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Park in Sons Exam

Park in Sons Exam

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Published by Tom Mallinson

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Published by: Tom Mallinson on Apr 03, 2011
Copyright:Attribution Non-commercial

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07/16/2013

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PARKINSONS HISTORY + EXAMINATION
Its all about the duration and complications
 
-
 
Will typically be ONE –SIDED
-
 
Will eventually spread to other limbs and trunkASK ABOUT:
 
Stiffnessand slowed movements: Cogwheel rigidity
 
Tremoror shaking at rest ( ! PILL-ROLLING TREMOR ! )= relieved by goal-oriented activity 
 
Difficulty getting out of a chair or rolling over in bed
 
Frequent falls or tripping
 
Difficulty walking
 
Memory loss
 
Posture shifts forward into stoop
 
Speech changes(eg, whispering, rapid speech)
 
Micrographia
 
Slowness in performing ADLs
 
Drooling (“sialorrhoea”)
 
Ask: when did they stop driving?(a good indicator of progression)Findings on Examination1. Look at the GAIT:
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Shuffling,
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festinating (staggering forward)
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No arm movement
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Difficulty stopping
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Posture is stooped forward2. Kinesia Paradoxica:
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fast movements are OK
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slow movements are absent3. Tremor:
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characteristic pill-rolling 5 hertz movement, usuallyassymmetrical
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disappears with voluntary movement (i.e a resting tremor)4. Tone
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Cogwheel Rigidity: especially when distracted
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Reflexes are NORMAL !!5. Face
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Mask-like face
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Absence of blinking, the glassy “parkinsonian stare”
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Seborrhoea (feel the oily forehead)
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Weakness of upward gaze is CHARACTERISTIC of Parky’s6. Speech
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Monotonous, Rapid and whispering,
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“Palilalia” (repetition of last syllable)7. Autonomic features:
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Orthostatic Hypotension will be present.
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Slowed enteric motility and constipation
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Urinary retention and incontinence8. Dysphagia
F
 
IRST FEATURE
Is usually theLOSS OF ARM SWINGWHEN WALKING
 
MUST ASK ABOUT!!! DEPRESSION !!!

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