Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y4 Geriatrics > Week 3 - movement disorders (parkinsonism) > Flashcards

Week 3 - movement disorders (parkinsonism) Flashcards

1
Q

Is the tremor associated with Parkinson’s disease a coarse or fine tremor ?

A

fine tremor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

In what circumstances does the tremor associated with Parkinson’s disease worsen?

A
  • at rest
  • with distraction
  • with anxiety
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Is the tremor associated with Benign essential tremor a coarse or fine tremor ?

A

coarse tremor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When is the tremor associated with benign essential tremor worst ?

A

during movement/action

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which one has a more familial element..
a) parkinson’s disease?
b) benign essential tremor ?

A

benign essential tremor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

List some conditions that cause a tremor worse on movement …

A
  • benign essential tremor
  • hyperthyroidism
  • drug induced tremor
  • dystonic tremor
  • exaggerated physiological tremor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

As well as the hands, where else does a tremor often occur in a patient with essential tremor ?

A
  • hands
  • legs
  • jaw
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Does essential tremor cause bradykinesia and gait disorder, like parkinsonism does ?

A

not usually !

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What pharmacological intervention can be effective in reducing essential tremor ?

A

non specific beta blockers e.g propranolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the cardinal features of parkinsonism ?

A
  • bradykinesia
  • rigidity
  • resting tremor
  • postural and gait instability (this is an extra one!)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which is the most common condition that can cause the features of parkinsonism ?

A

idiopathic parkinson’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the common pattern of clinical signs of parkinsonism i idiopathic parkinson’s disease ?

A

asymmetrical
(usually unilateral on presentation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the common signs/symptoms of idiopathic parkinson’s disease ?

A
  • bradykinesia
  • rigidity
  • resting tremor
  • postural/gait instability (shuffling gait)
  • stooped posture
  • hypomimia (mask face)
  • reduced blinking rate
  • hypophonia (quiet, monotonous voice)
  • hypographia (small handwriting)
  • REM sleep disturbance (vivid dreams, acting them out)
  • insomnia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the principal management of idiopathic parkinson’s disease ?

A
  • levodopa or dopamine agonist
  • physical therapy/activity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the conditions that fall under the term of parkinsonism ?

A
  • idiopathic parkinson’s disease
  • vascular parkinsonism
  • dementia with lewy bodies
  • drug induced parkinsonism
  • PSP (progressive supranuclear palsy)
  • MSA (mutlisystems atrophy)
  • CBD (corticobasal degeneration)
  • normal pressure hydrocephalus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which of the parkinsonism conditions usually present bilaterally ?

A
  • vascular parkinsonism
  • drug induced parkinsonism
  • MSA (multisystem atrophy)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Why does vascular parkinsonism usually present bilaterally ?

A
  • vascular parkinsonism is caused by microvascular damage to vessels of/surrounding substantia nigra
  • damage to blood vessels is usually symmetrical as the precipitants (e.g glucose) travel through every vessel equally
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which drug class cause drug induced parkinsonism ?

A

antipsychotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

In which conditions are antipsychotics most commonly used ?

A
  • schizophrenia
  • bipolar
  • tourette’s disorder
  • nausea and vomiting
  • dizziness/vertigo in the elderly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which type of parkinsonism is the only condition to include sensory abnormalities ? why ? what type of sensory deficits ?

A

CBD (cortico basal degeneration)

because it involves the cortex which has sensory and motor components- other types of parkinsonism mainly target the substantial nigra

- pins and needles
- tingling
- numbness
- alien limb phenomenon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is an early sign of MSA (mutlisystem atrophy) ?

A

dysphagia occurs quite early on and is rapidly progressive

22
Q

Which type of parkinsonism is associated with cerebellar signs ? what cerebellar signs ?

A

PSP (progressive supranuclear palsy)

  • severe postural instability (poor balance)
  • dis-coordination
  • slow or slurred speech
23
Q

What specific sign is seen on MRI that is indicative of PSP ?

A

hummingbird sign

= reduction in mid brain volume

24
Q

What are the main signs of vascular parkinsonism ?

A
  • predominant lower body rigidity
  • lack of facial expression
  • less common to see tremor
25
Q

What is the treatment for vascular parkinsonism ?

A

50% respond to levodopa

26
Q

What are the main signs of dementia with lewy bodies ?

A
  • cognitive decline predating physical signs (approx 6 months before)
  • prominent visual hallucinations (often involving animals)
  • fluctuations in alertness
  • physical signs of idiopathic parkinson’s
  • REM-sleep disorder (vivid dreams, act out dreams etc)
27
Q

What is the management of dementia with lewy bodies ?

A

shared care with psychiatry, neurology and geriatrics

28
Q

What is the treatment for drug induced parkinsonism ?

A

it is usually irreversible, but you would stop or reduce the drug and liaise with psychiatry

29
Q

What are the signs of drug induced parkinsonism ?

A
  • drug history of antipsychotics
  • symmetrical rigidity
  • lack of facial expression
30
Q

What are the signs of MSA (multisystem atrophy) ?

