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Flashcards in Parkinsons disease Deck (51):
1

Pathology of PD

neurodegeneration of dopaminergic neurons in pars compacta of the substantia nigra (SNpc) of basal ganglia

2

Cardinal features of PD (triad)

Bradykinesia
Resting tremor (4-6Hz)
Rigidity hypertonia

3

Motor features of PD

Bradykinesia
Tremor
rigidity
shuffling gait
loss of arm swing
stooped
postural instability
difficulty initiating gait
difficulty turning
low amplitude finger tapping

4

Non-motor features of PD

DEPRESSION
dementia
anosmia
constipation
REM behavioural disorder
hypomimia
micrographia
hypersalivation
hallucinations
GI dysfunction

5

Causes of Parkinsonism

idiopathic PD
drugs: metaclopramide, haloperidol, lithium, B blockers
environmental/chemical exposure
MS, Wilson's, post encephalitis

6

management of PD

Levodopa +-carbidopa
dopamine agonists
PT, OT, S+LT

7

describe dementia in Parkinsons

dementia:
- less than 1 year = DLB
- more than 1 year = PDD

8

Parkinsonism has a/symmetrical tremor
Parkinsons disease has a/symmetrical tremor

parkinsonism is symmetrical
parkinsons disease is asymmetrical

9

on macroscopic pathological specimens what can be noted

loss of normal black pigment in the substantia nigra (and locus coeruleus)

10

what is a neurohistological hallmark of PD

Lewy bodies containing a-synuclein
(however, not specific to PD)

11

what are the subtypes of motor features in PD

tremor dominant PD
non-tremor dominant PD
mixed

12

describe tremor dominant PD and what is the prognosis

relative absenceof other motor symptoms
slower rate of progression

13

describe non-tremor dominant PD

akinetic rigid syndrome and postural instability gait syndrome

14

imaging is part of the routine diagnostic work up in PD, true or false

false, PD is largely a clinical diagnosis
it is only used when there is uncertainty

15

which imaging types are structural

MRI
CT

16

which imaging types are functional

PET
SPECT
DaTSCAN

17

Risk factors for developing PD

advancing age
positive family history + genetics
male gender
environmental factors: pesticides, rural living, B blocker, prior head injury

18

monogenetic forms of PD

LRRK2 - AD
PARKIN - AR

19

what is the function of symptomatic treatments

increase dopamine concentrations or stimulate dopamine receptors

20

when should treatment be initiated

when symptoms cause disability or discomfort
with the aim of improving quality of life

21

to which treatment do bradykinesia and rigidity respond to

dopaminergic treatment

22

tremor is not responsive to dopamine therapy, true or false

true

23

which treatments are effective for tremor

anticholinergics
trihexyphenidyl
clozapine

24

what is levodopa

precursor of dopamine

25

what is a dopa decarboxylase inhibitor DDI and what is the benefit

reduced peripheral availability of levodopa
reduces side effects

26

what is usually prescribed with levodopa
and what is the indication

carbidopa (DDI)
motor symptoms

27

dopamine agonists improve motor symptoms in early/late disease and have more/less side effects

early
more side effects

28

classification of dopamine agonists

Ergot
Non-Ergot

29

list ergot derived D agonists and what are their side effects

bromocriptane
cabergoline
pergolide

cardiac valvulopathy and serosal fibrosis

30

list non-ergot D agonists

apomorphine
pramiprexole
ropinirole
rotigotine

31

side effects of dopamine agonists

N+V
daytime somnolence
Impulse Control Disorders ICD
peripheral oedema
dizziness
hallucinations
constipation

32

Levodopa provides the greatest symptomatic benefit, true or false

true

33

Longterm levodopa use is associated with __ ?

motor complications
- dyskinesia
- motor fluctuations

34

what are motor fluctuations

alterations between periods of good and bad motor symptom control

35

what are non-motor fluctuations

alterations between periods of good and bad non-motor symptom control

36

what is dyskinesia and when does it develop

involuntary choreiform or dystonic movements which occur when levodopa concentrations are at their maximum
develops at the beginning or end of levodopa dose

37

what are MAO B inhibitors used for

motor symptoms

38

examples of MAO B inhibitors

selegiline
rasagiline

39

are there diagnostic tests for PD at an early stage

no

40

resting tremor vanishes with active movement, true or false

true

41

in clinical practice when is resting tremor best observed

when the patient is focussed on a task eg counting backwards from 100

42

rigidity is velocity dependent, true or false

false
spasticity = velocity dependent
rigidity = non-velocity dependent

43

what is festination

very fast succession of steps and difficulties stopping

44

what are the Parkinsons plus syndromes and are they the same as Parkinsons disease

progressive supranuclear palsy
multiple system atrophy
not the same as PD

45

what is vascular parkinsonism

parkinsonism that predominantly affects the lower limbs
resting tremor is uncommon

46

drug induced parkinsonism tends to be a/symmetrical

symmetrical

47

drug induced parkinsonism tends to be a/symmetrical

symmetrical

48

what is multi system atrophy MSA and its core triad

dysautonomia - postural hypotension...
cerebellar features
Parkinsonism
jerky postural tremor

49

MRI findings of MSA?

cerebellar and pontine atrophy "hot cross bun" sign, hyperintense rim surrounding putamen

50

what is progressive supranuclear palsy PSP

ait and balance impairment
vertical gaze supranuclear palsy
pseudobulbar symptoms
eyes wide open
no response to levodopa

51

what type of drug is amantadine

NMDA antagonist