The classic triad of Parkinson's disease signs include: (Select All That Apply)
Bradykinesia.
Resting tremor.
Memory loss.
Loss of sensation.
"Cogwheel" rigidity.
Correct Answer : A,B,E
Choice A rationale
Bradykinesia is a fundamental component of the Parkinson's triad and refers to the generalized slowness of movement. This occurs due to the depletion of dopamine in the substantia nigra, which disrupts the basal ganglia's ability to facilitate motor output. Patients experience difficulty initiating movements and a reduction in automatic motions, such as swinging the arms while walking. It significantly impacts daily activities and is essential for a clinical diagnosis of the neurodegenerative disease.
Choice B rationale
Resting tremor is a classic sign often described as a pill-rolling motion of the hands. It typically occurs when the limb is relaxed and disappears during purposeful movement or sleep. This tremor results from the rhythmic firing of neurons in the subthalamic nucleus and globus pallidus due to the loss of dopaminergic inhibition. While not all patients exhibit a tremor, it is one of the most recognizable and frequent symptoms included in the hallmark diagnostic triad.
Choice C rationale
Memory loss and cognitive decline can occur in Parkinson's disease, particularly in the later stages, but they are not part of the "classic triad" used for initial diagnosis. Dementia associated with Parkinson's is a separate clinical consideration from the primary motor symptoms. The triad focuses specifically on motor dysfunction resulting from basal ganglia pathology. Memory issues are more central to Alzheimer's disease or Lewy body dementia rather than being a defining primary motor sign.
Choice D rationale
Loss of sensation is not a characteristic feature of Parkinson's disease. Parkinson's is primarily a motor system disorder affecting the extrapyramidal tract. While some patients may report vague aches or pains, true sensory loss involving touch, temperature, or proprioception suggests a peripheral neuropathy or a lesion in the sensory cortex or spinal cord. Sensory pathways remain intact in Parkinson's, as the underlying pathology is concentrated in the dopamine-producing cells of the midbrain.
Choice E rationale
Cogwheel rigidity is the third component of the classic triad. It refers to a specific type of muscle stiffness where there is a jerky, lead-pipe resistance to passive limb movement. This "cogwheel" sensation is thought to be the combination of basic rigidity and an underlying tremor. It affects both agonist and antagonist muscles equally. This increased muscle tone contributes to the characteristic stooped posture and masked facies seen in individuals progressing through the stages of Parkinson's.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Endocarditis is the inflammation or infection of the endocardium, which is the innermost lining of the heart chambers and the heart valves. This condition often involves the formation of vegetations on the valves, which can lead to valvular insufficiency or systemic emboli. Because the endocardium is the interior layer in direct contact with the blood, it does not represent the outermost layer of the heart, which serves as a protective sac-like covering.
Choice B rationale
Pericarditis is the inflammation of the pericardium, the double-layered fibroserous sac that surrounds and protects the heart. The pericardium is the outermost layer, consisting of the visceral and parietal layers with a small amount of lubricating fluid between them. Inflammation here can cause chest pain, a friction rub, and potentially cardiac tamponade if fluid accumulates. As the most superficial layer of the cardiac structure, it fits the definition of the outermost layer perfectly.
Choice C rationale
Myocarditis is the inflammation of the myocardium, which is the thick, muscular middle layer of the heart wall responsible for the pumping action. This layer is situated between the internal endocardium and the external epicardium or visceral pericardium. While inflammation of the myocardium can be serious and lead to heart failure or arrhythmias, it is not the outermost layer; it is the functional contractile tissue located within the walls of the heart.
Choice D rationale
Vasculitis refers to the inflammation of blood vessels, including arteries, capillaries, and veins. This process can lead to the weakening, narrowing, or scarring of the vessel walls, potentially obstructing blood flow to various organs. While the heart contains blood vessels like the coronary arteries, vasculitis is a general term for vessel inflammation throughout the body and does not specifically name the outermost anatomical layer of the heart itself, which is the pericardium.
Correct Answer is ["C","D","E"]
Explanation
Choice A rationale
This clinical finding occurs when blood backs up into the pulmonary circulation from the left ventricle. Increased hydrostatic pressure in the lung capillaries causes fluid to leak into the alveoli, leading to shortness of breath when lying flat. This reflects left-sided cardiac dysfunction rather than right-sided failure. Normal capillary wedge pressure ranges between 4 and 12 mmHg, but this increases significantly when the left side fails to pump effectively.
Choice B rationale
This condition involves fluid accumulation in the lungs due to the inability of the left atrium and ventricle to move blood forward into the systemic circulation. It results in crackles, tachypnea, and cough. Since the right side of the heart pumps blood into the lungs, its failure would actually decrease pulmonary flow, not cause congestion. This symptom is a hallmark of left-sided heart failure and elevated pulmonary artery occlusive pressures above 18 mmHg.
Choice C rationale
When the right ventricle fails, it cannot effectively pump blood into the pulmonary artery, causing a backup into the superior and inferior vena cava. This systemic venous congestion leads to increased pressure in the hepatic veins. The liver becomes engorged with blood, leading to enlargement and tenderness. Central venous pressure typically rises above the normal range of 2 to 8 mmHg, indicating volume overload in the systemic venous circuit and hepatic congestion.
Choice D rationale
Right-sided heart failure increases systemic venous hydrostatic pressure, which forces fluid out of the capillaries and into the interstitial spaces. Due to gravity, this fluid primarily accumulates in the lower extremities of ambulatory patients or the sacrum of bedridden patients. Normal interstitial fluid volume is maintained by a balance of pressures, but right ventricular dysfunction disrupts this, leading to visible swelling. This is a classic sign of systemic backup from the right heart.
Choice E rationale
Chronic systemic venous hypertension from right-sided failure leads to fluid leakage into the peritoneal cavity. This occurs because the high pressure in the portal system and systemic veins overrides the oncotic pressure provided by albumin. Normal portal venous pressure is 5 to 10 mmHg; elevations beyond this due to heart failure cause significant abdominal distension. This systemic accumulation of fluid is characteristic of the right ventricle's inability to handle the venous return from the body.
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