Parkinsons disease

Question 1

Pathology of PD

Answer 1

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

Question 2

Cardinal features of PD (triad)

Answer 2

Bradykinesia
Resting tremor (4-6Hz)
Rigidity hypertonia

Question 3

Motor features of PD

Answer 3

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

Question 4

Non-motor features of PD

Answer 4

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

Question 5

Causes of Parkinsonism

Answer 5

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

Question 6

management of PD

Answer 6

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

Question 7

describe dementia in Parkinsons

Answer 7

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

Question 8

Parkinsonism has a/symmetrical tremor

Parkinsons disease has a/symmetrical tremor

Answer 8

parkinsonism is symmetrical

parkinsons disease is asymmetrical

Question 9

on macroscopic pathological specimens what can be noted

Answer 9

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

Question 10

what is a neurohistological hallmark of PD

Answer 10

Lewy bodies containing a-synuclein

however, not specific to PD

Question 11

what are the subtypes of motor features in PD

Answer 11

tremor dominant PD
non-tremor dominant PD
mixed

Question 12

describe tremor dominant PD and what is the prognosis

Answer 12

relative absenceof other motor symptoms

slower rate of progression

Question 13

describe non-tremor dominant PD

Answer 13

akinetic rigid syndrome and postural instability gait syndrome

Question 14

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

Answer 14

false, PD is largely a clinical diagnosis

it is only used when there is uncertainty

Question 15

which imaging types are structural

Answer 15

MRI

CT

Question 16

which imaging types are functional

Answer 16

PET
SPECT
DaTSCAN

Question 17

Risk factors for developing PD

Answer 17

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

Question 18

monogenetic forms of PD

Answer 18

LRRK2 - AD

PARKIN - AR

Question 19

what is the function of symptomatic treatments

Answer 19

increase dopamine concentrations or stimulate dopamine receptors

Question 20

when should treatment be initiated

Answer 20

when symptoms cause disability or discomfort

with the aim of improving quality of life

Question 21

to which treatment do bradykinesia and rigidity respond to

Answer 21

dopaminergic treatment

Question 22

tremor is not responsive to dopamine therapy, true or false

Answer 22

true

Question 23

which treatments are effective for tremor

Answer 23

anticholinergics
trihexyphenidyl
clozapine

Question 24

what is levodopa

Answer 24

precursor of dopamine

Question 25

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

Answer 25

reduced peripheral availability of levodopa | reduces side effects

Question 26

what is usually prescribed with levodopa | and what is the indication

Answer 26

carbidopa (DDI) | motor symptoms

Question 27

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

Answer 27

early | more side effects

Question 28

classification of dopamine agonists

Answer 28

Ergot | Non-Ergot

Question 29

list ergot derived D agonists and what are their side effects

Answer 29

bromocriptane cabergoline pergolide cardiac valvulopathy and serosal fibrosis

Question 30

list non-ergot D agonists

Answer 30

apomorphine pramiprexole ropinirole rotigotine

Question 31

side effects of dopamine agonists

Answer 31

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

Question 32

Levodopa provides the greatest symptomatic benefit, true or false

Answer 32

true

Question 33

Longterm levodopa use is associated with __ ?

Answer 33

motor complications - dyskinesia - motor fluctuations

Question 34

what are motor fluctuations

Answer 34

alterations between periods of good and bad motor symptom control

Question 35

what are non-motor fluctuations

Answer 35

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

Question 36

what is dyskinesia and when does it develop

Answer 36

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

Question 37

what are MAO B inhibitors used for

Answer 37

motor symptoms

Question 38

examples of MAO B inhibitors

Answer 38

selegiline | rasagiline

Question 39

are there diagnostic tests for PD at an early stage

Answer 39

no

Question 40

resting tremor vanishes with active movement, true or false

Answer 40

true

Question 41

in clinical practice when is resting tremor best observed

Answer 41

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

Question 42

rigidity is velocity dependent, true or false

Answer 42

false spasticity = velocity dependent rigidity = non-velocity dependent

Question 43

what is festination

Answer 43

very fast succession of steps and difficulties stopping

Question 44

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

Answer 44

progressive supranuclear palsy multiple system atrophy not the same as PD

Question 45

what is vascular parkinsonism

Answer 45

parkinsonism that predominantly affects the lower limbs | resting tremor is uncommon

Question 46

drug induced parkinsonism tends to be a/symmetrical

Answer 46

symmetrical

Question 47

drug induced parkinsonism tends to be a/symmetrical

Answer 47

symmetrical

Question 48

what is multi system atrophy MSA and its core triad

Answer 48

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

Question 49

MRI findings of MSA?

Answer 49

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

Question 50

what is progressive supranuclear palsy PSP

Answer 50

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

Question 51

what type of drug is amantadine

Answer 51

NMDA antagonist