SLOWING DOWN

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SLOWING DOWN by Mind Map: SLOWING DOWN

1. peripheral decarboxilase inhibitors

1.1. e.g. carbidopa

2. Step1

2.1. difficult words

2.1.1. with suffle

2.1.2. clumsy:moving and doing things in careless way

2.1.3. clenching

2.2. cues

2.2.1. 1- retied soldier

2.2.2. 2- he skipped a dental examiation

2.2.3. 3- 69yo

2.2.4. 4- posterior teeth discomfort in the last 6months .

2.2.5. 5- is appearant ige is considered more than the actual age.

2.2.6. 7- slowing down

2.2.7. 8- seems clumsy

2.2.8. 9- wooden face

2.2.9. 10-clenching his teeth is a habit for long time

2.2.10. 11recent deterioration in his oral hygen

2.2.11. 12-complain his face is stiff

2.2.12. symptos

2.2.12.1. 6-walking with a shuffle

3. Step2: problem formulation

3.1. 69yo retired soldier, whose appearant age seems older than his actual age, was refferd from a dentist to seek medical care for many changes including posterior teeth discomfort. shuffling gate was noticed and he is clumsy. wooden face with a habit of clenching his teeth.

4. Step3: Hypothesis generation

4.1. by Yousef

4.1.1. movement disorder related to age

4.1.2. muscle regidity

4.1.2.1. more release of ACH

4.2. by R. alsulamy

4.2.1. problem related to damage for

4.2.1.1. substantia nigra

4.2.1.2. Red nucleus

4.2.1.3. pyramidal and extrapyramidal tract

4.3. by Homoud

4.3.1. might be a prolem affecting

4.3.1.1. basal ganglion

4.3.1.1.1. activated(direct) or inactivated(indirect) by Dopamin

4.3.1.2. cerebellum

4.4. by Hassan

4.4.1. basal ganglia and substantia nigra are affecting the coordination

4.5. by Essam

4.5.1. movement disorder

4.5.1.1. mainly parkinson's

4.5.2. by Faris

4.5.2.1. infections or environmantal factors may lead to this pesentation

4.5.2.1.1. mercury disolvment

4.6. By kashi

4.6.1. neurological problem

4.6.2. generalized musculer problem

4.6.3. central problem

4.7. by Adeeb

4.7.1. more investigation to find the diagnosis

5. Step4: Hypothesis organization

5.1. parkinsonism

5.2. Huntington

5.3. metallosis

6. Step5: Learning Objectives

6.1. To know about parkinsonism and huntington disease

6.1.1. define

6.1.2. sign&symptoms

6.1.3. pathophysiology

6.1.4. causes

6.1.5. investigations

7. Step6: Review

7.1. Parkinsonism

7.1.1. cardinal manifestation

7.1.1.1. TREMOR

7.1.1.2. RIGIDITY

7.1.1.2.1. shuffling gait

7.1.1.2.2. mask face

7.1.1.3. BRADYKINESIA

7.1.1.4. POSTURAL INSTABILITY

7.1.2. MANIFESTATION

7.1.2.1. motor symptoms

7.1.2.1.1. shuffling gait

7.1.2.1.2. resting tremor

7.1.2.1.3. craniofacial

7.1.2.1.4. visual

7.1.2.1.5. MSK

7.1.2.1.6. gait

7.1.2.2. non motor symptoms

7.1.2.2.1. depression

7.1.2.2.2. anxiety

7.1.2.2.3. anosmia

7.1.3. pathophysiology

7.1.3.1. neurodegeneration

7.1.3.2. accumolation of body fluid

7.1.3.3. nigrostriatal pathway. is affected

7.1.3.3.1. indirect pathway predominate on the direct pathway

7.1.3.4. lewy bodies

7.1.3.4.1. accumolate in the olfactory tract first

7.1.3.5. genetics

7.1.3.5.1. park1

7.1.3.5.2. park2

