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Neurology > Parksinsons > Flashcards

Parksinsons Flashcards

1
Q

Age of presentation of Parkinson’s ?

A

45-60

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2
Q

Parkinsonism triad?

A

Bradykinesia, tremor, rigidity. Usually bilateral but can start unilateral

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3
Q

What happens to tremor in Parkinson’s ?

A

Disappears with activity

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4
Q

What is rigidity?

A

Increased resistance to passive movement

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5
Q

What is rigidity like throughout the range of movement ?

A

Equal throughout

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6
Q

Gait in Parkinson’s ?

A

Show, shuffling gait

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7
Q

Arms and posture during walking ?

A

Stopped posture and reduced arm swing

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8
Q

What is speech like ?

A

may be slow and monotonous. In late stage disease may be slurred, or even lost

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9
Q

Power and sensory loss?

A

Power remains normal and there is no sensory loss

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10
Q

What other psychiatric conditions associated with Parkinson’s ?

A

Dementia and depression

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11
Q

Why do you get hallucinations.

A

A combination of the disease and the drugs used. Often they are not unpleasant

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12
Q

What are kayser fleisher rings seen in?

A

Wilson’s disease (copper)

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13
Q

Which drugs can cause Parkinsonism?

A

Drugs (usually dopamine antagonsists)–e.g. prochlorperazine, metoclopramide (antiemetics) phenozanthines, butyrophenones (neuroleptics)

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14
Q

pathological hallmark of parkinsons disease

A

prominent dopaminergic neurone loss in the substantial nigra with alphasyneuclein containing lewey bodies and lewey neurites

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15
Q

which part of the brain is the substantial nigra found?

A

basal ganglia

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16
Q

what are upper motor neurone features?

A

pyramidal weakness and spasticity

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17
Q

triad of parkinsonianism?

A

bradykinesia, resting tremor and rigidity

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18
Q

Fragments of movements flow irregularly from one body segment to another causing a dance-like appearance?

A

chorea

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19
Q

what does PD present with?

A

PD presents with tremor, muscular rigidity, akinesia, rest tremor, and gait and postural impairment

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20
Q

which subtype has the slower rate of progression ?

A

tremor dominant

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21
Q

non motor features of PD?

A

olfactory dysfunction, cognitive impairment, psychiatric symptoms, sleep disorders, autonomic dysfuncLon, pain, and faLgue.

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22
Q

when does diagnosis occur in PD?

A

with the onset of motor symptoms

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23
Q

what is progression of PD characterised by?

A

progression of motor symptoms

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24
Q

Neuronal loss in PD occurs in many other regions including?

A

ocus ceruleus, nucleus basalis Meynert, pedunculoponLne and raphe nuclei, dorsal motor nucleus of vagus, amygdala, hyopthalamus

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25
Q

how are lewey bodies formed?

A

Misfolded α-synuclein,which is insoluble and aggreagated, forms intracellular inclusions (Lewy bodies)

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26
Q

Prolonged muscle spasms and abnormal postures

A

dystonia

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27
Q

Fragments of movements flow irregularly from one body segment to another causing a dance-like appearance

A

chorea

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28
Q

a parasomnia characterized by abnormal or disrupLve behaviours (such as talking, laughing, shouLng, gesturing, grabbing, punching, kicking,, sirng up in bed)

A

Rapid eye movement sleep behaviour

29
Q

treatment of rapid eye movement sleep disorder?

A

clonazepam or malatonin

30
Q

what is the frequency of the rest tremor in parkinsons?

A

4-6Hz

31
Q

where are lewey bodies found in parkinsons?

A

not confined to the brain, they are also present in spinal cord and peripheral nervous system

32
Q

what are lewey bodies?

A

misfolded alpha sinuclein, which is insoluble and aggregated. These form intracellular inclusions

33
Q

what does pigment loss correlate with?

