Parkinson's Disease Flashcards

1
Q

What is the most common neurodegenerative disorder?

A

AD

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2
Q

What is the second most common neurodegenerative disorder?

A

PD

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3
Q

What causes PD?

A

loss of dopamine producing neurones in the substantia nigra, causing a pigment loss which can be seen on biopsy

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4
Q

What explains why there isa high incidence of depression in PD?

A

5HT-producing neurones in the brainstem are also affected

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5
Q

What does degeneration of neurones cause?

A

clumps of protein called Lewy Bodies

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6
Q

Strongest risk factors for PD?

A

old age/FH

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7
Q

Other risk factor for PD?

A

pesticide exposure

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8
Q

Protection against PD?

A

smoking, NSAIDs, high uric acid levels

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9
Q

In whom with PD is there more likely to be a genetic cause?

A

early onset (below 40)

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10
Q

Parkinson’s triad?

A

bradykinesia, rigidity, resting tremor

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11
Q

What is bradykinesia?

A

slowness of movement, gets slower each time it is attempted

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12
Q

What is hypomimia (ass with PD)?

A

decreased facial expression and blinking

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13
Q

What is micrographia?

A

progressively smaller handwriting

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14
Q

Is a head tremor typical for PD?

A

NO

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15
Q

When is a resting tremor best observed?

A

while patient is focused on a mental task

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16
Q

What is a positive Froment’s maneuvre?

A

rigidity increases in examined body segment by voluntary movement of other body parts

17
Q

What type of rigidity is felt in PD, and where is it especially noticeable?

A

cogwheel rigidity

Wrist

18
Q

Why does stooped posture occur in PD?

A

impaired postural reflexes

19
Q

What is camptocormia?

A

extreme anterior truncal flexion

20
Q

What is the typical Parkinsonian gait?

A

slow, occurs at narrow base, short shuffling steps

21
Q

What is festination?

A

very fast succession of steps and difficulties stooping

22
Q

What is the pull test?

A

pulling back on the patient while they try to maintain posture

23
Q

Name some early non motor symptoms of Parkinson’s.

A

Hyposmia, REM, constipation, depression

24
Q

What are some late non motor symptoms of PD?

A

dementia, hallucination

25
Q

In what type of PD is a resting tremor uncommon, and structural brain imaging needed for diagnosis?

A

Vascular Parkinson’s

26
Q

What should be 1st line treatment for Parkinson’s?

A

Levodopa
OR
Dopamine agonist (eg repoinorole, rotigotine, pramipexole, apomorphine)
OR
MAO B Inhibitors (eg rasagiline, selegiline)

27
Q

If an “ergot” type of Dopamine agonist is chosen to treat PD, eg pergolide or bromocriptidine, what should be done?

A

Renal function tests, ESR and CXR

28
Q

What other drugs may be used in Parkinsons but should not be first choice?

A

Beta blockers
Amantadine
Anticholinergics
Modified release levodopa

29
Q

What is the aim of treatment in Parkinson’s?

A

to treat symptoms

30
Q

What can be used to treat erectile dysfunction in PD?

A

sidenafil

31
Q

What additional drug type may be used in late PD?

A

COMT inhibitors eg entacapone, tolcapone

32
Q

When should Single photon emission computed tomography (SPECT) be used in diagnosis of Parkinson’s?

A

only where essential tremor cannot be clinically differentiated from parkinsonism.

33
Q

How is PD diagnosed?

A

CLINICALLY - MRI etc not used

34
Q

Why may D3 agonists sometimes be preferred to Levodopa?

A

in younger patients, due to Levodopa’s decreased efficacy over time

35
Q

A rare side effect of Bromocriptidine ( A D2 agonist)?

A

fibrosis

36
Q

Main side effect of dopamine agonists?

A

hallucinations

37
Q

What is selegiline?

A

MAO B inhibitor