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Year 2: Neuromuscular II > Test 2: Parkinson's > Flashcards

Test 2: Parkinson's Flashcards

1
Q

how many people are affected by PD every year

A

1 million americans

10 million globally

2% people over 65

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2
Q

average onset age of PD

A

between 50 and 60

can have young onset (21-50) or Juvenile (<21) (10% of cases)

more likely men

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3
Q

etiology of PD

A

disturbance if dopamine (DA) system in basal ganglia

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4
Q

types of PD

A

idiopathic (78%)
- Postural instability gait disorder subtype
-tremor dominant subtype

genetic

secondary parkinsonisms

atypical parkinsonisms

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5
Q

characteristics of postural instability gait disturbance type PD

A

worse prognosis

more bradykinesia

higher prevalence of non-motor symptoms

higher likelihood of dementia

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6
Q

characteristics of tremor dominant parkinsons

A

better prognosis

less difficulty with bradykinesia and postural instability

lower incidence of non-motor S&S

lower risk of developing dementia

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7
Q

genetic markers for PD

A

10% cases = genetic

some families share gene mutations: SNCA, PARK1, PINK1, LRRK2, DJ-1, glucocerebrosidase

2 types of gene mutations:
- those that cause PD
- those that increase risk of developing

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8
Q

what is postencephalitic PD

A

caused by strain of influenza between 1917 and 1926

no recent outbreaks; if you see these pts they will be 90-100

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9
Q

what is toxic parkinsonism

A

exposed to pesticides/industrial chemicals

manganese = most common; miners often exposed

synthetic heroin with chemical MPTP

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10
Q

what is drug induced parkinsonism

A

drugs that interfere with DA systems

neuroepileptic drugs, antidepressants, and some antihypertensives

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11
Q

types of PD plus syndromes

A

progressive supranuclear palsy

multiple systems atrophy

cortical bassal ganglionic degeneration

lewy body dementia

normal pressure hydrocephalus

creutzfeldt-jakob disease

wilsons disease

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12
Q

parts of basal ganglia

A

caudate nucleus
putamen
globus pallidus
subthalamic nucleus
substantia nigra

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13
Q

pathophysiology of PD

A

degeneration of dopaminergic neurons

produce less dopamine (DA)

can get alpha synuclein cytoplas inclusions (Lewy bodies) as disease progresses

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14
Q

describe how the direct loop works

A

excitation of putamen to globus pallidus

GP to ventral lateral nucleus of thalamus

VL to SMA

result = voluntary motor movement and positive feedback loop

need DA from substantia nigra to help with activation

Inhibition of the direct pathway and functioning of the indirect (double inhibition)

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15
Q

general categories of symptoms of PD

A

cardinal motor

other motor S&S

non-motor symptoms

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16
Q

cardinal motor S&S

A

bradykinesia
tremor - resting
postural instability - falls are likely
rigidity

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17
Q

describe the rigidity that comes with PD

A

uniform in agonist and antagonist

cogwheel (jerky) or leadpipe (constant) resistant to passive movement

constant regardless of task or speed of movement

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18
Q

other motor S&S of PD (mm performance, motor function, gait, dysphagia, etc)

A

mm performance
- motor recruitment delayed

motor function
- difficulty with speed/accuracy
- difficult with dual tasking
- difficulty with starting and stopping motion

gait
- 25% = this is initial symptom
-flexed posture
- bradykinesia
- decreased arm swing
- freezing possible

dysphagia
- 95% will have swallowing difficulty

hypokinetic dysarthria

19
Q

clusters of non-motor S&S of PD

A
  1. rapid eye movement sleep behavior disorders
  2. cognition related
  3. mood related
  4. sensory and disautonomia
20
Q

characteristics of rapid eye movement sleep behavior disorders

A

frequent nightmares

dream enacting behaviors

insomnia

21
Q

cognition related symptoms for PD

A

memory complaints

cognitive fatigue

inattention

excessive day- timeless sleepiness

mild cognitive impairments

22
Q

mood related symptoms related to PD

A

anehodonia
- lack of interest, enjoyment, or pleasure in things that generally bring joy

apathy
-flat affect

mood disturbance
- depression
- subclinical depression
- suicidal ideation
- anxiety

23
Q

sensory and dysautonomia S&S associated with PD

A

loss of taste

loss of smell (often early sign of PD; will happen in 100% pts)

visual perception disturbances

chest pain

unexplained pain

paresthesias

hyperhydrosis (excessive sweating)

