Archive:Parkinson disease: Difference between revisions
wikademia>Koppertone No edit summary |
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*Soft | *Soft | ||
*Faint | *Faint | ||
*[http://en.wikipedia.org/wiki/Palilalia Palilalia] | *[http://en.wikipedia.org/wiki/Palilalia Palilalia] - repetition of last word similar to stuttering | ||
*Hard to understand | *Hard to understand | ||
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6. Dampening - difficulty with repeated movements such as tapping the thumb and index finger together | 6. Dampening - difficulty with repeated movements such as tapping the thumb and index finger together | ||
7. Tone | |||
*test at both wrists | |||
*begins as weakness, tremor, motor slowness, stiffness, fatigable in a single limb or hemiparetic | |||
*cogwheel rigidity | |||
*if no hypertonia, ask the patient to move their head side to side. This maneuver should increase cogwheeling rigidity | |||
*Dorsal tendon reflexes are unaffected | |||
8. Face | |||
*Titubation - tremor of head | |||
*blinking absence | |||
*blepharospasm - involuntary closure of the eyelids | |||
*blepharoclonus - flutter of closed eyelids | |||
*sialorhea - excessive drooling | |||
*masked facies | |||
*glabellar tap positive | |||
*speech - monotone, soft, faint, repetition of last word | |||
*supranuclear palsy - weakness of upward gaze | |||
*seborrheic brow - a sweaty or greasy brow | |||
*diaphoretic brow - due to autonomic dysfunction | |||
9. Orthostatic hypotension | |||
10. Writing | |||
*micrographia | |||
11. Mental status - do an Minimental Status Exam and also look for | |||
*dementia | |||
*slowed thinking | |||
*depression | |||
*insomnia | |||
*drug effects | |||
[[Category:OSCE]] | [[Category:OSCE]] | ||
Revision as of 04:54, 6 May 2007
Physical Examination of Parkinson's Disease
1. Introduce yourself and wash your hands
2. Listen for the patient's characteristic speech pattern
- Microphonia
- Soft
- Faint
- Palilalia - repetition of last word similar to stuttering
- Hard to understand
3. Inspection
- Mask like facies
- Flexed posture
- Few spontaneous movements
- Stooped posture
- Sialorrhea (Drooling)
4. Tremor
- Resting
- Pill rolling (4-8Hz)
- Begins distally, fingers hands, forearm, feet and can involve the chin and mouth
- Decreased tremor with finger to nose testing
- Increaqsed tremor in left hand if clenching the right hand
- Increased tremor with serial 7's
5. Gait
- Ask to ris, walk, turn quickly, stop and start
- March a petite pas (shuffling gait)
- Difficulty initiating, stopping, turning and with balance
- Propulsion/retropulsion (difficulty maintaining balance if tapped)
- Festination (walk faster and faster so that they do not fall over)
- Lack of arm swing
- Kinesia paradoxica (can do rapid movements but not slow ones)
- Bradykinesia
6. Dampening - difficulty with repeated movements such as tapping the thumb and index finger together
7. Tone
- test at both wrists
- begins as weakness, tremor, motor slowness, stiffness, fatigable in a single limb or hemiparetic
- cogwheel rigidity
- if no hypertonia, ask the patient to move their head side to side. This maneuver should increase cogwheeling rigidity
- Dorsal tendon reflexes are unaffected
8. Face
- Titubation - tremor of head
- blinking absence
- blepharospasm - involuntary closure of the eyelids
- blepharoclonus - flutter of closed eyelids
- sialorhea - excessive drooling
- masked facies
- glabellar tap positive
- speech - monotone, soft, faint, repetition of last word
- supranuclear palsy - weakness of upward gaze
- seborrheic brow - a sweaty or greasy brow
- diaphoretic brow - due to autonomic dysfunction
9. Orthostatic hypotension
10. Writing
- micrographia
11. Mental status - do an Minimental Status Exam and also look for
- dementia
- slowed thinking
- depression
- insomnia
- drug effects