Parkinson disease (OSCE)

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Physical Examination of Parkinson's Disease

Contents 1 Vitals 2 General 3 Facies 4 Speech 5 Tremor 6 Dampening 7 Gait and Posture 8 Cog-Wheel Rigidity and Tone 9 Mental Status 10 Other OSCE modules

[edit] Vitals

• orthostatic hypotension

[edit] General

• depressed affect
• loss of spontaneous movements

[edit] Facies

• blank and expressionless face with ↓ blinking (mask like facies)
• sialorrhea (drooling)
• facial seborrhea (dry flaking skin)
• blepharospasm (forced involuntary closing of eyelids)
• blepharoclonus - flutter of closed eyelids
• Titubation - tremor of head
• glabellar tap positive
• supranuclear palsy - weakness of upward gaze
• seborrheic brow - a sweaty or greasy brow
• diaphoretic brow - due to autonomic dysfunction

[edit] Speech

• microphonia
• soft, faint and hard to understand
• Palilalia - repetition of last word similar to stuttering
• slow thinking

[edit] Tremor

• pill rolling (4 - 8 Hz)
• begins distally (fingers, hands, forearm), can involve chin and mouth
• resting tremor (less prominent with movement)
  • ↓ with finger to nose testing
  • ↑ tremor in L hand if clench R hand or serial 7's

[edit] Dampening

• difficulty with repeating movements
• effort dampens when asked to repeated tap thumb and index finger together

[edit] Gait and Posture

• have patient rise from a chair, walk, and turn, look for:
  • difficulty initiating, stopping, and turning (en bloc turning)
  • shuffling gait (march a petit pas)
  • propulsion/retropulsion - tendency to fall forward or backwards)
  • festination - patient walks faster and faster as to not fall over
  • lack of arm swing
• stooped posture
• Kinesia paradoxica (can do rapid movements but not slow ones)

[edit] Cog-Wheel Rigidity and Tone

• test by flexing-extending the patient’s elbow or supinating-pronating their wrists
• ↑ when patient moves head side to side
• if no hypertonia, ask the patient to move their head side to side. This maneuver should increase cogwheeling rigidity
• Dorsal tendon reflexes are unaffected

[edit] Mental Status

• MMSE
• dementia
• slowed thinking
• depression
• insomnia

[edit] Other OSCE modules