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Flashcards in Geriatric's Medical Potpourri 2 Deck (24)
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1
Q

Parkinson’s Dz
1. What is it? 3

  1. PP?
A
  1. An idiopathic, slowly progressive degenerative CNS disorder characterized by:
    - Tremor (usually resting)
    - Muscular rigidity
    - Bradykinesia
  2. Striatal dopamine is deficient and dopaminergic neurons are lost in the substansia nigra
2
Q

Some patients will develop what from this?

A

Some patients develop dementia

3
Q

How should we Dx parkinson’s Dz?

2

A
  1. By history and physical exam

2. Diagnosed clinically if 2 of the 3 cardinal features (tremor, rigidity, bradykinesia) are present

4
Q

Parkinson’s
1. Symptoms & signs in PD typically begin where and move where?

  1. Symptoms reported by patients can include the following:
    10
A
  1. one extremity or one side but eventually involve other limbs and trunk
    • Stiffness & slowed movements
    • Tremor or shaking at rest
    • Difficulty getting out of chair or rolling in bed
    • Frequent falls or tripping
    • Difficulty walking
    • Memory loss
    • Speech changes (whispering, rapid speech)
    • Small handwriting
    • Slowness in performing activities of daily living
    • Sialorrhea
5
Q

Physical findings in Parkinson’s disease

What is initially affected and what does it move to?

A

Hands initially affected but legs, chin and head are involved with advanced disease.

6
Q

Physical findings in Parkinson’s disease:

14

A
  1. Muscle rigidity, cog wheeling type
  2. Bradykinesia
  3. Postural instability , assumes a stooped forward posture
  4. Decreased arm swinging in ambulatory activity
  5. Resting tremor / pill-rolling tremor
  6. Masked facies
  7. Micrographia
  8. Dysarthria, hypokinetic, monotonous low volume
  9. Painful dystonia
  10. Dementia
  11. Depression up to 50%
  12. Akathisia inability to sit still
  13. Seborrheic dermatitis face & scalp
  14. Autonomic dysfunction e.g. orthostatic hypotension
7
Q

Initial Treatment for Parkinson’s

A

Initial drug treatment includes carbidopa/levodopa or dopamine agonists
-After 2 to 5 years levodopa becomes less effective

8
Q

Other options include: Parkinson’s?

4

A
  1. monoamine oxidase type B inhibitors
  2. Catechol-O-methyltransferase inhibitors
  3. Amantadine
  4. Deep brain stimulation (electrodes placed in subthalamic nucleus connected to a pacemaker) for drug resistant tremor or levodopa induced motor complications
9
Q

What is a common problem in this?

How should it be managed?

A

Constipation is common and should be

prevented or relieved with dietary fiber, fruit juices, sometimes laxatives

10
Q

Parkinson’s-end of life issues

5

A
  1. Many patients eventually become severely impaired and immobile and are at risk for aspiration
  2. Eating may become impossible
  3. Dementia
  4. Discuss end-of-life care issues early
  5. Advise patient to appoint a surrogate to make medical care decisions if they become incapacitated
11
Q

Polymyalgia Rheumatica characterized by what?

2

A

characterised by

  1. severe bilateral pain and
  2. morning stiffness of the

shoulder, neck and pelvic girdle.

MEDIUM VESSEL VASCULITIS

12
Q

Polymyalgia Rheumatica:
1. There is an increased incidence of the disorder where?

  1. Women are more frequently affected than men with a M:F ratio of approximately what?
A
  1. At higher latitudes

2. 1:3.

13
Q
  1. Polymyalgia Rheumatica: What genes is it linked to?

2. What else has been linked to? 5

A
  1. HLA-DRBI*04 and *01 alleles
    • antibodies to respiratory syncitial virus and
    • adenovirus in PMR and the association between the increased incidence of the disorder and epidemics of
    • Mycoplasma pneumoniae,
    • chlamydia pneumoniae and
    • Parvovirus B19.
14
Q

Polymyalgia Rheumatica: Other symptoms and signs may include?
8

A
  1. Pain on active and passive movement of joints ( shoulders 70-95%, hips and neck 50-70%)
  2. Morning stiffness of more than one hour and also after periods of rest.
  3. Myositis
  4. Lethargy
  5. Loss of weight
  6. Depression
  7. Fever
  8. Joint effusions
15
Q

Polymyalgia Rheumatica: May or may not see symptoms of what?

3

A

± Asymmetric peripheral arthritis ( mainly knee and wrist)
± Carpal tunnel syndrome
± edema of hands, wrists, ankles and feet

16
Q

Polymyalgia Rheumatica: Labs?

3 (whats the most important test)

A
  1. ESR…the most useful laboratory test -
    although up to 20% of patients may have a normal ESR at diagnosis. Plasma Viscosity can be used instead of ESR.
  2. C-reactive protein
  3. IL-6 levels
  4. CBC –
  5. Rheumatoid and ANA
  6. LFTs
17
Q

What levels of ESR?

A

raised to a level of at least 40 mm/hour and often 100 mm/hour

18
Q

How are the following changed in Polymyalgia Rheumatica:

  1. IL-6 levels?
  2. CBC?
  3. Rheumatoid and ANA?
  4. LFTs?
A
  1. usually raised, and a useful marker of disease activity
  2. normochromic, normocytic anemia
  3. not elevated!!
  4. mildly elevated in 1/3 of patients
19
Q

Polymyalgia Rheumatica Associated Dzs?

A

Giant cell arteritis co-exists in about 30% of patients with PMR and shares many features of the disease

20
Q

Polymyalgia Rheumatica:

Advise people with PMR to seek medical attention if they developed any symptoms of GCA. Such as? 3

A
  1. any new headache,
  2. jaw claudication or
  3. visual disturbances.
21
Q

Polymyalgia Rheumatica:

Monitor response to treatment by assessing changes in clinical features and inflammatory markers– Such as? 2

A
  1. ESR

2. CRP

22
Q

DOC for PMR?

A

Prednisone remains the drug of choice for treating PMR.

-Treatment is generally initiated at 15mg/day per day

23
Q

What should be given to all PMR patients who are receiving doses of prednisone (or equivalent)>5mg daily for >6 months?
2

A
  1. Bisphosphonates, or

2. if they are not tolerated, Calcium and vitamin D supplementation

24
Q
  1. PMR occurs in patients who on average are > how old?
  2. Cardinal symptoms are what?
  3. Clinicians must be alert to mimics, including what? 4
  4. What is usually raised at disease onset?
  5. ___________ is present in about 30% of patients
  6. PMR is treated with what?
A
  1. 70 years of age.
  2. shoulder & hip girdle pain with pronounced stiffness lasting at least one hour.
    • infection,
    • malignancy,
    • metabolic bone disease, and
    • elderly onset rheumatoid arthritis.
  3. ESR or CRP , or both,
  4. Giant cell arteritis
  5. oral glucocorticoids.