Parkinsons and falls

Question 1

what is sarcopenia?

Answer 1

decreased muscle strength

Question 2

what are the parkinsons plus syndromes?

Answer 2

• Progressive supranuclear palsy
• Multiple system atrophy
• Cortico-basal degeneration
• Lewy body dementia

Question 3

presentation of cortico-basal degeneration

Answer 3

Parkinsons + apraxia, alien limb phenomenon

Question 4

presentation of multiple system atrophy?

Answer 4

Parkinsons + autonomic dysfunction (orthostatic hypotension, bladder dysfunction, cerebellar involement)

Question 5

presentation of progressive supranuclear palsy?

Answer 5

vertical gaze palsy and early postural instability

Question 6

presentation of lewy body dementia?

Answer 6

fluctuating cognition, visual hallucinations

Question 7

how is the diagnosis of parkinsons made?

Answer 7

clinically

Question 8

criteria for clinical diagnosis of parkinsons?

Answer 8

motor parkinsons symptpms + SUPPORTIVE (clear beneficial response to increased dopamine)

Question 9

what neuroimaging can be done for parkinsons?

Answer 9

DAT scan

MRI brain

Question 10

Treatment of parkinsons?

Answer 10

LEVADOPA

Question 11

A patient on levadopa has dyskinesias, how do you treat this SE?

Answer 11

amantadine

Question 12

A patient on levadopa has ‘wear offs’, how do you treat this?

Answer 12

+COMT, DBT

Question 13

entacapone =

Answer 13

COMT inhibitor (blocks peripheral breakdown of levadopa)

Question 14

Define dementia

Answer 14

Chronically progressive cognitive decline involving > 2 cognitive domains. Effects on daily living.

Question 15

define mild cognitive impairment

Answer 15

Acquired loss of cognition. Only ONE domain effected. NO effects on daily living.

Question 16

do we use the T score or Z score to diagnose osteoporosis?

Answer 16

T score

Question 17

diagnosis of osteoporosis?

Answer 17

-T score

Question 18

Someone has a T score between -2.5 and -1. Should you treat them?

Answer 18

ONNLY if their 10 year probably of HIP fracture is >3%, or any fracture > 10 %

Question 19

Define pyrexia of unknown origin

Answer 19

Temp > 38.3 for more than 3 weeks and no obvious source

Question 20

What level is considered mild neutropenia?

Answer 20

1.0 - 1.5

Question 21

Moderate neutropenia?

Answer 21

0.5 - 1

Question 22

Severe neutropenia?

Answer 22

< 0.5

Question 23

initial approach to treating febrile neutropenia?

Answer 23

-isolation/barrier nursing
SEPSIS 6 (includes broad spectrum antibiotics)
Supportive care

Question 24

febrile neutropenia persists > 48 hrs on antibiotics. NOW WHAT?

Answer 24

• add antifungal (capsofungin)
• add antiviral
• consider mycobacterium