Neurology IMG SURVIVOR style

[IMG SURVIVOR]

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So you have a 58 year old guy that comes to your private practice because of a shaking in his hand. You notice that when he shakes your hand the tremor stops.
Now my question to you is the difference between a cerebella tremor and the tremor from Parkinson’s?
Cerebella tremor: The patient is at rest and has NO TREMOR, when the patient start to move then the tremor starts. Not cool is a very bad disability disease.
Parkinson’s: The patient is at rest and has TREMOR, when the patient start to move then the tremor stops.

Now you know the difference between these 2 types of tremor
My question is Do you know a tremor disease that part of the treatment is drink alcohol? No I’m not kidding.

Now what substance is deficient in Parkinson’s disease?
Dopamine you say, ok Is Dopamine.
Now where Dopamine is created? Do you know?

Now why people get Parkinson’s?
Trauma could be a cause, drugs could be another cause. Now about drugs what drugs and why?
So lets rewind a little here people with parkinsonism have low levels of dopamine, now the question is what medication will lower dopamine in the brain or what disease give you high levels of dopamine?
What about antipsychotic medications
What about the patient that is diabetic and they just give a story of a guy with diabetes and now has Parkinsonism symptoms? And you need to fill the blanks in this case for the diabetic patient you can say that is because of the use of metoclopramide.
Do you know for what is use metoclopramide?
A tumor can give you Parkinson’s
What about MPTP? Can this drug give you Parkinson’s? Yes
Carbon monoxide poisoning can give you Parkinsons

So ALWAYS, when you have a patient with signs and symptoms of Parkinson’s think what medication could be responsible for this sign and symptoms. And if you find it then ask yourself can I change the medication so he gets better.

Listen EVEN STROKE can give you signs and symptoms of Parkinson’s

Now what about the treatment?
There is so many drugs out there and you need to know the MOA= mechanism of action and you need to know the side effects.
Know that the BEST DRUG for Parkinsons is levodopa and carvidopa.
You remember Levodopa is a dopamine agonist and is able to transform into dopamine in the brain, and carvidopa will prevent that the drug transform into dopamine before it reach the brain.
What will happen if this levodopa transform into dopamine before it reach the brain then you will get Sympathetic stimulation. Not cool
So here I will make it short and sweet because this is the part you guys will not find when you are reviewing for step1

How do you answer the question: what is the best initial treatment for this patient?

This is how it goes ok
If the patient is younger than 60 and is able to do his every day activities meaning he can function, and then the initial treatment is what are you thinking levodopa and carvidopa?
That is the most common wrong answer the correct answer is anti Ach.

If the patient is older than 60 then you give Amantadine

So you will say wait wait you just said that the best treatment is levodopa and carvidopa why don’t we give that to ALL the patients with Parkinson’s well because of the side effects its side effect are worst than the other drugs and also the what will happen to a patient that has an excess of dopamine in the brain? They become psychotic yes psychotic AAAAAAAAAAAAAAAAAA, do you understand my dear future ECFMG CERTIFICATE friends?
Also remember that the patients that use this drugs for a long time get what is call the ON/OFF phenomenon presentation.


I will stop here so you can digest this part and then I will do a second part, I will like to thank Gogeta for telling me about this finding to help people in step1.

[Dr. X]

lol.. i think this method can turn out to be pretty effective.. it seems as if you are choking the person to get the information across... and oh ya.. that was subtle how you screamed.. "psychotic.. aaaaaa" and then call us friends afterwards..

nehoo.. seriously, good stuff.. thnx.

[IMG SURVIVOR]

Originally Posted by Dr. X

lol.. i think this method can turn out to be pretty effective.. it seems as if you are choking the person to get the information across... and oh ya.. that was subtle how you screamed.. "psychotic.. aaaaaa" and then call us friends afterwards..

nohow.. seriously, good stuff.. thnx.

THANKS nice that at least one person found it useful

[IMG SURVIVOR]

Let me bump this tread so I remember I have to finish the second part