Parkinson disease (OSCE)

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Physical Examination of Parkinson's Disease

Vitals[edit]

  • orthostatic hypotension

mask face patient / expressionless / slow gait

General[edit]

  • depressed affect
  • loss of spontaneous movements

Facies[edit]

  • 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

Speech[edit]

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

Tremor[edit]

  • 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

Dampening[edit]

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

Gait and Posture[edit]

  • 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)

Cog-Wheel Rigidity and Tone[edit]

  • 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

Mental Status[edit]

  • MMSE
  • dementia
  • slowed thinking
  • depression
  • insomnia

Other OSCE modules[edit]