Tuesday, August 25, 2015

Multiple Choice Questions - Parkinson's Disease

Multiple Choice Questions - Parkinson's Disease

The common cause of chronic progressive parkinsonism is
·         Gene mutation
·         Toxins
·         Trauma
·         All of the above
Answer: All of the above
The peak age of onset for Parkinson’s Disease is in the following decade
·         Third
·         Fourth
·         Fifth
·         Sixth
Answer: Sixth
Parkinson’s Disease is more commonly seen among
·         Men
·         Women
Answer: Men

What is the usual blinking rate per minute in a human being?

·         12 to 20
·         15 to 25
·         18 to 28
·         21 to 31
Answer: 12 to 20

What is the blinking rate per minute for a patient with Parkinson’s Disease?

·         5 to 10
·         12 to 17
·         19 to 24
·         26 to 31
Answer: 5 to 10

The characteristic tremor of Parkinson’s disease is described as

·         Alternating
·         Pill-rolling
·         Resting
·         All the above
Answer: All the above

Micrographia of Parkinson’s disease is

·         Hurried walking
·         Slowness of movement
·         Small handwriting
·         Soft speech
Answer: Small handwriting

The characteristic tremor of Parkinson’s disease usually involves

·         Arm
·         Eyelids
·         Hand
·         Jaw
·         Tongue
Answer: Hand

Bradykinesia of Parkinson’s disease is

·         Hurried walking
·         Slowness of movement
·         Small handwriting
·         Soft speech
Answer: Slowness of movement

The part of the brain most affected in Parkinson’ Disease is

·         Corpus striatum
·         Putamen
·         Substantia nigra
·         Thalamus
Answer: Substantia nigra

Eosinophilic cytoplasmic inclusions seen in the brain cells of a patient with Parkinson’ Disease are

·         Golgi bodies
·         Lewy bodies
·         Paschen bodies
·         All of the above
Answer: Lewy bodies

Which of the following genes are linked to Parkinson's Disease?

·         SNCA and PARK2
·         PARK2 and PARK7
·         PARK7 and PINK1
·         PINK1 and LRRK2
·         All of the above
Answers: All of the above

Which of the following tests aid to determine the levels of dopamine in the brain cells of a patient with Parkinson’s Disease ?

·         MRI
·         Olfactory testing
·         PET scan
·         Sonography
Answer: PET scan

Which is the drug of choice for the symptomatic treatment of Parkinson's Disease?

·         Amantadine
·         Anticholinergic
·         Dopamine
·         Levodopa
Answer: Levodopa

Characteristics of normal speech

Areas of Speech in Brain

Speech is the verbal means of communicating.
The components of speech includes -
How speech sounds are made - pronunciation
Use of the vocal folds and breathing to produce sound
   The ease and flow of speech
speaker’s speech is considered to be normal and good when it posses good quality of voice, means pleasant and intelligible.

Speaker should use his optimum pitch where output is maximum with less vocal efforts.

That means he should not deviate from his optimum speech.
Pitch should not be too high, too low or monotonous or stereotype.

the speaker’s loudness should be normal i.e. in range of 40-80 dB.

   INTELLIGIBILITY OF SPEECH: clarity of speech
 It refers to the number of words or syllables uttered in a particular time period.
•Speakers rate of speech should be 140 words/minute & 300 syllables/minute or 2.5 words/second & 7syllables/second.
•Being too fast may result in omission of syllable and articulation may not be similar.

•Intonation means variation of pitch or fluctuation of pitch during delivery of speech.
 Speech is considered having good characteristics when there is proper use of intonation or inflexion (tone).

It refers to easy and smooth flow of speech or continuity of speech.

•A good speaker’s easy flow of speech can be observed during his delivery of speech that means he should not have any struggle or effortful speech neither he repeats, hesitates, pauses nor stops in syllables.

It refers to extra pressure given on particular syllable during speech.
Speaker is considered to have good speech if he doesn’t lay stress on making us clear his speech.

•All Parameters or components of speech are normal

•Articulation – Misarticulation - Difficulty in producing speech
Distortion -
A speech sound is distorted when it sounds more like the intended phoneme than another speech sound but is conspicuously wrong.
The /s/ sound, for example, is relatively difficult to produce; children may produce the word “sleep” as “schleep,” “zleep,” or “thleep.”

•Some speakers have a lisp; others a whistling /s/.

•Distortions can cause misunderstanding, although parents and teachers often become accustomed to them

 Children sometimes substitute one sound for another, as in saying “train” for “crane” or “doze” for “those.”
 Children with this problem are often certain they have said the correct word and may resist correction.
•Substitution of sounds can cause considerable confusion for the listener.
•Children may omit certain sounds, as in saying “cool” for “school.”
•They may drop consonants from the ends of words, as in “pos” for “post.”
•Most of us leave out sounds at times, but an extensive omission problem can make speech unintelligible.