A
  • rapid progression
  • early onset dysphagia
  • postural hypotension
  • bladder instability
  • symmetrical parkinsonism signs
31
Q

what is the treatment for MSA (multisystem atrophy) ?

A

levodopa and supportive treatments

32
Q

What are the signs of PSP (progressive supranuclear palsy) ?

A
  • vertical gaze palsy (can’t look up easily in H test)
  • early falls (due to severe postural instability and discoordination)
  • truncal rigidity
  • hummingbird sign on MRI
33
Q

What is the treatment for PSP (progressive supranuclear palsy) ?

A
  • speech and language review
  • supportive therapies
34
Q

What are the signs of CBD (corticobasal degeneration) ?

A
  • asymmetrical parkinsonism
  • dyspraxia
  • sensory deficits (numbness, pins and needles, tingling)
  • alien limb phenomenon (feeling estranged from a limb)
35
Q

What is the treatment for CBD (corticobasal degeneration) ?

A
  • symptomatic control
  • does not respond well to levodopa
36
Q

What are the signs of normal pressure hydrocephalus ?

A
  • memory loss
  • gait disturbance
  • bladder incontinence
37
Q

What is the management of normal pressure hydrocephalus ?

A
  • diagnostic lumbar puncture and CSF removal, then a…
  • ventricolo-peritoneal shunt
38
Q

What are some signs of parkinsonian gait disorder ?

A
  • small step/shuffling gait
  • loss of arm swinging
  • broad based stance
  • impaired turning
  • asymmetry
  • freezing
  • fenestrated/festinant gait (small steps, picking up speed as they go)
39
Q

What is the frequency (Hz) of the resting tremor seen in parkinson’s disease ?

A

4 - 6 Hz

40
Q

What is the UK PDS Brain Bank criteria for diagnosing parkinson’s disease ?

A

3 steps …

  1. bradykinesia with at least one other cardinal symptom (rigidity, tremor, postural instability)
  2. exclude a history of drug induced, repeated strokes, head injury, unilateral after 3 years, cerebral tumour etc…
  3. three or more of:
    - unilateral onset
    - persistent asymmetry affecting side of onset most
    - rest tremor
    - progressive disorder
    - excellent response to levodopa
    - severe levodopa induced chorea
    - levodopa response for over 5yrs
    - clinical disease course of over 10yrs
41
Q

What is the recommended first step of management in a patient with parkinsonian symptoms ?

A

refer to movement disorder clinic before medication - drugs can influence presentation and make diagnosis in clinic harder

42
Q

What is the epidemiology of parkinson’s disease ?

A
  • more common in men
  • incidence is 10-20 out of 100,000
43
Q

What are the first line drug options for treatment of parkinson’s disease ?

A

in order of preferred drug class

  • co-beneldopa / co-careldopa (levodopa and a dopa decarboxylase inhibitor)
  • ropinirole (dopamine agonist)
  • rotigotine (dopamine agonists)
  • pramipexole (dopamine agonist)
  • rasagaline (MAO-B inhibitor)
  • selegiline (MAO-B inhibitor)
44
Q

When should levodopa medications be commenced ?

A

as late in the disease progression as is tolerable by patient because long term use can exacerbate symptoms

(this is mostly only in patients under 60, if 60+ usually start but on smaller doses)

45
Q

What are some PMHx risk factors for vascular parkinsonism ?

A
  • diabetes
  • HTN
  • stroke
  • ischaemic heart disease
46
Q

What is a common initial side effect of levodopa treatment ?

A

nausea
vomiting
diarrhoea
postural hypotension

47
Q

What is a common investigation used when a patient presents with signs of any type of parkinsonism ?

A

MRI brain

48
Q

Who is involved in the MDT for parkinson’s disease ?

A
  • specialist nurses
  • physio
  • speech and language therapist
  • occupational therapist
  • pharmacist
  • psychologists
  • dieticians
  • social workers
  • carers
49
Q

What are some side effects to be wary of in the dopamine agonist meds (ropinirole, rotigotine, pramipexole..) ?

A
  • confusion
  • hallucinations
  • impulse control disorders (gambling, hyper sexuality, overspending etc)

do not use in Pts with known cognitive/psychiatric impairments and counselling is required before starting these meds

50
Q

What is the 4 stages of progression of parkinson’s ?

A
  1. pre diagnosis - usually not overt symptoms
  2. diagnosis and treatment - good response to meds at first
  3. complex - development of drug associated dyskinesias/motor problems or cognitive decline
  4. palliative - poor drug response and cognitive decline/dementia predominates. swallowing may be impaired and require feeding therapies (PEG). discussions about end of life care.
51
Q

describe what causes parkinson’s to a patient …

A
  • there are neurones in the brain that deliver dopamine around
  • dopamine is important for lots of things like mood, memory and motor skills
  • unfortunately genetics and environment can cause those neurones to deteriorate
  • this causes a lack of dopamine delivery around the brain which can cause the motor signs, and decrease in memory and mood.

Y4 Geriatrics (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions