Parkinsons

Question 1

pathophysiology of Parkinsons disease (PD)

Answer 1

loss of dopaminergic neurons in the substantia nigra pars compacta

Question 2

triad of symptoms in PD

Answer 2

TEMOR
RIGIDITY
BRADYKINESIA

Question 3

features of tremor in PD

Answer 3

asymmetrical
worst at rest
usually hands- “pill rolling” tremor
4-6Hz

Question 4

what improves a tremor in Parkinsons disease

Answer 4

voluntary movement

Question 5

features of rigidity in PD

Answer 5

increased tone - lead pipe rigidity

rigidity + tremor – cogwheel rigidity

Question 6

gait seen in PD

Answer 6

shuffling
absent arm swing
flexed trunk

Question 7

features of bradykinesia in PD

Answer 7

Decreased initiation of movement
Decreased speed of movement
Decreased amplitude of repetitive movements

Question 8

speech in PD

Answer 8

monotone

quiet

Question 9

what autonomic dysfunction contributes to instability + falls risk in Parkinsons

Answer 9

Orthostatic hypotension

Question 10

sleep disorder seen in PD

Answer 10

REM sleep disorder

Question 11

what is micrographia

Answer 11

small handwriting

- feature of PD

Question 12

features suggestive of drug induced parkinsons

Answer 12

BILATERAL motor symptoms
rapid onset symptoms
resting tremor uncommon

Question 13

what imaging modality can differentiate between drug induced parkinsons and parkinsons disease

Answer 13

DaTSCAN

- will show striata dopaminergic neuron loss in parkinsons disease

Question 14

what class of drugs typically cause drug induced parkinsons

Answer 14

typical antipsychotics
- haloperidol, chlorpromazine

Block dopamine in substantia nigra

Question 15

1st line treatment in PD where motor symptoms having greatest impact on life

Answer 15

Levodopa + dopa-decarboxylase inhibitor

• carbidopa
• madopar

Question 16

what is the purpose of prescribing levodopa with a dop-decarboxylase inhibitor

Answer 16

reduces peripheral conversion of levodopa to dopamine

Question 17

list 5 short term side effects of levodopa

Answer 17

Nausea + vomiting 
postural hypotension 
red urine 
confusion / hallucinations / delusions / vivid dreams 
daytime drowsiness

Question 18

what are the main long-term side effects of levodopa

Answer 18

dyskinesia (common -50%)
- involuntary movement

unpredictable ‘on-off’
- leads to bradykinesia

Question 19

treatment of nausea in PD

Answer 19

Domperidone

Question 20

which anti-emetic can induce parkinsons

Answer 20

metoclopramide

Question 21

treatment of daytime sleepiness in Parkinsons

Answer 21

modafinil

Question 22

treatment of REM sleep disorder in PD

Answer 22

melatonin or clonazepam

Question 23

1st line treatment in PD if motor symptoms are not impacting quality of life

Answer 23

MAO-B inhibitor

Dopamine agonist

Question 24

mechanism of action MAO-B inhibitors

Answer 24

block dopamine degradation within cell

Question 25

rasagiline and selegiline are examples of which class of drug

Answer 25

MAO-B inhibitors

Question 26

what drug can MAO-B inhibitors not be prescribed with

Answer 26

SSRI | - risk of serotonin syndrome

Question 27

side effects of rasagiline / selegiline

Answer 27

anticholinergic: - dry mouth - blurred vision - constipation - urinary retention - postural hypotension

Question 28

ropinirole, cabergoline, pramipexole are examples of which class of drug

Answer 28

dopamine agonists

Question 29

subcut apomorphine is an example of which class of drug

Answer 29

dopamine agonist

Question 30

side effects of dopamine agonists

Answer 30

fatigue nausea + vomiting Impulse control disorders - gambling, sex, eating, shopping oedema

Question 31

mechanism of action catechol- O- methyltransferase inhibitors (COMT)

Answer 31

block dopamine + levodopa degradation outside the cell

Question 32

entacapone and tolcapone are examples of which class of drug

Answer 32

COMT inhibitors

Question 33

treatment pathway parkinsons disease

Answer 33

1st line motor - L-Dopa + dopa-decarboxylase inhibitor 1st line non-motor - MAOB (rasagiline) or dopamine agonist (ropinirole) 2nd line motor or development of dyskinesia add - MAOB / dopamine agonist / COMT inhibitor

Question 34

what drug can be used to treat dyskinesia if other agents have been ineffective

Answer 34

amantadine | - increases dopamine release and reduces reuptake

Question 35

what drugs can be used to treat tremor in drug-induced parkinsons

Answer 35

antimuscarinics | - procyclidine

Question 36

what is progressive supranuclear palsy

Answer 36

a parkinsons plus syndrome - features of Parkinsonism + - vertical gaze palsy - slurred speech - falls - axial involvement

Question 37

what is multi-system atrophy

Answer 37

a parkinsons plus syndrome - autonomic dysfunction: postural hypotension, erectile dysfunction, atonic bladder - cerebellar features

Question 38

hot cross bun sign

Answer 38

cerebellar + pontine atrophy | - multi-system atrophy

Question 39

bilateral tremor, worse with movement/arms outstretched | improves with alcohol

Answer 39

essential tremor

Question 40

treatment essential tremor

Answer 40

propanolol

Question 41

uncomfortable sensations in lower legs, worse at rest | intense urge to move + movement providing relief

Answer 41

restless leg syndrome

Question 42

1st line management restless leg syndrome if affecting sleep/functioning

Answer 42

gabapentin / pregabalin

Question 43

what haematological abnormality is associated with restless leg syndrome

Answer 43

iron deficiency anaemia