•The addition of extra sounds makes comprehension difficult.
•For example, a child might say “buhrown” for “brown” or “hamber” for “hammer.”
A voice disorder can be defined as a problem involving abnormal pitch, loudness or quality of the sound produced by the larynx, more commonly known as the voice box.
Almost every disorder may present in more than one symptom and one cannot associate one single symptom with one specific voice disorder.
For example, hoarseness, increased vocal effort or limitations in pitch and loudness may be a sign of any number of disorders.
Severity of the voice symptoms varies according to the disorder and the individual.
Voice disorders may be present in both adults and children.

•Misuse, abuse or overuse of voice

•Tips should be followed to take care of voice
-Hydrate yourself well
-Don’t take too much caffeinated drinks, aerated drinks
-Don’t shout
-Less consumption, oily foods and spicy foods

•Stuttering affects the fluency of speech. It begins during childhood and, in some cases, lasts throughout life.
•The disorder is characterized by disruptions in the production of speech sounds, also called "disfluencies."
•Most people produce brief disfluencies from time to time.
•For instance, some words are repeated and others are preceded by "um" or "uh." Disfluencies are not necessarily a problem; however, they can impede communication when a person produces too many of them.

•"W- W- W- Where are you going?" (Part-word repetition: The person is having difficulty moving from the "w" in "where" to the remaining sounds in the word. On the fourth attempt, he successfully completes the word.)
 "SSSS ave me a seat." (Sound prolongation: The person is having difficulty moving from the "s" in "save" to the remaining sounds in the word. He continues to say the "s" sound until he is able to complete the word.)


Quality of life; the term provoked me to think and look into myself and question whether I am leading a quality life or simply just pulling on.
What determines my quality of life? Is it the amount of wealth I have? Is it about how much my husband loves me? Is it about whether my children walking on the right path in life? Is it about me enjoying a robust health? Is it about I getting surrounded by my friends and rejoicing? Is it about going to parties and eating out at restaurants?
Well, all of the above mentioned factors may contribute to our happiness and we think momentarily that we are leading a very good quality life. But the moment these stimuli are taken out we start feeling empty inside. So what is the missing factor? It is the self. It is about looking into our own self.
There are various methods prescribed by experienced people about how to look inside our own mind. Practising different breathing techniques like pranayama, practising, yoga, mindfulness, meditation, guided imagery; the list goes on. Of course, all these techniques are very good in maintaining a very good mental health. Some of these techniques have been scientifically studied and many such studies are still going on all over the world.
It does not stop there. How to further improve ourselves to achieve a joyful state of mind and to maintain that continuously in life? GIVE……. GIVE………. GIVE……….
Give food to a poor man.
Give clothes to a poor child
Give toys to a poor child
Give LOVE to the deprived and the suffering
The joy of giving is incomparable to any other feeling. The joy of givingLOVE is the highest

Love and Compassion

The joy of giving is incomparable to any other feeling.
The joy of giving LOVE is the highest


Bible says “Love your neighbour as yourself” In Jesus’s teachings love for fellow human beings is also a form of expressing your love and relationship towards God. HE tells us to love all of mankind including our enemies.
Swami Ranganathananda the 13thpresident of Ramakrishna Math & Mission tells us to love others and to find peace within us to grow spiritually.
‘Are you growing spiritually? Can you love others? Can you feel oneness with others? Have you peace within yourself? And do you radiate it around you? That is called spiritual growth which is stimulated by meditation inwardly, and by work done in a spirit of service outwardly.’
— Swami Ranganathananda
I bow down before these great men in awe! These great men who have achieved a higher state of mind give us hints on how to improve our quality of life by inculcating love and compassion towards others. Now the question is “Can we ordinary people at least take the first step towards improving our quality of life?

How to Prevent Medication Errors?

Today when I went to the ward, I came across a student loading an injection. Of course she was under the supervision of the nurse responsible for that patient.
I went close by and asked the student slowly ‘What is the name of the patient? For whom are you loading the drug? What is the name of the injection”?
She was just a second year student. But to my surprise she didn’t know answer to all the three questions.
She was blindly following the instruction of the nurse without even reading the label of the drug. I explained to her that she should be more careful and follow all the steps of medication administration

So what are the precautions to prevent medication errors?

  • Read the prescription and make sure that you reconstitute the correct drug
  • Check the name of the patient; you can ask a conscious patient, or you can check the patient’s name tag.
  • Check the dosage of the drug. Larger dosages may result in some side effects; smaller dosages may be inadequate to treat the patient
  • Check the route. A patient may have intravenous lines, arterial lines or intracranial pressure monitoring lines etc. Please stop a moment and make sure you have taken the right route for medication administration. Otherwise it may result in serious complications.
  • If it is oral administration, please make sure the patient swallows the drug nad does not keep it under the tongue or within the cheeks and spit it later.
  • After the drug is administered, please record it carefully and legibly with the name of the drug, doage, route and date and time

Bedside nursing is the most rewarding experience, a nurse can have. Enjoy it