parkinsons

Question 1

definition

Answer 1

progressive neurodegenerative condition caused by loss of dopaminergic neurons in the substantia nigra

Question 2

triad of features

Answer 2

bradykinesia
tremor
rigidity

Question 3

describe the tremor seen in Parkinson’s disease

Answer 3

'’pill rolling’’, improving with voluntary movement

Question 4

describe the rigidity seen in parkinsons

Answer 4

lead pipe, cog wheel rigidity

Question 5

other features of parkinsons

Answer 5

depression
postural hypotension

Question 6

drug induced Parkinson’s

Answer 6

rapid onset and bilateral motor symptoms
rigidity and rest tremor less common

Question 7

differentiating essential tremor and Parkinson’s

Answer 7

SPECT - single photon emission computed tomography

Question 8

management if symptoms affecting patient’s life

Answer 8

levodopa

Question 9

management if symptoms not affecting patients life

Answer 9

dopamine agonist, levodopa or MAO-B

Question 10

link to impulse control disorders

Answer 10

dopamine agonist therapy
previous impulsive behaviours
history of alcohol consumption

Question 11

side effects of levodopa

Answer 11

dry mouth
anorexia
palpitations
postural hypotension
psychosis

Question 12

problems of long term levodopa use

Answer 12

end of dose wearing off : symptoms worse towards the end of dose interval
on-off : variation in motor performance
dyskinesia

Question 13

do you stop levodopa in illness

Answer 13

no , give dopamine agonist via patch to prevent acute dystonia

Question 14

main side effects of dopamine receptor agonists- give examples

Answer 14

bromocriptine, ropinirole, cabergoline.

s/e includes : impulse control disorders, excessive daytime somnolence, hallucinations