Share your insights

Help us by sharing what content you've recieved in your exams


Parkinson’s disease focussed examination

Introduction

  • Wash hands
  • Introduce self
  • Ask Patient’s name, DOB and what they like to be called
  • Explain examination and obtain consent

General observations

  • General inspection: patient, around bed (mobility aids etc.)
  • Tremor: note any obvious tremor (if none, ask the patient to close their eyes and count down from 20 to distract them)
    • Asymmetrical resting pill-rolling tremor (4-8 Hz) 
    • Begins distally (fingers, hands, forearms), can involve chin and mouth 
    • Reduced with finger to nose testing 
    • Accentuated by distraction
  • Gait: ask patient to walk up and down the room
    • Shuffling (reduced stride length) 
    • Hesitant (difficulty initiating and turning (multiple steps))
    • Festinating (patient walks faster and faster so as to not fall over) 
    • Lack of arm swing (early sign due to increased tone) 
    • Unsteadiness (propulsion/retropulsion – tendency to fall forward or backward)
  • Posture: observe posture while walking (stooped)

Now work down the body:

Face

  • Facial inspection (hypomimia, decreased blinking, drooling)
  • Glabella tap test (Myerson’s sign = blinking fails to cease with continued tapping)
  • Speech: ask the patient to say a sentence, e.g. describe the room they are in (hypophonia, slow thinking, soft faint voice)

Focussed upper limbs

  • Tone: increased tone can be accentuated with distraction by asking patient to move contralateral arm up and down (lead pipe = increased tone; cogwheel rigidity = tremor superimposed on increased tone)
  • Bradykinesia
    • Open and close thumb and index finger like a β€˜snapper’ as fast as possible (lack or decay of amplitude; slow and asynchronous)
    • Play imaginary piano (slow)
    • Open and close big imaginary doorknob (difficulty pronating and supinating)

Focussed lower limbs

  • Bradykinesia: heel tap (lack or decay of amplitude; slow and asynchronous)

Extras

  • Function: test undoing buttons, assess writing for micrographia
  • Exclude Parkinson-plus syndromes
    • Vertical eye movements (vertical limitation = progressive supranuclear palsy)
    • Horizontal eye movements (nystagmus = multisystem atrophy)

To complete

  • Thank patient 
  • β€˜To complete my exam, I would look for cerebellar signs (multisystem atrophy), check postural blood pressure (significant drop may be present in multisystem atrophy) and undertake a mini-mental state exam (Lewy body dementia)I would also review any drug charts (parkinsonism drugs).’
  • Summarise and suggest further investigations you would consider after a full history

Here are some questions

List 3 causes of Parkinsonism

Oops! This section is restricted to members. Click here to signup!

What are the Parkinson-plus syndromes?

Oops! This section is restricted to members. Click here to signup!

What is the Parkinson’s disease tetrad?

Oops! This section is restricted to members. Click here to signup!

List some clinical features of Parkinson’s disease

Oops! This section is restricted to members. Click here to signup!

Which common class of drugs may cause drug-induced parkinsonism?

Oops! This section is restricted to members. Click here to signup!

Learn more here…

There’s more learning on Parkinson’s disease here!

No comments yet πŸ˜‰

Leave a Reply