A

dopaminergic cell loss

34
Q

greatest risk factor of parkinsons?

A

age

35
Q

male to female?

A

more common in males

36
Q

greatest genetic risk factor for PD

A

mutations in GBA

37
Q

what is treatment in PD aimed at doing ?

A

enhancing intracerebral dopamine concentrations or stimulate dopamine receptors

38
Q

which drug class associated with oedema?

A

dopamine agonists

39
Q

which drug associated with dyskinesia? (writhing movements)

A

levodopa

40
Q

what is the “on-off effect” of levodopa

A

alterations between periods of good motor symptom control and periods of reduced motor symptom control

41
Q

PsyChosis in PD is most efficiently managed with

A

Clozapine

42
Q

motor symptoms in PD?

A

bradykinesia
rest tremor
rigidity
postural and gait impairment (stooped posture and show, shuffling gait with reduced arm swing)

43
Q

Slowness of movement with progressive loss of amplitude or speed during aWempted rapid alternaLng movement of body segments

A

BRADYKINESIA

44
Q

how can you assess bradykinesia?

A

can be assessed by asking the patient to perform some repetitive movements as quickly and wisely as possible

45
Q

decreased facial expression and eye blinking ?

A

hypomimia

46
Q

what happens to rhythmic oscillatory tremor on voluntary active movement

A

disappears

47
Q

what is re emerging tremor?

A

tremor reappears after hands held out

48
Q

is head tremor typical for PD?

A

no

49
Q

what is cog wheel rigidity

A

“Cogwheel” rigidity occurs when there is also a tremor and is characterized by a “stop and go” effect during a range of motion maneuver. Felt especially at the wrist

50
Q

why do you get a stooped posture?

A

impaired postural reflexes

51
Q

what is the parkinsonian gait like ?

A

slow, shuffling gait with a narrow base

52
Q

what is hyposmia?

A

reduced ability to smell (hypnosemia)

53
Q

what are premotor symptoms to ask about?

A

REM sleep behaviour, loss of smell, constipation

54
Q

exposure to what can be a risk factor for parkinsons?

A

manganese, pesticides

55
Q

do you get dementia early in the disease course?

A

no

56
Q

investigations for parkinsons?

A 
structural brain imaging 
possibly structural brain imaging 
dopamine functional imaging is unable to distnguish PD from other causes of degeneratve Parkinsonism, but should be normal in essenLal tremor, dystonic tremor, psychogenic parkinsonism.
positive levodopa challenge 
genetic testing where appropriate
57
Q

what is vascular parkinsonism?

A

parkinsonism affects mainly the lower limbs. rest tremor is uncommon. get a poor levodopa response

58
Q

does parkinsonism tend to be symmetrical or assymetrical?

A

symmetrical, although can start unilateral

59
Q

what drugs can cause parkinsonism?

A

any drugs that block the action of dopamine (especially neuroleptic drugs)

60
Q

what improves essential tremor?

A

alcohol and beta blockers

61
Q

frequency of essential tremor?

A

higher frequency (12Hz)

62
Q

inheritnace pattern of essential tremor?

A

autosomal dominant

63
Q

typical onset of essential tremor?

A

15 years

64
Q

common cause of degenerative parkinsonism, hot cross bun sign on MRI?

A

multi system atrophy O+

65
Q

Symmetric akineLc-rigid syndrome with predominantly axial involvement. Vertical gaze supra nuclear palsy?

A

progressive supranuclear palsy

66
Q

Core symptoms include cerebellar gait ataxia, postural / intenLon tremor, variably Parkinsonism, dysautonomia, cogniLve decline of frontal type, and peripheral neuropathy

A

fragile x tremor ataxia syndrome

67
Q

useful for managing tremor in drug induced parkinsonism?

A

procyclidine

68
Q

which features of parkinsons disease are uncommon in drug induced parkinsonism?

A

Rigidity and resting tremor

Neurology (19 decks)

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