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(2) MS: Neurological Conditions 🩺 > S2_L1: Parkinson's Disease > Flashcards

S2_L1: Parkinson's Disease Flashcards

1
Q

Identification:
Proponent of Parkinson’s Disease

A

James Parkinson

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2
Q

Fill in the blanks:
PD results from (1)____ of dopamine-producing cells in the (2)_____.

A
  1. degeneration
  2. substantia nigra
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3
Q

Identification: Components of the TRAP mnemonic.

A

Tremors
Rigidity
Akinesia / Bradykinesia
Postural Instability

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4
Q

Matching Type: Clinical Manifestation with its characteristics / feature

  1. Develop stoop / forward-flexed posture
  2. Decreased speed & amplitude of complex voluntary movement
  3. Pill rolling at rest
  4. Cogwheeling
  5. Pinching & circling can elicit it

Choices:
A. Tremors
B. Limb Rigidity
C. Bradykinesia
D. Postural Instability

A
  1. D
  2. C
  3. A
  4. B
  5. C
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5
Q

TRUE OR FALSE: Camptocornia is when patients have their trunk & head bowed downward (extreme forward flexion of the spine) & correspondingly severe stooping occur.

A

True

Source: Merritt; Adams & Victor

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6
Q

Identification: Which stage of PD is “bilateral involvement but no postural abnormality”?

A

Stage II

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7
Q

Matching Type: Differential dx c hx

  1. Present for many years; + family history
  2. Parkinsonism w/ autonomic system dysfunction
  3. Involuntary movement, cognitive or behavioral problem
  4. Exposure to haloperidol or metoclopramide
  5. Gradual onset; tremor; gait disturbance; slowed movements

Choices:
A. Drug-Induced Parkinsonism
B. Multisystem Atrophy
C. Idiopathic Parkinson’s Disease
D. Huntington’s Disease
E. Essential Tremor

A
  1. E
  2. B
  3. D
  4. A
  5. C
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8
Q

Identification:
In this condition, orthostatic hypotension & skin changes are findings in the physical exam.

A

Multisystem Atrophy

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9
Q

Identification:
In this condition, tremor with arms raised & head & voice involved are findings in the physical exam.

A

Essential Tremor

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10
Q

Matching Type: Clinical Manifestation with its characteristics / feature

  1. slowness in initiation & execution of voluntary movements
  2. increase muscle tone & resistance to movement
  3. At rest, when person sits, arm shakes & stops when person attempts to grab something
  4. Righting reflex

Choices:
A. Tremors
B. Limb Rigidity
C. Bradykinesia
D. Postural Instability

A
  1. C
  2. B
  3. A
  4. D
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11
Q

Identification:
5 ways to elicit bradykinesia

A
  1. Micrographia
  2. Tapping fingers or feet
  3. Twiddling of hands
  4. Pinching & circling
  5. Tapping with the heel
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12
Q

Matching Type: Classification of Parkinsonism

  1. Wilson’s Disease
  2. Lewy Body Dementia
  3. Juvenile Parkinsonism
  4. Related to drugs
  5. Shy-Drager Syndrome / Autonomic Impairment

A. Primary / Idiopathic
B. Secondary / Acquired
C. Heredodegenerative
D. Multiple-System Degenerative Parkinsonism-Plus

A
  1. C
  2. D
  3. A
  4. B
  5. D
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13
Q

Matching Type: Classification of Parkinsonism

  1. Progressive Supranuclear Palsy / Steele-Richardson Olszewski
  2. Huntington’s Disease
  3. Multisystem Atrophy
  4. Related to infections, toxins
  5. Corticobasal Degeneration

A. Primary / Idiopathic
B. Secondary / Acquired
C. Heredodegenerative
D. Multiple-System Degenerative Parkinsonism-Plus

A
  1. D
  2. C
  3. D
  4. B
  5. D
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14
Q

Identification:
A critical modulator of striatal output that is markedly decreased in Parkinson’s disease.

A

Dopamine

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15
Q

Identification:
It is a chronic age-related progressive disorder of the Central Nervous System, the most common movement disorder, & 2nd most common neurodegenerative disease after Alzheimer’s Disease.

A

Parkinson’s Disease

Source: Merritt

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16
Q

TRUE OR FALSE: PD is more commonly seen in males than females.

A

True

Male to female: 3:2

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17
Q

Enumeration: what the
Oxidative Stress Theory states

A

Alterations in the substantia nigra of patients w/ PD is suggestive of oxidative damage.

