NRS 301 EXAM 4 QUESTIONS WITH ACTUAL
SOLUTIONS!!
Parkinson's disease Answer - long-term neurodegenerative disease that affects
primarily the motor system
Parkinson's disease symptoms (early) Answer - Classic triad:
1. Bradykinesia
2. Tremor
3. Rigidity
Bradykinesia Answer - slow movement
Tremor Answer - shaking that occurs at rest
Rigidity in the muscles Answer - difficulty walking, autonomic function
compromised
Parkinsonism Answer - can be caused by other types of disorders or a side
effect of certain medications - motor function symptoms
Substantia nigra (dark) Answer - contains pigmented dopamine-producing
neurons that are lost due to parkinsons disease
,Pathogenesis of PD Answer - Dopamine activity is greatly reduced
Substantia nigra is lost and the dopmine-producing neurons in the SN project
to the Striatum (Motor movement)
Misfolded alpha-synuclein aggregates
Dopamine Answer - main neurotransmitter in the striatum
Medium spiny neurons (MSNs) Answer - activated/inhibited by dopamine
Dopamine in striatum Answer - Activates direct pathway and inhibits indirect
pathway
PD: imbalance of pathways Answer - Dopamine neurons die which leads to
less activated direct movements and less inhibited indirect movements which
leads to trouble in initiating movements
PD histological changes Answer - substantial loss of SN dopamine cell bodies
Remaining neurons have Lewy bodies
Lewy bodies Answer - accumulation of alpha-synuclein
Alpha-synuclein misfolding Answer - Lewy bodies spread throughout the brain
starting in the lower brain stem and olfactory bulb
The a-synuclein spread throughout the brain like a prion
Prion Answer - a protein that has the ability to spread by inducing normal
proteins to misfold
, PD starts in the gut Answer - misfolded a-synuclein in the gut leads to a
cascading of misfolding of endogenous protein in the brain, travel through the
vagus nerve
Levodopa Answer - precursor to dopamine
DDC (dopa decarboxylase) converts it to dopamine
DDC inhibitors do not cross BBB and cause for increased levodopa to the brain
peripherak side effects - DDC inhibitors reduce them
COMT Answer - breaks down DA
COMT inhibitors can increase DA but have liver toxicity
DA agonists Answer - replaces DA by acting post synaptically
not as effective as levodopa
less side effects
MAO-B inhibitors Answer - MAO-B breaks down DA
inhibitors can increase DA
not as effectve and lots of side effects
Deep brain stimulation Answer - electrical stimulation of the brain to increase
motor function
MRI is used to guide the insertion
DBS effectiveness Answer - Prior to DBS, patient oscillates between
symptomatic periods (immobility), to effective mobility periods to periods
where side effects are present (dyskinesias)
DBS widens the "on" window allowing for medications to be effective longer
SOLUTIONS!!
Parkinson's disease Answer - long-term neurodegenerative disease that affects
primarily the motor system
Parkinson's disease symptoms (early) Answer - Classic triad:
1. Bradykinesia
2. Tremor
3. Rigidity
Bradykinesia Answer - slow movement
Tremor Answer - shaking that occurs at rest
Rigidity in the muscles Answer - difficulty walking, autonomic function
compromised
Parkinsonism Answer - can be caused by other types of disorders or a side
effect of certain medications - motor function symptoms
Substantia nigra (dark) Answer - contains pigmented dopamine-producing
neurons that are lost due to parkinsons disease
,Pathogenesis of PD Answer - Dopamine activity is greatly reduced
Substantia nigra is lost and the dopmine-producing neurons in the SN project
to the Striatum (Motor movement)
Misfolded alpha-synuclein aggregates
Dopamine Answer - main neurotransmitter in the striatum
Medium spiny neurons (MSNs) Answer - activated/inhibited by dopamine
Dopamine in striatum Answer - Activates direct pathway and inhibits indirect
pathway
PD: imbalance of pathways Answer - Dopamine neurons die which leads to
less activated direct movements and less inhibited indirect movements which
leads to trouble in initiating movements
PD histological changes Answer - substantial loss of SN dopamine cell bodies
Remaining neurons have Lewy bodies
Lewy bodies Answer - accumulation of alpha-synuclein
Alpha-synuclein misfolding Answer - Lewy bodies spread throughout the brain
starting in the lower brain stem and olfactory bulb
The a-synuclein spread throughout the brain like a prion
Prion Answer - a protein that has the ability to spread by inducing normal
proteins to misfold
, PD starts in the gut Answer - misfolded a-synuclein in the gut leads to a
cascading of misfolding of endogenous protein in the brain, travel through the
vagus nerve
Levodopa Answer - precursor to dopamine
DDC (dopa decarboxylase) converts it to dopamine
DDC inhibitors do not cross BBB and cause for increased levodopa to the brain
peripherak side effects - DDC inhibitors reduce them
COMT Answer - breaks down DA
COMT inhibitors can increase DA but have liver toxicity
DA agonists Answer - replaces DA by acting post synaptically
not as effective as levodopa
less side effects
MAO-B inhibitors Answer - MAO-B breaks down DA
inhibitors can increase DA
not as effectve and lots of side effects
Deep brain stimulation Answer - electrical stimulation of the brain to increase
motor function
MRI is used to guide the insertion
DBS effectiveness Answer - Prior to DBS, patient oscillates between
symptomatic periods (immobility), to effective mobility periods to periods
where side effects are present (dyskinesias)
DBS widens the "on" window allowing for medications to be effective longer
