Archive:Parkinson disease
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
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