GI disorders (urinary incont/constipation)

orthostatic hypotension

24
Q

describe the movement disorder society (MDS) clinical diagnostic criteria for PD

A
  1. Bradykinesia in combo with at least resting tremor and/or rigidity
  2. absence of absolute exclusion criteria, at least 2 supportive criteria (i.e. responding well to domaminergic agents) and no red flags
25
Q

medical management of PD

A

pharmacology

nutritional management
- high protein diets can block effectiveness of levodopa
- need high calorie, low protein diet
- some need PEG tubes

deep brain stimulation
- for tremor usually
- can impact gait, on/off symptosm
- electrodes typically in globus pallidus internus or subthalamic nucleus

referrals to other specialties

26
Q

pharmacology management of PD

A

goal = want to increase/keep dopamine

carbidopa/levodopa = replaces lost DA

dopamine agonists = stimulate DA receptors in basal ganglia

COMT inhibitors = block breakdown of levodopa

MAO-B inhibitors = block breakdown of levodopa

anticholinergics = reduce excessive ACh influence caused by decrease of DA

27
Q

what specific systems should be screened for PD pts in PT

A

cognition
-Mini Best
- mini mental
- MOCA
psychosocial function
- depression screen
-QOL
sensory
MSK
ANS
neuromuscular

28
Q

common outcome measures for PD

A

Hoehn and Yahr

United Parkinson’s Disease Rating Scale

PD EDGE

29
Q

describe the staging of PD with UPDRS as well as what is being measured with the scale

A

gold standard for determining disease severity

often done by neurologist

time consuming

score 0-4 on each item, higher numbers are worse

measures:
- mentation, behavior, and mood (4 items)
- ADLs (13 items)
- motor scale (14 items)
- additional section for other symptoms (11 items) on things like on/off periods, hypotension, etc

30
Q

what does the UDRS section 1 (mentation, behavior, and mood) include

A

intellectual impairment

thought disorder

depression

motivation/initiative

31
Q

UDRS section 2 (ADLs) looks at what

A

speech
salivation
swallowing
handwriting
cutting food/utensil use
dressing
hygiene
turning in bed
falling
freezing
walking
tremor
sensory complaints

32
Q

UDRS section 3 (motor exam) looks at what

A

speech
facial expression
tremor at rest
action or posture tremor
rigidity
finger taps
hand movement
rapid alternating movement
leg agility
rising from chair
posture
gait
postural instability
brady/hypo kinesia

33
Q

recommended measures for body structure and function for PD edge

A

MDS- UPDRS revision part 3
MDS UPDRS part 1
montreal cognitive assessment

34
Q

recommended measures for activity section for PD edge

A

6 MWT
10 MWT
MINI best
MDS-UPDRS part 2
FGA
5x STS
9 hole peg test

35
Q

recommended measures for participation with PD edge

A

PDQ- 8

PDQ- 39

36
Q

PD specific measures tests

A

parkinsons datigue scale (PFS-16)

UPDRS

parkinsons disease questionnaire 39 (PDQ-39)

parkinsons disease questionnaire 8 (PDQ-8)

new freezing gait questionnaire (NFOG-Q)

37
Q

highly recommended interventions for PD

A

aerobic ex
resistance training
balance
external cueing
community based ex
gait training
task specific training
behavior change approach
integrated care

38
Q

can pts with PD remediate function? How?

A

yes

can use neuroplasticity
- use it or lose it
- repetition matters
- use it improve it
- intensity matters - high/big
- salience matters

improving function/brain response… NOT changing disease itself

high intensity/high reps for PD; don’t have as much fatigue and stress response as other neurodegenerative diseases

39
Q

what to keep in mind when treating PD MSK probs

A

treat the MSK problems but keep in mind the neurologic condition

i.e. frozen shoulder is common, but this is often due to the decreased movement and overall movement/gait pattern associated with PD

40
Q

cueing to keep in mind with PD

A

visual cues help

auditory cues help

too many cues are not helpful

weight shifts can help get out of freezing

41
Q

PT POC for PD pts

A

remediation og function is possible

treatment of MSK is possible

still ultimately progressive

may consider skilled maintenance between remediation episodes

medication timing may matter

42
Q

where will you typically see PD pts (what setting of PT)

A

typically OP PT but can see in any setting

43
Q
A

Year 2: Neuromuscular II (18 decks)

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