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ENT, neuro, eyes > Parkinsons > Flashcards

Parkinsons Flashcards

1
Q

What does the extrapyramidal system do?

A

Control the motor system
Inhibtiion
Coordination
Like traffic lights for movements

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2
Q

What NT is to do with the extrapyramidal system in the substantia nigra?

A

Dopamine

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3
Q

Parkinsons gait

A

Shuffling
Difficulty turning initiation
Later = freezing episodes, gait initiation difficulty

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4
Q

Why do you get Parkinsoniam symptoms with Lewy body dementia?

A

Lewy bodies are part of parkison pathology. In parkinsons physical symptoms start first

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5
Q

What diseases show a Parkinsonian tremor?

A

Parlkinsons
Wilsons disease
Parkinsonism eg MSA

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6
Q

When is the tremor in Parkinson?

A

Resting tremor

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7
Q

What can stop essential tremor

A

Alcohol

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8
Q

Why should you not prescribe some anitemetics eg metaclopramide long term?

A

Causes parkinsonian symtpoms

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9
Q

What is parkinsonism?

A

Bradykinesia + one of
Tremor
Rigidity
Postural instability

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10
Q

What is parkinsons disease?

A

Idiopathic progressive neurodegenerative condition caused by degeneration of dopaminergic neirones in substantiat nigra at basal ganglia

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11
Q

Causes of parkinsonism

A

Parkinsons disease
Drugs
Progressive supranuclear palsy or Steele Richardson Olszewski syndrome
Multiple systems atrophy
Wilsons disease
Post encephalitis
Demenita puglistitica or Chronic traumatic encephalopathy - chronic head trauma eg boxing
Toxins = CO, MPTP, copper

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12
Q

Pathology of parkinsons disease

A

Loss pigmented dopaminergic neurones in pars compacta of substantia nigra
Presence of Lewy bodies and neurites

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13
Q

Complications of parkinsonism

A

Infections eg aspiration pneumoinia
Bed sores
Poor nutrition
Falls
Contractures
Bowel and bladder disorders
Acute akinesia

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14
Q

What happens to rigidity and tone in parkinsons?

A

Increase - lead pipe and cog wheeling rigiditiy

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15
Q

Parkinsons gait

A

Decreased arm swing
Festinating - shuffling steps, difficult to stop, flexed trunk
Freezing
Cant turn corners

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16
Q

What condition is ass with a blank facial expression?

A

Parkinsons

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17
Q

Autonomic symptoms of parkinsonism

A

Reduced sense of smell
Constipation
Frequency/urgency
Dribbling
Sweating

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18
Q

What disorder often precedes signs of parkinsons by a few years?

A

REM sleep disorder

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19
Q

What happens in REM sleep disorder?

A

Lose movement inhibition control in sleep - act act dreams, move violently in bed

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20
Q

Symptoms of progressive supranuclear palsy vs PD

A

Impairment of vertical gaze
Early postural instability
Symmetrical onset
Speecha dn swallowing problmes
Little tremor

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21
Q

What symptoms in Lewy body first?

A

Fluctuating cognition with visual hallucinations and early dementia
THEN motor signs

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22
Q

Symptoms of MSA on top of PD

A

Early autonomic disturbanvce - postural hypotension, impotence/incontinence
Cerebellar signs

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23
Q

Signs of corticobasal degeneration

A

Akinetic rigidity in one limn
Cortical sensory loss
Apraxia

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24
Q

hat is seen in vascular parkinsonism?

A

Pyramidal signs eg diabetic/HPTNsicve patients who fall or have gait problems

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25
Q

Investigations for parkinsonism

A

Clinical diagnosis - exclusion
CT/MRI brain - tumours
PET, sPECT, DAT scans
gENETIC TESTING
Olfactory testing
Caeruloplasmin levels
Syphilis serology

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26
Q

When do you test caeruloplasmin levels and syphilis serology in parkinsonism?

A

young onset or atypical disease
Caeruloplasmin = wilsons disease
syphilis

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27
Q

What disease is normally looked for on genetic testing

A

Huntingtons
Parkinsons is 5% monogenic

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28
Q

What do PET, SPECT and DAT scans measure

A

Dopaminergic function of basal ganaglia where diagnosis unclear

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29
Q

Mental health conditions ass with parkinsons

A

Depression, anxiety, and apathy.
Dementia and cognitive impairment.
Impulse control disorders and psychotic symptoms (delusions and hallucinations).

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30
Q

symptoms other than mental health, autonimc and motor parkinsons

A

Nausea and vomiting.
Pain.
Sleep disturbance and daytime sleepiness.
Aspiration pneumonia.
Pressure sores.

31
Q

What happens to efficacy of parkinsons drugs over time?

A

Decrease

32
Q

Motor complications related to medicaitons parkinsons

A

End of dose fading - benefit wears off before take next dose
ON off phenomenon
Dose failures

33
Q

ON off phenomenon parkinsons

A

Years of use
Increasingly rapid fluctuations between on and off periods due to fluctuating responses to levodopa

34
Q

Dyskinesic movement in parkinsons

A

Choreiform
Dystonic

35
Q

What is a life threatening syndrome if parkinsons drugs are suddenly stopped?

