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724: Medical Lectures > Parkinsonism and Parkinson's Disease > Flashcards

Parkinsonism and Parkinson's Disease Flashcards

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USMLE® Step 1 flashcards
1
Q

What can be defined as any combination of tremor, rigidity, bradykinesia, and progressive postural instability?

A

Parkinsonism

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2
Q

What is the gender and ethnic distribution among patients with Parkinsonism?

A

Occurs in all ethnic groups, with an approximately equal sex distribution

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3
Q

Idipathic Parkinson disease begins most often between the ages of __-__.

A

45-65

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4
Q

Parkinsonism may result form mutation of hat 5 genes?

A
  • Alpha-synuclein
  • Parkin
  • LRRK2
  • DJ1
  • PINK1
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5
Q

Mutations in what gene account for some cases of sporadic Parkinson disease?

A

LRRK2

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6
Q

What environmental factors may lead to Parkinsonism?

A
  • Exposure to certain toxins (maganese dust, carbon disulfide)
  • Severe cases of carbon monoxide poisoning
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7
Q

Reversible parkinsonism is sometimes seen in what type of patients?

A

patients receiving neuroleptic drugs, reserpine, or metoclopramide

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8
Q

What is the main cause of idiopathic parkinsonism?

A

Dopamine depletion which leads to an imbalance of dopamine and acetylcholine

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9
Q

Because dopamine depletion is often the cause what is the focus of treatment?

A

Blocking the effect of acetylcholine

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10
Q

Serum urate levels are a prognostic factor in that the rate of progression declines as the urate level _____.

A

increases

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11
Q

What are 5 risk factors for developing Parkinson’s disease?

A
  • Age
  • Family history
  • Male sex
  • Ongoing herbicide/pesticide exposure
  • Significant prior head trauma
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12
Q

What are 4 protective factors against Parkinson’s disease?

A
  • previous ibuprofen use
  • smoking
  • caffeine
  • coffee
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13
Q

A disruption in the direct pathway leads to what?

A

Akinesia/bradykinesia

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14
Q

A disruption in the indirect pathway leads to what?

A

Resting tremor

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15
Q

What are the 4 cardinal signs of parkinsonism?

A
  • Tremor
  • Rigidity
  • Bradykinesia
  • Postural instability
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16
Q

Describe tremors associated with parkinsonism

A
  • they can occur in all limbs

- a tremor of 4-6 cycles is conspicuous at rest

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17
Q

What increases tremors?

A

emotional stress

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18
Q

What produces less severe tremors?

A

voluntary activities

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19
Q

What is responsible for the characteristically flexes posture?

A

rigidity

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20
Q

Define rigidity

A

an increase in resistance to passive movement

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21
Q

What is the most disabling symptom of parkinsonism?

A

bradykinesia

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22
Q

Define bradykinesia

A

A slowness in voluntary movement and a reduction of automatic movements such as swing of the arms while walking

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23
Q

What are 10 other characteristics of parkinsonism?

A
  • relatively immobile face
  • decreased or infrequent blinking
  • lack of facial expression
  • saliva drooling from the mouth
  • seborrhea of the scalp and face
  • mild blepharoclonus
  • tremor around the mouth and lips
  • tremor around the mouth and lips
  • impaired swallowing
  • soft and poorly modulated voice
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24
Q

Do people with parkinsonism exhibit with muscle weakness or decreased DTRs?

A

No

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25
Q

How is parkinsonism diagnosed?

A

If bradykinesia is present with either a tremor or rigidity

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26
Q

What 2 common diagnoses may be mistaken for mild parkinsonism?

A
  • old age (hypokinesia and resting tremor)

- depression (absent facial expressions)

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27
Q

What is the major difference between an essential tremor and parkinsonism?

A

Essential tremors are typically more of an action tremor than resting type tremor

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28
Q

What movements do essential tremors affect?

A

head movements

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29
Q

What type of tremors are associated with parkinsonism?

A

tremors of the jaw or lips

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30
Q

What are 6 differential diagnoses to Parkinson’s disease?

A
  • Wilson disease
  • Huntington disease
  • multiple system atrophy
  • progressive supranuclear palsy
  • Jakob-Creutzfeldt disease
  • corticobasilar degeneration
  • drug induced parkinsonism
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31
Q

How can Wilson’s disease be distinguished from PD?

A
  • early age onset
  • Kayser-Fleischer rings (iris)
  • chronic hepatitis
  • increased copper concentrations in the tissues
32
Q

How can Huntington’s disease be distinguished from PD?

A
  • early age onset
  • chorea like movements
  • athetosis
33
Q

How can multisystem atrophy be distinguished from PD?

A
  • autonomic insufficiency (postural hypotension, anhidrosis, disturbances of sphincter control, ED)
  • pyramidal deficits
  • lower motor signs
  • cerebellar dysfunction
34
Q

How can progressive supranuclear palsy be distinguished from PD?

A
  • eye movements (downward gaze)
  • postural instability (ataxia)
  • axial dystonia
  • pseudobulbar palsy (dysarthria/dysphagia)
  • pseudo-emotional liability
35
Q

What is Jakob-Creutzfeldt disease due to?

A

infection

36
Q

How can Jakob-Creutzfeldt disease be distinguished from PD?

A
  • Dementia: memory loss, hallucination, psychosis
  • Myoclonic jerking
  • Ataxia
  • Pyramidal signs
  • MRI and electroencephalograph findings
37
Q

How can corticobasal degeneration be distinguished from PD?

A
  • absence of tremor

- lack of L-dopa response

38
Q

What are the distinctive features of corticobasal degeneration?

