Parkinsons

Question 1

cardinal features of PD

Answer 1

tremor
bradykinesia
rigidity
postural instability

Question 2

describe the tremor seen in PD

Answer 2

rest tremor
low freq (4-6Hz)
asymmetrical
pill rolling

Question 3

what gait/postural instability can be seen in PD

Answer 3

shuffling
narrow base
asymmetrical arm swing
block turning
freezing/ trouble initiating
forward flexed posture
retropulsion

Question 4

what are some other features of PD

Answer 4

hypomimia (decreased fascial expression)
dysphagia
hypophonia
visual disturbance
depression
anosmia
sleep disturbance
cognitive decline

Question 5

pathology of PD

Answer 5

reduced dopamine in substantia nigra as dopaminergic neurones die

leads to over excitation of the thalamus through loss of inhibition

Question 6

side effects of levodopa

Answer 6

generally occur if dose is too high
dyskinesia (dystonia, chorea)

Question 7

what are COMT inhibitors

Answer 7

inhibit the enzyme which metabolises levodopa to extend duration of effects

Question 8

apart from levodopa what medications can be offered for PD

Answer 8

dopamine agonists
monoamine Oxidase-B inhibtors
less effective

Question 9

what is often prescribed in combination with levodopa

Answer 9

carbidopa (co-carledopa)
peripheral decarboxylase inhibitor to stop levodopa being broken down peripherally before reaching the brain

Question 10

what is the basal ganglia responsible for

Answer 10

muscle tone and learnt movement patterns