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18
Q

Matching Type: Classification of Parkinsonism

  1. Lubag (X-linked dystonia-parkinsonism)
  2. Hemiatrophy-hemiparkinsonism-syndrome
  3. Sporadic olivopontocerebellar degeneration / Cerebellar Impairment
  4. Neurodegeneration with brain iron accumulation
  5. Striatonigral degeneration / Parkinsonism

A. Primary / Idiopathic
B. Secondary / Acquired
C. Heredodegenerative
D. Multiple-System Degenerative Parkinsonism-Plus

A
  1. C
  2. B
  3. D
  4. C
  5. D
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19
Q

Matching Type: PD Late Disabilities

  1. Cognitive impairment
  2. Dyskinesia
  3. Incontinence
  4. Motor fluctuation
  5. Speech disturbance

Choices:
A. Levodopa-related disability
B. Non-levodopa-related disability

A
  1. B
  2. A
  3. B
  4. A
  5. B
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20
Q

Matching Type: PD Late Disabilities

  1. Gait disturbance
  2. Reduced response
  3. Neuropsychiatric toxicity
  4. Dysphagia
  5. Falls

Choices:
A. Levodopa-related disability
B. Non-levodopa-related disability

A
  1. B
  2. A
  3. A
  4. B
  5. B
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21
Q

Matching Type: Secondary effects of PD

  1. hallucination, depression, & psychosis
  2. constipation & hypersalivation
  3. orthostatic hypotension & arrhythmia
  4. increased urinary frequency

Choices:
A. Gastrointestinal effects
B. Genitourinary effects
C. Central nervous system effects
D. Cardiovascular effects

A
  1. C
  2. A
  3. D
  4. B
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22
Q

Enumeration:
4 Surgical treatment options for PD

A
  1. Pallidotomy
  2. Thalamotomy
  3. Thalamic stimulation
  4. Transplantation of fetal cells
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23
Q

Identification:
Most often used to rule out an etiology of secondary Parkinson’s disease

A

Tests, imaging

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24
Q

Identification:
It is one of the new technologies used to visualize dopamine uptake in the substantia nigra & basal ganglia.

A

Positron Emission Tomography (PET) Scan

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25
Q

Identification:
It can be helpful for diagnosis of Parkinsonian syndromes & non-parkinsonisms, particularly essential tremor.

A

Single Photon Emission Computed Tomography (SPECT)

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26
Q

TRUE OR FALSE: In diagnosis of PD, there must be at least two “cardinal” features present, with at least one of them being resting tremor or bradykinesia.

A

True

Source: Merritt

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27
Q

Fill in the blanks:
In clinical criteria of PD, there is the presence of at least 2 of the 3 cardinal features of parkinsonism: (1), (2), and (3).

A

1-3: Tremor, rigidity, bradykinesia

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28
Q

Fill in the blanks:
In clinical criteria of PD, there is evidence of (1)___, & absence of clinical features of (2)___, & absence of etiology known to cause (3)___ features.

A
  1. disease progression
  2. alternative diagnosis
  3. similar
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29
Q

Fill in the blanks:
In clinical criteria of PD, there is the presence of at least two of the following:
* Marked response to (1),
* Asymmetry of (2),
* Asymmetry of (3)

A
  1. levodopa
  2. signs
  3. onset
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30
Q

Modified True or False: Oxidative Stress Theory

Choices: A if true, B if false

  1. Increased iron levels
  2. Increased glutathione levels
  3. Decreased aluminum levels
  4. Lack of compensatory rise in iso-ferritins
  5. Selective defect in complex I of mitochondrial respiratory chain
A
  1. A
  2. B
  3. B
  4. A
  5. A
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31
Q

In the oxidative stress theory, there is evidence of oxidative damage to: (1-4).

A
  1. Lipids
  2. DNA
  3. Proteins
  4. Tyrosine-containing molecules
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32
Q

Enumeration:
The 2 symptomatic with neuroprotection treatment

A
  1. Dopamine agonists
  2. Selegiline
33
Q

TRUE OR FALSE: Globus pallidus internus pallidotomy entails the surgical resection of parts of the globus pallidus. This procedure improves contralateral dyskinesia.