A
  • ideomotor apraxia
  • alien limb phenomenon
  • aphasia
  • loss of cortical sensory function
39
Q

How can drug induced parkinsonism be distinguished from PD?

A

it is reversible

40
Q

What patient population is vulnerable to drug induce parkinsonism?

A

AIDS

41
Q

Symptoms of drug induced parkinsonism should subside - weeks after medication

A

4-6

42
Q

Because there is no cure for PD, treatment is focused on what?

A

controlling the symptoms associated with PD

43
Q

What are the 7 medical measures taken to treat PD?

A
  • amantadine
  • anticholinergic drugs
  • levodopa
  • dopamine agonists
  • selective monoamine oxidase inhibitors
  • COMT inhibitors
  • atypical antipsychotics
44
Q

What type of patients may be helped with amantadine?

A

those with mild symptoms but no disability

45
Q

The side effects of amantadine are uncommon with the typical dosage of ___mg given twice a day orally

A

100

46
Q

What are anticholinergic drugs beneficial in relieving?

A

tremors and rigidity (no so much bradykinesia)

47
Q

What are 5 examples of anticholinergic drugs?

A

Benzotropine mesylate (Cogentin)

  • Biperiden (Akineton)
  • Orphenadrine (Disipal, Norflex)
  • Procyclidine (Kemadrin)
  • Trihexyphenidyl (Artane)
48
Q

What is the most effective drug for treating PD?

A

Levodopa (L-DOPA)

49
Q

How does L-dopa function to treat PD?

A

It is converted into dopamine in the body which increases overall dopamine levels in the brain

50
Q

What symptoms of PD are improved through the use of L-dopa?

A

All major aspects of parkinsonism

However, it does not decrease progression of the disease

51
Q

The __-__ phenomenon is a late complication of L-dopa. Describe this phenomenon

A

on-off

Abrupt but transient fluctuations in the severity of parkinsonism occur unpredictably but frequently during the day

52
Q

What is the “off” period of the on-off phenomenon marked by?

A

bradykinesia

53
Q

What is the “on” period of the on-off phenomenon marked by?

A

increased mobility

54
Q

How does L-dopa cross the blood brain barrier?

A

An enzyme (DDC) converts L-dopa into dopamine which can then cross the barrier

55
Q

What DDC inhibitor is oftentimes given in combination with L-dopa in order to reduce the associated side effects?

A

Carbidopa

56
Q

Does the combination of Carbidopa and L-dopa prevent the “on-off” phenomenon?

A

No

57
Q

What medication provides an already prepared combination of carbidopa and L-dopa in either a 1:10 or 1:4 ratio?

A

Sinemet

58
Q

Precautions to taking L-dopa should be considered in what type of patients?

A

Those with active peptic ulcers or malignant melanomas

59
Q

How do dopamine agonists help in treating PD?

A

They act directly on dopamine receptors, and their use in parkinsonism is associated with a lower incidence of the response fluctuations and dyskinesias that occur with long-term L-dopa therapy

60
Q

When are dopamine agonists best administered?

A

before L-dopa or with a low dose of Sinemet

61
Q

What are 2 dopamine agents that are effective at the early and advanced stages of Parkinson disease?

A
  • Pramipexole

- Ropinirole

62
Q

Pramipexole – most individuals require __-__ mg 3x daily taken orally

A

0.5 - 1.5

63
Q

Ropinirole – most individuals require - mg 3x daily

A

2 to 8

64
Q

What are 2 examples of selective monoamine oxidase inhibitors (MAOIs)?

A
  • Rasagiline

- Selegiline

65
Q

How do MAOIs function in treating PD?

A

They inhibiting the metabolic breakdown of dopamine which improves the fluctuations or declining response to L-dopa

66
Q

Why should high tyramine foods be avoided while taking MAOIs?

A

They may cause hypertension

67
Q

What foods are high in tyramine?

A
  • cheese

- cured meats (pepperoni, summer sausage, salami)

68
Q

What are 2 examples of Catecholamine-O-Methyltransferase inhibitors (COMT inhibitors)?

A
  • Tolcapone

- Entacapone

69
Q

How do COMT inhibitors function in treating PD?

A

They reduce the metabolism of levadopa to 3-O-methyldopa which thereby alters the plasma pharmacokinetics of L-dopa, leading to more sustained plasma levels and more constant dopaminergic stimulation of the brain

70
Q

What does treatment with COMT inhibitors do?

A

Reduces the response fluctuations and increases period of responsiveness to levodopa. However, it does not delay levodopa-induced dyskinesia

71
Q

Which COMT inhibitor is used more frequently and why?

A

Entacapone, because Tolcapone may cause liver toxicity

72
Q

What drug is the commercial preparation of levodopa combined with carbidopa and entracapone?

A

Stalevo

73
Q

What are confusion and psychotic symptoms associated with dopaminergic therapy treated with?

A

atypical antipsychotics agents

74
Q

What are 4 examples of atypical antipsychotics used?

A
  • clozapine (most effective)
  • olanzapine
  • quetiapine
  • risperidone
75
Q

What types of therapy may benefit patients with parkinsonism?

A
  • PT
  • OT
  • Speech
76
Q

What 2 surgical procedures can be used for patients who become unresponsive to medical treatment or have intolerable side effects?

A
  • Thalamotomy: destruction of part of the thalamus with a liquid nitrogen frozen probe
  • Pallidotomy: destruction of the globus pallidus on one side of the body
77
Q

Describe what a deep brain stimulator does

A

Provides high frequency electrical stimulation of the subthalamic nuclei or globus pallidus

724: Medical Lectures (42 decks)

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