediate referral (<6 weeks)
• treat levodopa
• non-pharm: PT, OT, speech

Question 4

differential of parkinsonism

Answer 4

• dementia with Lewy bodies
• essential tremor
• drug-induced (esp 1st > 2nd gen antipsychotics, metoclopramide, prochlorperazine)
• multiple system atrophy
• progressive supranuclear palsy

Question 5

atypical parkinsonism (points away from PD)

Answer 5

• falls at presentation
• bilateral at onset
• rapid progression
• lack of tremor
• autonomic dysfunction (urinary or fecal incontinence)
• early dementia
• poor response to levodopa

Question 6

features of parkinson’s disease tremor

Answer 6

• begins unilaterally
• upper extremity
• 4-5 Hz
• “pill rolling”
• tremor improves with movement

Question 7

drugs that cause parkinsonism

Answer 7

• amphotericin B
• calcium channel blockers
• chemotherapy
• cholinergics
• lithium
• metoclopramide
• neuroleptics
• prochlorperazine
• SSRIs
• valproate

Question 8

non-pharm management PD

Answer 8

• PT / OT / speech
• ## early referral to neurology