A

True

34
Q

Modified True or False: Management Therapies

Choices: A if true, B if false

  1. Urinary urgency: apomorphine
  2. Urinary retention: oxybutynin
  3. Daytime sleepiness: selegiline
  4. Nightmares: amitriptyline, clonazepam
  5. Hypersalivation: antihistamine, anticholinergic
A
  1. B
  2. B
  3. A
  4. A
  5. A
35
Q

Modified True or False: Management Therapies

Choices: A if true, B if false

  1. Tenesmus: clonazepam, apomorphine
  2. Orthostatic hypotension: domperidone, desmopressin
  3. Panic attacks and depression: liquid levodopa, amitriptyline
  4. Pain: amitriptyline, fluvoxamine, SSRIs
  5. Constipation: fiber, polyethylene glycols, laxatives
  6. Sweating crises: 3-blockers, anticholinergic agents
A
  1. A
  2. A
  3. A
  4. A
  5. A
  6. A
36
Q

TRUE OR FALSE

Management therapy for dysphagia is to reduce levodopa dosage & gastrostomy tube feeding is advised. Management therapy for dysphonia is speech therapy & liquid levodopa.

A

Both statements are false.

Dysphagia - liquid levodopa, gastrostomy tube
Dysphonia - reduce levodopa dosage, speech therapy

37
Q

TRUE OR FALSE: Parkinsonism, also known as parkinsonian syndrome, is viewed as a striatal dopamine deficiency disorder.

A

True

Source: Merritt

38
Q

TRUE OR FALSE: In parkinsonism, majority is from Parkinson’s disease, followed by parkinson plus syndromes & drug induced, extrapyramidal symptoms.

A

True

39
Q

Fill in the blanks: The proposed etiologies of PD are (1)___, (2)___, and the influence of (3)___. The latter is known as the backbone of PD risk.

A
  1. environmental toxins or drugs
  2. genetic susceptibility
  3. aging

Source: Merritt

40
Q

Fill in the blanks: In young onset PD, the onset is (1)___ years old, while in juvenile onset PD, it is (2)___ years old.

A
  1. < 40
  2. < 20
41
Q

Identification: It is the major cause of young onset autosomal recessive PD & isolated juvenile PD.

A

Parkin mutation

42
Q

Fill in the blanks: Mutations in (1)___ and (2)___ are seen in autosomal dominant PD. This leads to the accumulation of excessive (3)___ that can be harmful to the neurons.

A
  1. ɑ synuclein
  2. ubiquitin carboxyl hydrolase
  3. protein
43
Q

Identification: The 4 components of non-pharmacologic management

A

Education, support, exercise, & nutrition

44
Q

Matching Type:

  1. Can stimulate the subthalamic nucleus
  2. Implantation of embryonic dopaminergic cells into the denervated striatum to replace degenerated neuronal cells
  3. High-frequency stimulation that induces functional inhibition of target regions of the brain by implanting an electrode into a target site
  4. A subcutaneously placed pacemaker is present

Choices:
A. Deep brain stimulation
B. Globus pallidus internus pallidotomy
C. Fetal nigral transplantation

A
  1. A
  2. C
  3. A
  4. A
45
Q

Matching Type:

  1. Bromocriptine
  2. Carbidopa-L-dopa
  3. Selegiline
  4. Entacapone
  5. Benztropine

Choices:
A. Dopamine agonist
B. MAO-inhibitor
C. COMT Inhibitor
D. Anticholinergic
E. Levodopa

A
  1. A
  2. E
  3. B
  4. C
  5. D
46
Q

Matching Type:

  1. Rasagiline
  2. Tolcapone
  3. Pramipexole
  4. Amantadine
  5. Pergolide

Choices:
A. Dopamine agonist
B. MAO-inhibitor
C. COMT Inhibitor
D. Anticholinergic
E. Levodopa

A
  1. B
  2. C
  3. A
  4. A
  5. A
47
Q

Matching Type:

  1. Increases the bioavailability of levodopa
  2. No benefit in reducing levodopa induced motor fluctuations
  3. Indirect dopamine agonist
  4. Block muscarinic cholinergic receptors
  5. Mainstay of therapy

Choices:
A. Amantadine
B. Selegiline
C. COMT Inhibitor
D. Anticholinergic
E. Levodopa

A
  1. C
  2. B
  3. A
  4. D
  5. E
48
Q

Matching Type:

  1. Its downside is hepatocellular injury & possible neurotoxicity in PD
  2. Monoamine oxidase-B (MAO-B) inhibitor
  3. Long-term use leads to dyskinesias & motor response fluctuations (“on-off” phenomenon)
  4. Restores motor function -> less hyperkinesis
  5. Its adverse effects include: restlessness, confusion, depression, nausea, hypotension

Choices:
A. Amantadine
B. Selegiline
C. COMT Inhibitor
D. Anticholinergic
E. Levodopa

A
  1. C
  2. B
  3. E
  4. D
  5. A
49
Q

TRUE OR FALSE: At present, L-dihydroxyphenylalanine (L-dopa) is the most effective agent for the treatment of PD.

