Parkinsons Disease

Question 1

Underlying pathology of PD

Answer 1

Loss of dopaminergic neurones in the substantia negra of the midbrain

Question 2

Describe the genetic aetiology of PD

Answer 2

Multifactorial and genetically heterogeneous

Question 3

Possible risk factors for PD (2)

Answer 3

Positive family history, environmental toxins

Question 4

Three potential cause of secondary PD

Answer 4

Vascular insult (e.g. basal ganglia infarct)
Repeated head injury (e.g. boxing)
Post-encephalitis

Question 5

Four cardinal symptoms of PD

Answer 5

Bradykinesia
Rest tremor
Rigidity
Postural and gait impairment

Question 6

Classical tremor seen in hands of PD patients

Answer 6

Pill-rolling tremor

Question 7

Features of muscle tone seen in PD (2)

Answer 7

“Lead pipe” rigidity

Superimposed tremor- “cogwheel rigidity” particularly seen in pronation of wrist

Question 8

Classical description of gait in PD

Answer 8

Stooped, “simian”, shuffling gait

Question 9

Hypomimia

Answer 9

Decreased facial expression

Question 10

Hypophonia

Answer 10

Soft monotonous voice

Question 11

Micrographia

Answer 11

Progressively smaller writing

Question 12

How is tremor best observed in clinical practice?

Answer 12

Distraction- ask the patient to focus on a particular mental task

Question 13

Positive Froment’s manouevre

Answer 13

Rigidity increases in body segment when other body segments are being moved voluntarily

Question 14

Early non-motor symptoms (3)

Answer 14

Hyposmia
Constipation
Depression

Question 15

Late nonmotor symptoms (2)

Answer 15

Dementia

Hallucinations

Question 16

Diagnosis of PD (2)

Answer 16

Mainly clinical

Levodopa trial may be useful

Question 17

Features which might suggest a vascular cause of parkinsonism rather than classic PD (5)

Answer 17

Lower body predominately affected
Poor levodopa response
Lack of rest tremor
Dementia prominent or early
Occurs in people older than 70

Question 18

Feature which might suggest drug-induced parkinsonism

Answer 18

Emergence of symptoms after exposure; resolution after withdrawal

Question 19

Distinguish between essential tremor and PD?

Answer 19

ET tends to be symmetrical, usually not at rest
Improves with alcohol
Has a mean onset of about 15 years

Question 20

Imaging modality which can be used as an aid to clinical diagnosis?

Answer 20

SPECT (commonly known as DAT-SCAN) which looks for dopamine-releasing cells in the brain

Question 21

Treatment for daytime somnolence in PD?

Answer 21

Modafinil

Question 22

Autonomic failure + parkinsonism + pyramidal signs + ataxia

Answer 22

Multi-system atrophy (Shy-Drager syndrome)

Question 23

Up and down gaze palsy + axial rigidity and falls + dysarythria and dysphagia

Answer 23

Progressive supranuclear palsy

Question 24

Drugs which can induce parkinsonism?

Answer 24

Neuroleptics e.g. haloperidol

Anti-emetics e.g. metoclopramide

Question 25

Most appropriate anti-emetic to prescribe in Parkinson’s, and why?

Answer 25

Domperidone

Does not cross blood brain barrier