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Neurology > Parkinsons disease > Flashcards

Parkinsons disease Flashcards

1
Q

Pathology of PD

A

neurodegeneration of dopaminergic neurons in pars compacta of the substantia nigra (SNpc) of basal ganglia

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2
Q

Cardinal features of PD (triad)

A

Bradykinesia
Resting tremor (4-6Hz)
Rigidity hypertonia

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3
Q

Motor features of PD

A 
Bradykinesia 
Tremor 
rigidity 
shuffling gait 
loss of arm swing 
stooped 
postural instability 
difficulty initiating gait 
difficulty turning
low amplitude finger tapping
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4
Q

Non-motor features of PD

A 
DEPRESSION
dementia
anosmia 
constipation 
REM behavioural disorder 
hypomimia 
micrographia
hypersalivation
hallucinations 
GI dysfunction
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5
Q

Causes of Parkinsonism

A

idiopathic PD
drugs: metaclopramide, haloperidol, lithium, B blockers
environmental/chemical exposure
MS, Wilson’s, post encephalitis

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6
Q

management of PD

A

Levodopa +-carbidopa
dopamine agonists
PT, OT, S+LT

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7
Q

describe dementia in Parkinsons

A

dementia:
- less than 1 year = DLB
- more than 1 year = PDD

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8
Q

Parkinsonism has a/symmetrical tremor

Parkinsons disease has a/symmetrical tremor

A

parkinsonism is symmetrical

parkinsons disease is asymmetrical

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9
Q

on macroscopic pathological specimens what can be noted

A

loss of normal black pigment in the substantia nigra (and locus coeruleus)

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10
Q

what is a neurohistological hallmark of PD

A

Lewy bodies containing a-synuclein

however, not specific to PD

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11
Q

what are the subtypes of motor features in PD

A

tremor dominant PD
non-tremor dominant PD
mixed

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12
Q

describe tremor dominant PD and what is the prognosis

A

relative absenceof other motor symptoms

slower rate of progression

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13
Q

describe non-tremor dominant PD

A

akinetic rigid syndrome and postural instability gait syndrome

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14
Q

imaging is part of the routine diagnostic work up in PD, true or false

A

false, PD is largely a clinical diagnosis

it is only used when there is uncertainty

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15
Q

which imaging types are structural

A

MRI

CT

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16
Q

which imaging types are functional

A

PET
SPECT
DaTSCAN

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17
Q

Risk factors for developing PD

A

advancing age
positive family history + genetics
male gender
environmental factors: pesticides, rural living, B blocker, prior head injury

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18
Q

monogenetic forms of PD

A

LRRK2 - AD

PARKIN - AR

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19
Q

what is the function of symptomatic treatments

A

increase dopamine concentrations or stimulate dopamine receptors

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20
Q

when should treatment be initiated

A

when symptoms cause disability or discomfort

with the aim of improving quality of life

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21
Q

to which treatment do bradykinesia and rigidity respond to

A

dopaminergic treatment

22
Q

tremor is not responsive to dopamine therapy, true or false

A

true

23
Q

which treatments are effective for tremor

A

anticholinergics
trihexyphenidyl
clozapine

24
Q

what is levodopa

A

precursor of dopamine

25
Q

what is a dopa decarboxylase inhibitor DDI and what is the benefit

A

reduced peripheral availability of levodopa

reduces side effects

26
Q

what is usually prescribed with levodopa

and what is the indication

A

carbidopa (DDI)

motor symptoms

27
Q

dopamine agonists improve motor symptoms in early/late disease and have more/less side effects

A

early

more side effects

28
Q

classification of dopamine agonists

A

Ergot

Non-Ergot

29
Q

list ergot derived D agonists and what are their side effects

A

bromocriptane
cabergoline
pergolide

cardiac valvulopathy and serosal fibrosis

30
Q

list non-ergot D agonists

A

apomorphine
pramiprexole
ropinirole
rotigotine

31
Q

side effects of dopamine agonists

A 
N+V
daytime somnolence
Impulse Control Disorders ICD
peripheral oedema 
dizziness
hallucinations 
constipation
32
Q

Levodopa provides the greatest symptomatic benefit, true or false

A

true

33
Q

Longterm levodopa use is associated with __ ?

A

motor complications

  • dyskinesia
  • motor fluctuations
34
Q

what are motor fluctuations

A

alterations between periods of good and bad motor symptom control

35
Q

what are non-motor fluctuations

A

alterations between periods of good and bad non-motor symptom control

36
Q

what is dyskinesia and when does it develop

A

involuntary choreiform or dystonic movements which occur when levodopa concentrations are at their maximum
develops at the beginning or end of levodopa dose

37
Q

what are MAO B inhibitors used for

A

motor symptoms

38
Q

examples of MAO B inhibitors

A

selegiline

rasagiline

39
Q

are there diagnostic tests for PD at an early stage

A

no

40
Q

resting tremor vanishes with active movement, true or false

A

true

41
Q

in clinical practice when is resting tremor best observed

A

when the patient is focussed on a task eg counting backwards from 100

42
Q

rigidity is velocity dependent, true or false

A

false
spasticity = velocity dependent
rigidity = non-velocity dependent

43
Q

what is festination

A

very fast succession of steps and difficulties stopping

44
Q

what are the Parkinsons plus syndromes and are they the same as Parkinsons disease

A

progressive supranuclear palsy
multiple system atrophy
not the same as PD

45
Q

what is vascular parkinsonism

A

parkinsonism that predominantly affects the lower limbs

resting tremor is uncommon

46
Q

drug induced parkinsonism tends to be a/symmetrical

A

symmetrical

47
Q

drug induced parkinsonism tends to be a/symmetrical

A

symmetrical

48
Q

what is multi system atrophy MSA and its core triad

A

dysautonomia - postural hypotension…
cerebellar features
Parkinsonism
jerky postural tremor

49
Q

MRI findings of MSA?

A

cerebellar and pontine atrophy “hot cross bun” sign, hyperintense rim surrounding putamen

50
Q

what is progressive supranuclear palsy PSP

A 
ait and balance impairment 
vertical gaze supranuclear palsy 
pseudobulbar symptoms 
eyes wide open 
no response to levodopa
51
Q

what type of drug is amantadine

A

NMDA antagonist

Neurology (25 decks)

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