7.1.3.5.3. park5

7.1.3.5.4. park8

7.1.3.6. ubiquitin

7.1.3.6.1. not degradation for misfolded

7.1.3.7. dopamine depletion

7.1.4. epidemiology

7.1.4.1. 12000/100000

7.1.4.2. over 60

7.1.4.2.1. 1%

7.1.5. causes

7.1.5.1. idiopathic

7.1.5.2. secondary causes

7.1.5.2.1. mptp

7.1.5.2.2. heroin

7.1.5.2.3. anti psychotic drugs

7.1.5.2.4. trauma

7.1.6. diagnosis

7.2. Huntington's disease

7.2.1. define

7.2.1.1. autosomal dominant

7.2.1.2. neurodegenerative disease

7.2.1.3. affect the indirect way

7.2.1.4. progressive

7.2.1.5. disease of adult hood

7.2.2. pathology

7.2.2.1. head of caudate nucleus affected

7.2.3. complications

7.2.3.1. psychological effect

7.2.4. sign and symptoms

7.2.4.1. chorea

7.2.4.1.1. disappear late in the disease

7.2.4.2. dementia

7.2.4.3. late appearing

7.2.4.3.1. dystonia

7.2.4.3.2. myoclonus

7.2.5. life expectency is around 15yo

7.2.6. investigations

7.2.6.1. having family history

7.2.6.2. genetic testing

7.2.6.2.1. 4q22

7.2.6.3. imaging

7.2.6.3.1. MRI

8. Step7: Inquiry plan

8.1. HISTORY

8.1.1. 69yo

8.1.2. suburban

8.2. PHYSICAL EXAMINATION

8.3. INVESTIGATION

9. Step8: Diagnostic decision

10. Step9:review

11. Step10: management

11.1. symptomatic treatment

11.1.1. the gold standard

11.1.1.1. carbidopa/levodopa

11.1.1.1.1. 25/100

11.1.1.1.2. used

11.1.1.1.3. givien in an empty stomach

11.1.1.1.4. freezing phenomonon

11.1.1.1.5. can't be used for long time

11.1.2. start with non-dopamenergic drugs

11.1.2.1. anticholinergic drugs.

11.1.3. dopamin agonist

11.1.3.1. ergot derivatives

11.1.3.1.1. valvulopathies

11.1.3.2. non-ergot derivatives

11.1.4. MAO inhibitors

11.1.4.1. high possibility of hallucination when used with levodopa

11.1.5. COMT inhibitors

11.1.5.1. entacapone

11.1.5.1.1. act peripherally

11.1.5.1.2. tolacapone

11.1.6. non-motor symptoms

11.1.6.1. to prevent hallucination

11.1.6.2. dementia

11.1.6.2.1. anticholinestrase inhibitors

11.1.6.3. seboric dermatitis

11.1.6.3.1. steroid cream

11.1.6.4. urinary urgency

11.1.6.4.1. oxybutinin

11.1.6.5. constipation

11.1.6.5.1. fluid intake

11.1.6.5.2. exercise

11.1.6.6. GI problem

11.1.6.6.1. domperidone

11.1.6.7. sailorrhea

11.1.6.7.1. oral anticholinergic

11.1.6.8. sexual dysfunction

11.1.6.8.1. either stopping the medications

11.1.6.8.2. sildenafil

11.1.6.9. orthostatic hypotenstion

11.1.6.9.1. stopping antihypertensive drugs

11.1.6.9.2. domaperidone

11.1.6.10. pain

11.1.6.10.1. gapapentin

11.1.6.11. sleep disturbances

11.1.6.12. PSYCHOSIS

11.1.6.12.1. antipsychotic drugs

11.2. non-pharmacological treatment

11.2.1. cognitive behavioral therapy

11.2.1.1. reduce anxiety

11.2.2. surgical therapy

11.2.2.1. transplanted SN

11.2.2.2. pallidetomy

11.2.2.3. thalmotomy

11.2.2.4. subthalatomy

11.2.2.5. D B S

11.2.3. exercise

11.2.4. patient education

11.2.5. social support

11.2.6. canes and walkers

11.2.7. occupational therapy

12. Resources

12.1. Harrison's

12.2. medscape

12.3. kumar

12.4. up-to-date

12.5. mayoclinic

12.6. parkinson.org

12.7. medicine.net