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Year 2 Neurology > Parkinson disease > Flashcards

Parkinson disease Flashcards

1
Q

what are the cardinal clinical features of parkinson disease? which is usually the initial presenting feature?

A
  • tremor
  • bradykinesia
  • rigidity
  • postural instability
  • tremor
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2
Q

if a tremor is present during sleep, is that PD?

A

no

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3
Q

what is usually the most disabling feature of PD?

A

bradykinesia

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4
Q

rigidity is assessed based on resistance to ___________

A

passive ROM

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5
Q

what feature of PD accounts for the falls / fractures?

A

postural instability

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6
Q

what are the autonomic dysfunctions associated with PD?

A
  • postural hypotension
  • hyperhydrosis
  • bowel / bladder
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7
Q

dementia is present in what % of PD patients? does it usually present earlier or later?

A
  • 20-80%

- later (if early, PD is not the diagnosis)

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8
Q

what is the pathology in PD?

A
  • degeneration of basal ganglia, locus ceruleus, vagal nerve nucleus
  • zona compacta of substantia nigra
  • loss of dopaminergic neurons
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9
Q

what are lewy bodies? where are they seen in excess in PD?

A
  • eosinophilic cytoplasmic inclusion bodies

- zona compata

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10
Q

are lewy bodies seen in patients with essential tremor?

A

no

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11
Q

what protein is seen in lewy bodies?

A

ubiquitin

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12
Q

what are secondary causes of parkinsonism?

A
  • post encephalitis
  • drug induced
  • toxin induced
  • post traumatic
  • NPH
  • brain tumor
  • multiple strokes
  • wilsons disease
  • HIV
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13
Q

what are the degenerative causes of parkinsonism?

A
  • HD
  • spinocerebellar degen
  • striatonigral degen
  • progressive supranuclear palsy
  • LBD
  • shy-drager syndrome / MSA
  • AD
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14
Q

which drug is highly associated with parkinsonism?

A

metoclopramide

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15
Q

what is the MOA of metoclopramide?

A

irreversibly binds in post synaptic membrane, preventing action of DA across synapse

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16
Q

which drug types cause parkinsonism?

A
  • DA receptor blockers (antipsychotics, anticonvulsant, antiemetic, GI motility)
  • DA depleting drugs (anti HTN)
17
Q

what toxins are associated with parkinsonism?

A
  • CO
  • manganese
  • MPTP
  • methanol / ethanol
18
Q

NPH is characterized by what triad of features?

A
  • cognitive dysfunction / lethargy
  • gait disorder
  • urinary incontinence
19
Q

how is NPH diagnosed?

A
  • H&P
  • neuro imaging studies
  • LP
20
Q

what is the pathology in HD?

A

atrophy of the caudate nucleus

21
Q

what are the inclusion criteria for PD?

A
  • bradykinesia
  • muscular rigidity
  • postural instability
  • *all 3 prove PD
  • *2/3 are suggestive
22
Q

what are the PD supportive criteria?

A
  • unilateral onset
  • resting tremor
  • progressive disorder
  • excellent response to LDOPA
  • clinical course over 10 years
23
Q

can you make a diagnosis for PD based on response to treatment?

A

NO

24
Q

what are the PD exclusion criteria?

A
  • history of repeated stroked, head trauma, encephalitis
  • oculogyric crisis
  • neuroleptic treatment at onset
  • more than one affected relative
  • sustained remission
  • unilateral disease over 3 years
  • supranuclear gaze palsy
  • cerebellar signs
  • early autonomic dysfunction
  • early dementia
  • babinski sign
  • cerebral tumor / hydrocephalus
  • no response to LDOPA
  • MPTP exposure
25
Q

can PD diagnosed after 80 years of age?

A

no

26
Q

does PD have a gender preference?

A

no

27
Q

what are four (proposed) etiologies of PD?

A
  • genetic predisposition (10%)
  • protein aggregation (ubiquitin)
  • oxidative stress
  • environmental risk factors
28
Q

what are the protective environmental risk factors for parkinsonism?

A
  • physical exercise
  • smoking
  • increased uric acid
29
Q

what are putative environmental risk factors for parkinsonism?

A
  • constipation

- head injury, anxiety / depression, BBs

30
Q

how is diagnoses established for PD?

A
  • H&P
  • rule out secondary forms
  • scans can be suggestive but not diagnostic (MRI)
31
Q

what drug classes are used for PD treatment?

A
  • dopaminergic
  • anticholinergics
  • LDOPA / carbidopa
  • COMT inhibitors
  • MAOB inhibitors
32
Q

which dopaminergic drugs are used for PD treatment?

A
  • amantadine
  • ropinirole, pramipexole
  • apomorphine
33
Q

entacapone and tolcapone are what drug class?

A

COMT inhibitors

Year 2 Neurology (23 decks)

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