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Flashcards in Parksinsons Deck (68)
1

Age of presentation of Parkinson’s ?

45-60

2

Parkinsonism triad?

Bradykinesia, tremor, rigidity. Usually bilateral but can start unilateral

3

What happens to tremor in Parkinson’s ?

Disappears with activity

4

What is rigidity?

Increased resistance to passive movement

5

What is rigidity like throughout the range of movement ?

Equal throughout

6

Gait in Parkinson’s ?

Show, shuffling gait

7

Arms and posture during walking ?

Stopped posture and reduced arm swing

8

What is speech like ?

may be slow and monotonous. In late stage disease may be slurred, or even lost

9

Power and sensory loss?

Power remains normal and there is no sensory loss

10

What other psychiatric conditions associated with Parkinson’s ?

Dementia and depression

11

Why do you get hallucinations.

A combination of the disease and the drugs used. Often they are not unpleasant

12

What are kayser fleisher rings seen in?

Wilson’s disease (copper)

13

Which drugs can cause Parkinsonism?

Drugs (usually dopamine antagonsists)–e.g. prochlorperazine, metoclopramide (antiemetics) phenozanthines, butyrophenones (neuroleptics)

14

pathological hallmark of parkinsons disease

prominent dopaminergic neurone loss in the substantial nigra with alphasyneuclein containing lewey bodies and lewey neurites

15

which part of the brain is the substantial nigra found?

basal ganglia

16

what are upper motor neurone features?

pyramidal weakness and spasticity

17

triad of parkinsonianism?

bradykinesia, resting tremor and rigidity

18

Fragments of movements flow irregularly from one body segment to another causing a dance-like appearance?

chorea

19

what does PD present with?

PD presents with tremor, muscular rigidity, akinesia, rest tremor, and gait and postural impairment

20

which subtype has the slower rate of progression ?

tremor dominant

21

non motor features of PD?

olfactory dysfunction, cognitive impairment, psychiatric symptoms, sleep disorders, autonomic dysfuncLon, pain, and faLgue.

22

when does diagnosis occur in PD?

with the onset of motor symptoms

23

what is progression of PD characterised by?

progression of motor symptoms

24

Neuronal loss in PD occurs in many other regions including?

ocus ceruleus, nucleus basalis Meynert, pedunculoponLne and raphe nuclei, dorsal motor nucleus of vagus, amygdala, hyopthalamus

25

how are lewey bodies formed?

Misfolded α-synuclein,which is insoluble and aggreagated, forms intracellular inclusions (Lewy bodies)

26

Prolonged muscle spasms and abnormal postures

dystonia

27

Fragments of movements flow irregularly from one body segment to another causing a dance-like appearance

chorea

28

a parasomnia characterized by abnormal or disrupLve behaviours (such as talking, laughing, shouLng, gesturing, grabbing, punching, kicking,, sirng up in bed)

Rapid eye movement sleep behaviour

29

treatment of rapid eye movement sleep disorder?

clonazepam or malatonin

30

what is the frequency of the rest tremor in parkinsons?

4-6Hz

31

where are lewey bodies found in parkinsons?

not confined to the brain, they are also present in spinal cord and peripheral nervous system

32

what are lewey bodies?

misfolded alpha sinuclein, which is insoluble and aggregated. These form intracellular inclusions

33

what does pigment loss correlate with?

dopaminergic cell loss

34

greatest risk factor of parkinsons?

age

35

male to female?

more common in males

36

greatest genetic risk factor for PD

mutations in GBA

37

what is treatment in PD aimed at doing ?

enhancing intracerebral dopamine concentrations or stimulate dopamine receptors

38

which drug class associated with oedema?

dopamine agonists

39

which drug associated with dyskinesia? (writhing movements)

levodopa

40

what is the "on-off effect" of levodopa

alterations between periods of good motor symptom control and periods of reduced motor symptom control

41

PsyChosis in PD is most efficiently managed with

Clozapine

42

motor symptoms in PD?

bradykinesia
rest tremor
rigidity
postural and gait impairment (stooped posture and show, shuffling gait with reduced arm swing)

43

Slowness of movement with progressive loss of amplitude or speed during aWempted rapid alternaLng movement of body segments

BRADYKINESIA

44

how can you assess bradykinesia?

can be assessed by asking the patient to perform some repetitive movements as quickly and wisely as possible

45

decreased facial expression and eye blinking ?

hypomimia

46

what happens to rhythmic oscillatory tremor on voluntary active movement

disappears

47

what is re emerging tremor?

tremor reappears after hands held out

48

is head tremor typical for PD?

no

49

what is cog wheel rigidity

"Cogwheel" rigidity occurs when there is also a tremor and is characterized by a "stop and go" effect during a range of motion maneuver. Felt especially at the wrist

50

why do you get a stooped posture?

impaired postural reflexes

51

what is the parkinsonian gait like ?

slow, shuffling gait with a narrow base

52

what is hyposmia?

reduced ability to smell (hypnosemia)

53

what are premotor symptoms to ask about?

REM sleep behaviour, loss of smell, constipation

54

exposure to what can be a risk factor for parkinsons?

manganese, pesticides

55

do you get dementia early in the disease course?

no

56

investigations for parkinsons?

structural brain imaging
possibly structural brain imaging
dopamine functional imaging is unable to distnguish PD from other causes of degeneratve Parkinsonism, but should be normal in essenLal tremor, dystonic tremor, psychogenic parkinsonism.
positive levodopa challenge
genetic testing where appropriate

57

what is vascular parkinsonism?

parkinsonism affects mainly the lower limbs. rest tremor is uncommon. get a poor levodopa response

58

does parkinsonism tend to be symmetrical or assymetrical?

symmetrical, although can start unilateral

59

what drugs can cause parkinsonism?

any drugs that block the action of dopamine (especially neuroleptic drugs)

60

what improves essential tremor?

alcohol and beta blockers

61

frequency of essential tremor?

higher frequency (12Hz)

62

inheritnace pattern of essential tremor?

autosomal dominant

63

typical onset of essential tremor?

15 years

64

common cause of degenerative parkinsonism, hot cross bun sign on MRI?

multi system atrophy O+

65

Symmetric akineLc-rigid syndrome with predominantly axial involvement. Vertical gaze supra nuclear palsy?

progressive supranuclear palsy

66

Core symptoms include cerebellar gait ataxia, postural / intenLon tremor, variably Parkinsonism, dysautonomia, cogniLve decline of frontal type, and peripheral neuropathy

fragile x tremor ataxia syndrome

67

useful for managing tremor in drug induced parkinsonism?

procyclidine

68

which features of parkinsons disease are uncommon in drug induced parkinsonism?

Rigidity and resting tremor