Brainscape's Knowledge GenomeTM

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


See full index

Neurology finals > Parkinsonism > Flashcards

Parkinsonism Flashcards

1
Q

What is parkinsonism an extrapyramidal triad of?

A

Hypertonia
Tremor
Bradykinesia

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

Describe the tremor in parkinsonism

A

Worse at rest, often pill rolling of thumb over finger

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

Describe hypertonia in parkinsonism

A

Rigidity and tremor gives cogwheel rigidity felt by the examiner during rapid pronation/supination

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

Describe bradykinesia in parkinsonism

A

Slow to initiate movement
Actions slow and decrease in amplitude with repetition
Gait is festinant
Expressionless face

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

Describe festinant gait

A

Shuffling
Pitched forward
Decreased arm swing
Freezing at obstacles and doors due to poor simultaneous motor and cognitive function

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

What are the causes of parkinsonism

A 
Parkinson's disease
Parkinson's plus syndromes
Vascular parkinsonism
Drugs
Toxins
Wilsons disease
Trauma
Encephalitis
Neurosyphilis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe the pathophysiology of Parkinson’s disease

A

Loss of dopaminergic neurons in the substantia nigra, associated with lewy bodies in the basal ganglia, brainstem and cortex

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

Is Parkinson’s disease a genetic disease

A

Most cases are sporadic however genetic loci have been implicated in familial cases

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

What is the mean age at onset of Parkinson’s disease

A

60yo

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

What does prevalence of Parkinson’s disease increase with?

A

Age

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

Describe the clinical features of Parkinson’s disease

A

Parkinsonism triad

Plus non motor symptoms

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

What non-motor symptoms are present in Parkinson’s disease

A

Autonomic dysfunction - postural hypotension, constipation, urinary frequency/urgency, dribbling of saliva
Sleep disturbance
Reduced sense of smell
Neuropsychiatric complications such as dementia, depression and psychosis

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

Describe how the diagnosis of Parkinson’s disease is made

A

Clinical diagnosis based on the core features of bradykinesia with resting tremor and/or hypertonia

Clinical response to dopaminergic therapy is supportive

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

Which diagnoses should be excluded when considering Parkinson’s disease

A

Cerebellar disease and frontotemporal dementia

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

Describe the location of symptoms in Parkinson’s disease

A

Unilateral - worse on one side

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

What imaging can be considered in Parkinson’s disease to support the diagnosis and exclude other causes

A

MRI - exclude structural problems
DaT scan - functional neuroimaging
PET scan - functional neuroimaging

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

Describe the focus of Parkinson’s disease treatment

A

Symptom control

Does not slow disease progression

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

List some non-pharmacological treatments of Parkinson’s disease

A

Deep brain stimulation

Surgical ablation of overactive basal ganglia circuits

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

Give examples of some Parkinson’s plus symptoms

A

Progressive supranuclear palsy
Multiple systems atrophy
Cortico-basal degeneration
Lewy body dementia

20
Q

Describe progressive supranuclear palsy

A 
Early postural instability 
Vertical gaze palsy 
Falls
Rigidity of trunk > limbs
Symmetrical onset 
Speech and swallowing problems 
Little tremor
21
Q

Describe multiple systems atrophy

A

Early autonomic features - incontinence/impotence
Postural hypotension
Cerebellar and pyramidal signs
Rigidity>tremor

22
Q

Describe cortico-basal degeneration

A

Akinetic rigidity involving one limb
Cortical sensory loss
Apraxia

23
Q

Describe vascular Parkinson’s

A

Postural instability and falls rather than tremor, bradykinesia and festination

24
Q

Which patients is vascular Parkinson’s common in?

A

Diabetics and hypertensives

25
Q

Which drugs commonly cause secondary Parkinsons

A

Neuroleptics
Metoclopramide
Prochlorperazine

26
Q

Which toxins cause secondary Parkinson’s

A

Manganese

27
Q

What is Parkinson’s disease caused by trauma called?

A

Dementia pugilistica

28
Q

Describe the management of Parkinson’s disease

A 
MDT input 
Assess disability and cognition objectively and regularly 
Monitor mood for depression 
Involve palliative care services early 
Offer respite care for the carers
29
Q

What happens to the efficacy of levodopa over time?

A

Decreases - requires larger doses and more frequent dosing and worsening of SEs and response fluctuations

30
Q

When should levodopa be started?

A

Age > 70yo
or when PD seriously interferes with life
Discuss pros and cons with the patient

31
Q

What might happen if you withdraw Parkinson’s disease medications too early ?

A

Acute akinesia

Neuroleptic malignant syndrome

32
Q

What is levodopa?

A

Dopamine precursor, given combined with a dopa-decarboxylase inhibitor in co-beneldopa and co-careldopa

33
Q

List the side effects of levodopa

A

Dyskinesia
Painful dystonia
Non motor SEs - psychosis, visual hallucinations, nausea and vomiting

34
Q

Which anti-emetic should be given to treat nausea in people with Parkinson’s disease?

A

Domperidone

35
Q

List some dopamine agonists

A 
Ropinirole
Pramipexole
Rotigotine 
Bromocriptine
Pergolide
Cabergoline
36
Q

What is the role of dopamine agonists

A

Can delay starting levodopa and also allows for decreased doses of levodopa

37
Q

What are the side effects of dopamine agonists

A

Nausea
Drowsiness
Hallucinations
Compulsive behaviour - gambling, hypersexuality

38
Q

What is the problem with ergot derived dopamine agonists

A

Fibrotic reactions

39
Q

Which weak dopamine agonist is used for drug-induced dyskinesias

A

Amantadine

40
Q

What is apomorphine, how is it given and what is it used for?

A

Potent dopamine agonist used with continuous SC infusion to even out end of dose effects or as a rescue pen for sudden off freezing

41
Q

What is a side effect of apomorphine

A

Injection site ulcers

42
Q

What class of drug can be given as an alternative to dopamine agonists in early Parkinson’s disease

A

Monoamine oxidase inhibitors

43
Q

List some side effects of Monoamine oxidase inhibitors

A

Postural hypotension

Atrial fibrillation

44
Q

What is the role of COMT inhibitors

A

May help with motor complications in late disease

Lessen the off time in those with end dose wearing off

45
Q

What is the complication and monitoring in the use of tolcapone

A

Hepatic complications

Requires close monitoring of LFT

46
Q

Give 2 examples of COMT inhibitor

A

Entacapone

Tolcapone

Neurology finals (32 decks)

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