Parkinson disease (OSCE)

Physical Examination of Parkinson's Disease

## Vitals

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* orthostatic hypotension

mask face patient / expressionless / slow gait

## General

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* depressed affect
* loss of spontaneous movements

## Facies

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* 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

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

## Tremor

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

## Dampening

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

## Gait and Posture

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* 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

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* 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

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* MMSE
* dementia
* slowed thinking
* depression
* insomnia

## Other OSCE modules

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* v
* t
* e

Objective structured clinical examination

Acute Confusion \- Acute Coronary Syndrome Orders \- Anemia \- Arterial Blood Gasses \- Asthma \- Blood Pressure \- Chest pain \- Chest XRay \- CHF \- Coma \- COPD \- Cranial Nerves \- Diabetic History \- Diabetic Foot \- Dysphagia \- EKGs \- Gallbladder and Liver \- Liver Disease \- Gait and Balance \- Headache \- Hematemesis \- Hypertension \- Jugular Venous Pulses \- Knee Exam \- Lymph Nodes \- Community Acquired Pneumonia \- Parkinson Disease \- Peripheral Arterial Insufficiency \- Pneumonia Examination \- Precordial Exam \- STD's \- Spleen \- Swollen Leg Exam \- Thyroid Exam \- Upper vs Lower Motor Neuron Lesions \- Urinary Incontinence
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