Parkinsons disease

Question 1

Parkinson’s disease pneumonic

Answer 1

T - tremor 
R - rigidity 
A - akinesia 
P - postural instability 
P - postural hypotension 
S - sleep disorders 

P - psychosis
D - depression / dementia

Question 2

hallmark of PD

Answer 2

dopaminergic neuron loss in substantia nigra pars compacta

Question 3

Classic tremor in PD

Answer 3

pill rolling tremor

tremor @ rest - vanishes with movement

Question 4

is head tremor typical in PD?

Answer 4

no

Question 5

Rigidity + rest tremor = ?

Answer 5

cog-wheel rigidity

Question 6

PD - narrow or wide based gait?

Answer 6

narrow

Question 7

greatest genetic RF in PD

Answer 7

GBA mutation

Question 8

tobacco smoking, NSAIDs, CCB use, alcohol &raquo_space; increased or decreased risk of PD?

Answer 8

decreased

Question 9

Treatment of PD

Answer 9

young + fit @ onset

1. Da agonists - ropinorole, pramipexole
2. MOABI - rasagiline, selegiline
3. L-DOPA

frail

1. L-DOPA
2. MOABI

Question 10

PD + dementia > Rx =?

Answer 10

Rivastigmine

Question 11

drug class good for tremor in PD

Answer 11

anticholinergics

Question 12

1st line for psychosis in PD

Answer 12

clozapine

antipsychotics can worsen PD!

Question 13

S/E of both dopamine agonists and levodopa

Answer 13

daytime somnolence and oedema

Question 14

Levodopa - end of dose effect tx?

Answer 14

COMT inhibitor

Question 15

when should dopamine agonists be avoided?

Answer 15

history of addiction, OCD

elderly due to hallucinations s/e

Question 16

what class of drugs is most associated with drug induced parkinsonism

Answer 16

antipsychotics

Question 17

which part of the body does vascular parkinsonism predominantly affect

Answer 17

lower limbs

Question 18

rest tremor in vascular parkinsonism

Answer 18

uncommon

Question 19

progressive supranuclear palsy

Answer 19

presents similarly to parkinsons with gait and balance impairment
rarely see tremor
inability to make vertical saccades
NO response to levodopa

Question 20

presentation of Fragile X tremor ataxia syndrome

Answer 20

late onset (>50)
postural/intention tremor
decreased frontal cognition
peripheral neuropathy

Question 21

• triad of multi system atrophy

- MRI feature?

Answer 21

dysautonomia
cerebellar features
parkinsonism

MRI: hot cross bun sign