Parkinsons

Question 1

Average age of onset of parkinsons

Answer 1

60 y/o

Question 2

Where is there degeneration of neurons in parkinsons?

Answer 2

Substantia nigra

Question 3

What type of neurons are degenerated in parkinsons?

Answer 3

Domapinergic

Question 4

What jobs can be linked to parkinsons and why?

Answer 4

Farmer - pesticides

Question 5

Classical triad of parkinsons

Answer 5

resting tremor, limb rigidity and bradykinesia

Question 6

In what state should they be referred to a specialist?

Answer 6

untreated

Question 7

How can a parkinsons tremor be exasserbated?

Answer 7

Distration / emotion

Question 8

rigidity =

Answer 8

stiffness of limbs

Question 9

how best is rigidity tested for?

Answer 9

Passive movement of the arms

Question 10

how to distinguish from spasticity?

Answer 10

EQUAL in both extensors and flexors

Question 11

what is intact on the neuro exam?

Answer 11

power

Question 12

5 cognitive / psychiatric features

Answer 12

Constipation 
Urinary difficulties 
depression 
sexual problems 
dementia (late)

Question 13

What is used when difficult to differentiate from essential tremor?

Answer 13

DAT scan - Dopamine active transporters

Nuclear medicine scan which allows you to see how the dopamine active transporters are working

Question 14

What is given in combo with L-dopa

Answer 14

peripheral decarboxylase inhibitor

Question 15

What does L-dopa specifically improve?

Answer 15

Bradykinesia and rigidity

Question 16

Below what age may L-dopa be held off?

Answer 16

<55

Question 17

3 SE of L-dopa

Answer 17

Drowsines
Postural hypotension
Psychiatric complications

Question 18

Example of a dopamine agonist

Answer 18

bromocriptine

Question 19

Additional SE with dopamine agonist

Answer 19

N&V

Question 20

Drug type that helps tremors

Answer 20

Anticholinergic drug

Question 21

Example of ACH drugs

Answer 21

Benzhexol

Question 22

SE of ACH drugs (5)

Answer 22

Dry mouth
Constipation 
Urinary retention 
Blurred vision 
Hallucinations

Question 23

Which drugs can delay the need for L-dopa

Answer 23

MOA B inhibitors

Question 24

4 drugs mimicking parkinsons

Answer 24

Neuroleptics
Metoclopromide
Prochloroperazine
Lithium

Question 25

5 red flags of P+

Answer 25

Early postural instability 
Early autonomic features 
Fluctuating cognition and hallucinations 
Akinetic rigidity in one limb 
Pyramidal signs

Question 26

Definition of P+

Answer 26

Other forms of parkinsonism that have clinical features not typical of parkinsons disease

Question 27

What may indicate progressive supranuclear palsy?

Answer 27

Little response to L-dopa

Question 28

3 characteristics of PSP

Answer 28

falls early on (backwards)
symmetrical parkinsonism
cognitive decline

Question 29

Multi-system atrophy 2 characteristics

Answer 29

symmetrical Parkinsonism and cerebellar signs

Question 30

Which drugs commonly lead to drug induced parkinsonims

Answer 30

Antipsychotics

Question 31

3 features of vascular Parkinsonism

Answer 31

Lower body signs predominate
Tremor less common
lack of facial expression

Question 32

dystonia =

Answer 32

state of abnormal muscle tone

Question 33

define akathisia

Answer 33

severe restlessness

Question 34

tardive dyskinesia =

Answer 34

abnormal involuntary movements

“choreoathetoid”

Question 35

anti emetic to be given in parkinsons

Answer 35

Domperidone (DOES NOT CROSS THE BBB)