A

Neuroleptic malignant syndrome

36
Q

Symptoms of neuroleptic malignant syndrome?

A

fever, altered mental state, muscle rigidity, and autonomic dysfunction.

37
Q

How does autonomic dysfunctinon present

A

Bladder problmes
Sexual problems
Excessive sweating and saliva
Weigth loss
Dysphagia
Orthostatic hypotension
Comstipation

38
Q

What drugs can induce parkinsonism?

A

Antipsychotics
metoclopramide
Phenothiazines eg chlorpromazene

39
Q

Why give levodopa with carbidopa or benserazisde?

A

Carbidopa/benserazide are decarboxylase inhibitors - prevent peripheral metabolism of L dopa

40
Q

Side effects of levodopa

A

Dyakinesia, dry mouth
On off effect
Drowsiness
Anorexia
Palpitations
Postural hypotnesion
Psychosis

41
Q

When is levodopa used in parkinsons?

A

Early stages PD when motor symptoms impact QOL

42
Q

When are dopamine recetpor agonists and MAO B inhibitors used in PD?

A

Early and symptomatic
Advanced - with Ldopa control fluctuations

43
Q

Which type of dopamine agonist is preferred?

A

Non ergot - fewer side effects

44
Q

Non ergot derived dopamine examples

A

Pramipexole, ropinirole

45
Q

What do before offer ergot derived dopamine agonists in Ldopa?

A

CXR, ECG, ECHO, ESR, creatinine and close monitoring

46
Q

Ergot derived dopamine agonists

A

Bromocriptine, cabergoline, lisuride

47
Q

What is the risk of ergot derived dopamine agonists

A

Pulmonary, retroperitoneal and cardiac fibrosis

48
Q

Side effects of dopamine agonists

A

Impulse control disorders
Excessive daytime somnolence
Hallcuinations
Postural hypotension
Nasal congestion

49
Q

What type of drgus are selegiline, rasagiline

A

MAO-B inhibitors

50
Q

What do MAO B inhibitors do?

A

Inhibit dopamine breakdown secreted by dopaminergic neurones

51
Q

Effect of COMT inhibitors on LDOPA

A

Increases half life

52
Q

What can be used to treat drug induced parkinsonism?

A

Antimuscarinics eg procyclidine, benzatropine, trihexyphenydil

53
Q

2nd line treatment PD

A

COMT inhibtiprs
Entacapone, tolcapone

54
Q

When is apomorphine used in PD?

A

Severe motor complications - decrease ‘off’ periods and dyskinesia
Rescue SC or infusion

55
Q

What can treat postural tremor in PD?

A

propanolol

56
Q

Why is haloperidol CI in parkinsons

A

Sedative blocks dopamine receptors - worsens symptoms

57
Q

What does missing medications cause in parkinsons?

A

Rigidity

58
Q

How administer meds if cant tolerate oral

A

NG tube OR
Rigotine patch based on usual levodopa dose

59
Q

Diagnosis of parkinsons

A

BRADYKINESIA+ at least one of
Muscular rigidity
4-6 Hz resting tremor
Postural instability
asymmetrical tremor, excellent response to levodopa, progression

60
Q

Pathology of parkinsons

A

Aggregation of alpha synucelin/lewy bodies

61
Q

What sign see in vascular parkinsons

A

Frontal release/applause sign
Ask to clap they continue clapping - frontal lobe affected

62
Q

Causes of vascular parkinsonism

A
  • Chronic microvascuar disease
  • Basal ganglia stroke
    Normal DAT scan
63
Q

Postural alterations in parinsons

A
  • Antecolitis - stooped
  • Pisa - lateral lean
  • Camptocormia - bent double
64
Q

Management of PDD

A

Co-careldopa - levodopa + COMT-i (MAO )

65
Q

Wht side effect comon with levodopa

A

Nausea and vomitting

66
Q

What is athetosis

A

coiling, snake like

67
Q

Dystonia

A

fixed upper posture, jerky

68
Q

Chroea

A

Large, restless, dancy movement

69
Q

Ballsimus + what causes

A

flinging movment (normally hemi due to lesion in basal ganglia, stroke, hypoglycaemia (one arm)

70
Q

Myoclonus + what causes

A

rapid sudden movement, epilepsy, anoxic brain injury (lauds adams syndrome → antiepileptic drugs eg kepra), painkillers eg large opiod doses, amitryptilline etc

71
Q

Causes of drug induced parkinsosnism

A

Antiemetics e metoclopramide, prochlorperazine
Typical antipsychotics eg haloperidol
Atypical eg aripirazole
Any dopamine anatagonists - > akathisia

72
Q

What is tardive dyskinesia

A

Grimacing, lip smakc and purse, tonue move, chorea

73
Q

What causes tardice dyskinesia

A

Long term use anti dopaminergic agents - increased sensitivty to dopamine

74
Q
A

ENT, neuro, eyes (34 decks)

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