A

True

Source: Adams & Victor

50
Q

Matching Type:

  1. One of its effects is orthostasis
  2. Can be efficacious for tremor & dystonia
  3. Improves bradykinesia & tremor
  4. Useful adjunct in early stage of PD & in patients w/ mild response fluctuations
  5. Most effective treatment for tremor

Choices:
A. Amantadine
B. Selegiline
C. COMT Inhibitor
D. Anticholinergic
E. Levodopa

A
  1. E
  2. D
  3. A
  4. C
  5. A
51
Q

Matching Type:

  1. Catechol-O-methyl-transferase
  2. Its peripheral side effects are dry mouth, blurred vision, urinary retention, constipation
  3. Discovered serendipitously because it is an antiviral med
  4. Safinamide
  5. May induce oxidative stress due to increased dopamine turnover & free radical formation

Choices:
A. Amantadine
B. Selegiline
C. COMT Inhibitor
D. Anticholinergic
E. Levodopa

A
  1. C
  2. D
  3. A
  4. B
  5. E
52
Q

Matching Type:

  1. Opicapone
  2. Can be used as monotherapy or as adjunct therapy to levodopa
  3. Precursor of dopamine
  4. Neuroprotective effects: Reduces oxidative stress and free radical production
  5. Its central side effects: confusion, memory loss

Choices:
A. Amantadine
B. Selegiline
C. COMT Inhibitor
D. Anticholinergic
E. Levodopa

A
  1. C
  2. A
  3. E
  4. B
  5. D
53
Q

Matching Type:

  1. Decreases dopamine reuptake
  2. Symptomatic effects are mild
  3. Decreases dopamine metabolism
  4. It is taken up by dopamine nerve terminals in the striatum
  5. Cholinergic neurons directly opposes the function of dopamine

Choices:
A. Amantadine
B. Selegiline
C. COMT Inhibitor
D. Anticholinergic
E. Levodopa

A
  1. A
  2. B
  3. B
  4. E
  5. D
54
Q

Identification: Four classes of drugs in the treatment of PD

A
  1. Direct-acting dopamine agonists
  2. Indirect-acting dopamine agonists
  3. Precursor of dopamine
  4. Anticholinergics
55
Q

Identification: In neuroprotective treatment, these 2 drug groups act as scavengers of free radicals

A
  1. MAO B inhibitors
  2. Dopamine agonists
56
Q

Fill in the blanks: The loss of dopamine-producing neurons in the substantia nigra results in the imbalance between dopamine, a/an (1)____ neurotransmitter, & the (2)___ neurotransmitter acetylcholine.

A
  1. inhibitory
  2. excitatory
57
Q

Identification: Parkinsonism is a combination of BTR. BTR stands for?

A

Bradykinesia
(Resting) Tremors
Rigidity

58
Q

Identification: 3 drug therapies for treating associated symptoms of PD

A
  1. Beta-blockers
  2. Antihistamine
  3. Tricyclic antidepressants
59
Q

Identification: Which stage of PD is “Bilateral involvement with postural instability; patient requires substantial assistance”?

A

Stage IV

60
Q

Identification: Which stage of PD is “Mild to moderate bilateral disease, mild postural imbalance, but still able to function independently”?

A

Stage III

61
Q

Identification: Which stage of PD is “Unilateral involvement, including the major features of tremor, rigidity, or bradykinesia; minimal functional impairment”?

A

Stage I

62
Q

Fill in the blanks: Dopamine agonists serve as scavengers of free radicals and (1)___ dopamine turnover & there is (2)___ in oxidative stress.

A
  1. decrease
  2. increase
63
Q

Fill in the blanks: Essential Tremor & Physiologic Tremors are (1)___ Hz and are (2)___ and/or (3)____. Resting Tremors are (4)___ Hz and disappear with (5)___ and (6)___.

A
  1. 8-12
  2. Kinetic
  3. Postural
  4. 4-6
  5. Sleep
  6. voluntary movement
64
Q

Fill in the blanks: PD is a neurodegenerative disease associated with (1)___ of the substantia nigra and loss of dopaminergic input to the (2)___. Most symptoms do not appear until striata dopamine levels decline by at least (3)___.

A
  1. depigmentation
  2. basal ganglia
  3. 70-80%
65
Q

Fill in the blanks: Levodopa is converted to dopamine by (1)___. Afterwhich, dopamine gets stuck in the (2)___. Conversely, COMT becomes (3)___ & competes with levodopa in crossing the (4)____ & going to the CNS.

