Archive:Parkinson disease: Difference between revisions
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Physical Examination of Parkinson's Disease | Physical Examination of Parkinson's Disease | ||
==Vitals== | |||
*orthostatic hypotension | |||
==General== | |||
* | *depressed affect | ||
* | *loss of spontaneous movements | ||
* | {{ntnes}} | ||
* | ==Facies== | ||
* | *blank and expressionless face with ↓ blinking ('''mask like facies''') | ||
*'''sialorrhea''' (drooling) | |||
*facial '''seborrhea''' (dry flaking skin) | |||
*'''blepharospasm''' (forced involuntary closing of eyelids) | |||
*'''blepharoclonus''' - flutter of closed eyelids | |||
*'''Titubation''' - tremor of head | |||
*'''glabellar tap''' positive | |||
*'''supranuclear palsy''' - weakness of upward gaze | |||
*seborrheic brow - a sweaty or greasy brow | |||
*diaphoretic brow - due to autonomic dysfunction | |||
==Speech== | |||
* | *'''microphonia''' | ||
* | *soft, faint and hard to understand | ||
* | *'''[http://en.wikipedia.org/wiki/Palilalia Palilalia]''' - repetition of last word similar to stuttering | ||
*slow thinking | |||
* | |||
==Tremor== | |||
* | *pill rolling (4 - 8 Hz) | ||
*begins distally (fingers, hands, forearm), can involve chin and mouth | |||
* | *resting tremor (less prominent with movement) | ||
* | **↓ with finger to nose testing | ||
* | **↑ tremor in L hand if clench R hand or serial 7's | ||
==Dampening== | |||
* | *difficulty with repeating movements | ||
*effort dampens when asked to repeated tap thumb and index finger together | |||
* | |||
==Gait and Posture== | |||
*have patient rise from a chair, walk, and turn, look for: | |||
**difficulty initiating, stopping, and turning ('''en bloc turning''') | |||
**shuffling gait ('''march a petit pas''') | |||
**'''propulsion/retropulsion''' - tendency to fall forward or backwards) | |||
**'''festination''' - patient walks faster and faster as to not fall over | |||
**lack of arm swing | |||
*stooped posture | |||
*'''Kinesia paradoxica''' (can do rapid movements but not slow ones) | |||
==Cog-Wheel Rigidity and Tone== | |||
*test by flexing-extending the patient’s elbow or supinating-pronating their wrists | |||
*↑ when patient moves head side to side | |||
*if no hypertonia, ask the patient to move their head side to side. This maneuver should increase cogwheeling rigidity | |||
*Dorsal tendon reflexes are unaffected | |||
==Mental Status== | |||
*MMSE | |||
*dementia | |||
*slowed thinking | |||
*depression | |||
*insomnia | |||
==Other OSCE modules== | |||
{{OSCE2}} | |||
[[Category:OSCE]] | [[Category:OSCE]] | ||
[[Category: Clinical Skills]] | |||
[[Category:Diseases]] | |||
[[Category:Geriatric medicine]] | |||
Latest revision as of 19:12, 6 June 2009
Physical Examination of Parkinson's Disease
Vitals
- orthostatic hypotension
General
- depressed affect
- loss of spontaneous movements
Facies
- blank and expressionless face with ↓ blinking (mask like facies)
- sialorrhea (drooling)
- facial seborrhea (dry flaking skin)
- blepharospasm (forced involuntary closing of eyelids)
- blepharoclonus - flutter of closed eyelids
- Titubation - tremor of head
- glabellar tap positive
- supranuclear palsy - weakness of upward gaze
- seborrheic brow - a sweaty or greasy brow
- diaphoretic brow - due to autonomic dysfunction
Speech
- microphonia
- soft, faint and hard to understand
- Palilalia - repetition of last word similar to stuttering
- slow thinking
Tremor
- pill rolling (4 - 8 Hz)
- begins distally (fingers, hands, forearm), can involve chin and mouth
- resting tremor (less prominent with movement)
- ↓ with finger to nose testing
- ↑ tremor in L hand if clench R hand or serial 7's
Dampening
- difficulty with repeating movements
- effort dampens when asked to repeated tap thumb and index finger together
Gait and Posture
- have patient rise from a chair, walk, and turn, look for:
- difficulty initiating, stopping, and turning (en bloc turning)
- shuffling gait (march a petit pas)
- propulsion/retropulsion - tendency to fall forward or backwards)
- festination - patient walks faster and faster as to not fall over
- lack of arm swing
- stooped posture
- Kinesia paradoxica (can do rapid movements but not slow ones)
Cog-Wheel Rigidity and Tone
- test by flexing-extending the patient’s elbow or supinating-pronating their wrists
- ↑ when patient moves head side to side
- if no hypertonia, ask the patient to move their head side to side. This maneuver should increase cogwheeling rigidity
- Dorsal tendon reflexes are unaffected
Mental Status
- MMSE
- dementia
- slowed thinking
- depression
- insomnia
Other OSCE modules
Acute Confusion - Acute Coronary Syndrome Orders - Anemia - Arterial Blood Gasses - Asthma - Blood Pressure - Chest pain - Chest XRay - CHF - Coma - COPD - Cranial Nerves - Diabetic History - Diabetic Foot - Dysphagia - EKGs - Gallbladder and Liver - Liver Disease - Gait and Balance - Headache - Hematemesis - Hypertension - Jugular Venous Pulses - Knee Exam - Lymph Nodes - Community Acquired Pneumonia - Parkinson Disease - Peripheral Arterial Insufficiency - Pneumonia Examination - Precordial Exam - STD's - Spleen - Swollen Leg Exam - Thyroid Exam - Upper vs Lower Motor Neuron Lesions - Urinary Incontinence