A
  1. dopa decarboxylase
  2. Gastrointestinal tract
  3. 3-OMD
  4. blood-brain barrier
66
Q

Identification: The presence of angle closure glaucoma is a contraindication to the use of this drug class.

A

Anticholinergic / Antimuscarinic drugs

67
Q

TRUE OR FALSE: The most widely used synthetic preparations of anticholinergic drugs are trihexyphenidyl & benztropine, which block ACh from binding to receptors.

A

True

Source: Adams & Victor, Merritt

68
Q

TRUE OR FALSE: Other motor features in PD are Restless Limb Syndrome, Akathisia, Loss of postural reflex, change in speech quality, freezing, and PD dementia.

A

True.

Source: Merritt

69
Q

Matching Type:

  1. Feet seemingly becomes glued to the floor. Abruptly afterward, the feet become “unstuck” and gait resumes.
  2. Delay/slowness in cognitive processing
  3. Tendency to fall backward can occur when a pt arises from seating or when walking backward
  4. Crawling sensations in the legs and may be associated with periodic limb movements during sleep
  5. Near-constant state of discomfort leading to voluntary movements

Choices:
A. Retropulsion
B. Bradyphrenia
C. Restless Limb Syndrome
D. Akathisia
E. Freezing

A
  1. E
  2. B
  3. A
  4. C
  5. D

Source: Merritt

70
Q

Identification: When a patient accelerates in quick forward steps in attempt to avoid falling backward.

A

Festination of gait

Source: Merritt

71
Q

Identification: These were the first effective medications used for PD. It may be used as a secondary pharmacologic option because of the side effects of levodopa and of dopaminergic agents.

A

Anticholinergic / Antimuscarinic Drugs

72
Q

Matching Type:

  1. Writing becomes smaller over time
  2. Voice becomes less audible and, finally, the patient only whispers. Soft, monotonous, cluttered speech.
  3. Extreme version of stammering with repetition of a word’s initial syllable
  4. May manifest Froment’s Sign
  5. Syllables are inadequately separated, resulting in words that run together.
  6. Monotonous tone with a lack of inflection

Choices
A. Tachyphemia
B. Essential tremor
C. Hypokinetic Dysarthria
D. Micrographia
E. Aprosody
F. Palilalia

A
  1. D
  2. C
  3. F
  4. B
  5. A
  6. E
73
Q

TRUE OR FALSE: Levodopa produces an immediate symptomatic response. The development of non-levodopa-responsive features such as freezing & autonomic dysfunction, is possible.

A

True

74
Q

Identification: These are the hallmark of PD & are largely composed of ubiquitin and aggregated α-synuclein (αSyn). They are eosinophilic proteinaceous cytoplasmic inclusions, surrounded by a faint halo that are present in many of the remaining cells of the pigmented nuclei of the SN.

A

Lewy bodies

75
Q

Identification: It is the repetitive to- & fro flexion extension or rotatory unilateral movement. It is accentuated by stress, anxiety, walking, excitement, & concentration.

A

Tremors

76
Q

TRUE OR FALSE: Normally, DA & ACh neurons are both balanced. However, in PD, ACh is increased, dopamine is decreased. This fluctuation causes tremors & rigidity.

A

True

Source: Ninja Nerd

77
Q

Matching Type:

  1. Tracing circles in the air
  2. Reduction in small facial muscle movements imparts the characteristic expressionless “masked” appearance
  3. Inability to inhibit blinking in response to a tap over the bridge of the nose or glabella. Unsuppressed reflex of obligate blinking.
  4. Intermittent resistance to slow movement. It is more common in the UE.
  5. Created from phenylalanine, which is subsequently converted to tyrosine

Choices:
A. Myerson Sign
B. Hypomimia
C. Cogwheeling
D. Levodopa
E. Froment Sign

A
  1. E
  2. B
  3. A
  4. C
  5. D
78
Q

Identification: There is involuntary hypertonia of skeletal muscles. When the examiner passively moves the limb, a mild resistance appears from the start & continues evenly throughout movement.

A

Limb Rigidity

79
Q

Fill in the blanks: The usual blink rate of 12 to 20/min is reduced in the parkinsonian patient to (1)___, and with it there is a slight widening of the palpebral fissures, creating a (2)___.

A
  1. 5 to 10/min
  2. stare

(2) MS: Neurological Conditions 🩺 (12 decks)

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