PD, MS, and TBI

  1. Cardinal symptoms of Charcot's triad
    SIN
    • Scanning speech
    • Intention tremor
    • Nystagmus
  2. Which of the following is not true about the epidemiology of multiple sclerosis?




    B) It is more common in men than in women by a ratio of 2:1 to 3:1.

    It is more common in women than in men by a ratio of 2:1 to 3:1.
  3. In multiple sclerosis, the geographical risk associated with an individual's birthplace is retained if emigration occurs after age 15 years. However, individuals migrating before this age assume the risk of their new location.




    C) Both statements are true.
  4. In multiple sclerosis, disruption of the axolemma and active demyelination slows neural transmission and causes nerves to fatigue rapidly. With severe disruption, conduction block occurs with resulting disruption of function.




    B) Only the second statement is true.

    In multiple sclerosis, disruption of the myelin sheath and active demyelination slows neural transmission and causes nerves to fatigue rapidly.
  5. True or False: During the early stages of multiple sclerosis, Schwann cells survive the initial insult and can produce remyelination.
    False

    During the early stages of multiple sclerosis, oligodendrocytes survive the initial insult and can produce remyelination. This process is incomplete and, as the disease becomes more chronic, stalls altogether. Eventually, the oligodendrocytes become involved and myelin repair cannot occur.
  6. Type of multiple sclerosis which appears to be associated exclusively with the disease of the oligodendrocytes




    A) Primary-progressive
  7. In multiple sclerosis, demyelinated areas eventually become filled with fibrous monocytes and undergo a process called gliosis. Gliosis refers to the proliferation of neuroglial tissue within the CNS and results in glial scars or plaques.




    C) Only the second statement is true.

    In multiple sclerosis, demyelinated areas eventually become filled with fibrous astrocytes and undergo a process called gliosis.
  8. All of the following are considered areas of predilection in multiple sclerosis, except:




    D) Corticobulbar tracts

    It should be corticospinal tracts. Optic nerves are also likely to be affected.
  9. Multiple sclerosis is said to be benign when the patient remains fully functional in all neurological systems 15 years after onset. Benign multiple sclerosis affects more than 20% of the cases.




    D) Only the first statement is true.

    Benign multiple sclerosis affects fewer than 20% of the cases.
  10. True or False: Malignant multiple sclerosis is a relatively rare disease course characterized by rapid onset and almost continual progression leading to significant disability or death within a relatively short time after onset.
    True

    Malignant multiple sclerosis is also known as Marburg disease.
  11. Which of the following is not true about the relapsing-remitting multiple sclerosis?




    A) It is the most common course, affecting 70% of patients with multiple sclerosis.

    It is the most common course, affecting 85% of patients with multiple sclerosis.
  12. Which of the following is not a characteristic of the secondary-progressive multiple sclerosis?




    D) It may be the result of new lesions.

     It may be the result of progressive axonal loss rather than new lesions.
  13. Which of the following is not a characteristic of the primary-progressive multiple sclerosis?




    A) It is associated with later onset (mean age of 40 years) and female gender.

    It is associated with later onset (mean age of 40 years) and more equal gender distribution.
  14. Which of the following is not true about the progressive-relapsing multiple sclerosis?




    A) None of these
  15. Multiple sclerosis relapses (exacerbations) are defined by new and recurrent MS symptoms lasting more than ____ hours but generally of longer duration that are unrelated to another etiology.




    D) 24
  16. All of the following are possible exacerbating factors in multiple sclerosis, except:




    A) None of these
  17. All of the following may trigger Uthoff's symptom, except:




    B) Short-duration exercise

    It should be prolonged exercise.
  18. Most common type of pain in multiple sclerosis




    A) Paroxysmal limb pain

    Paroxysmal limb pain presents as abnormal burning, aching pain (dysesthesias) that can affect any part of the body but is more common in the LEs. It is worse at night and after exercise. It can be aggravated by temperature elevations.
  19. True or False: Involvement of the optic nerve in multiple sclerosis produces altered visual acuity, but blindness is rare.
    True
  20. Optic neuritis, the inflammation of the optic nerve, is a common problem in multiple sclerosis. Which of the following is not a characteristic of this condition?




    C) None of these

    Optic neuritis rarely affects both eyes and is usually self-limiting.
  21. True or False: Marcus Gunn pupil often develops in individuals with multiple sclerosis who have had an episode of optic neuritis.
    True

    If the light is then shone in the affected eye only, a paradoxical widening (dilation) of both pupils occurs.
  22. Internuclear ophthalmoplegia produces incomplete eye adduction (lateral gaze palsy) on the affected side and nystagmus of the opposite abducting eye with gaze to one side. It is caused by demyelination of the pontine medial longitudinal fasciculus.




    C) Both statements are true.
  23. True or False: Severity of multiple sclerosis is related to fatigue severity.
    False

    Severity of disease does not seem to be related to fatigue severity; that is, individuals mildly affected by disease (ambulatory patients) report disabling fatigue as often as more severely disabled patients.
  24. Demyelinating lesions in the cerebellum and cerebellar tracts are common in multiple sclerosis. Ataxia is a general term used to describe uncoordinated movements characterized by all of the following, except:




    D) Intention tremors

    Intention (action) tremors are involuntary, rhythmic, shaking movements that occur when purposeful movement is attempted and results from the inability of the cerebellum to dampen motor movements.
  25. Sexual dysfunction is common in multiple sclerosis. In women, symptoms can include:




    D) All of these

    Meanwhile, in men, symptoms can include impotence, decreased sensation, difficulty or inability to ejaculate, and loss of libido.
  26. To diagnose multiple sclerosis, which of the following criteria must be met?




    D) All of these
  27. Criteria used to diagnose multiple sclerosis




    A) McDonald

    The revised 2010 McDonald Criteria of the International Panel on Diagnosis of MS has resulted in earlier diagnosis of MS with improved specificity and sensitivity.
  28. Diagnostic test that is highly sensitive for detecting MS plaques in the white matter of the brain and spinal cord




    D) MRI

    New lesions with active inflammation that occur during the preceding 6 weeks or so are seen as areas of increased signal intensity, “bright spots.” Contrast-enhanced T1weighted images (gadolinium-enhanced) are used to detect more long-term disease activity (i.e., loss of myelin and axons, gliosis). These lesions are seen as “black holes” on the MRI; the darker the lesion, the more extensive the tissue damage.
  29. True or False: In multiple sclerosis, lesions revealed on MRI do not always correlate with clinical disability.
    True

    “Silent attacks” documented by MRI changes outnumber the attacks that cause active symptoms such as paralysis or vision loss by 10:1.
  30. In multiple sclerosis, the presence of demyelinating lesions on visual, auditory, and somatosensory pathways produces slowed conduction. Of the three, somatosensory evoked potentials have been found to be the most helpful in the diagnostic process.




    B) Only the first statement is true.

    Of the three, visual evoked potentials have been found to be the most helpful in the diagnostic process.
  31. Patients with multiple sclerosis show elevated total immunoglobulin (IgG) in CSF and the presence of oligoclonal IgG bands in response to inflammatory demyelinating lesions. Patients with relapsing-remitting course have higher levels of immunoglobulins in spinal fluid than patients with primary-progressive course.




    C) Only the first statement is true.

    Patients with primary-progressive course have higher levels of immunoglobulins in spinal fluid than patients with relapsing-remitting course.
  32. Drugs used to treat acute disease relapses (exacerbations) in multiple sclerosis




    B) Corticosteroids

    Corticosteroids exert powerful anti-inflammatory and immunosuppressive effects, including diminished swelling within the CNS, decreased T-cell activation, limited immune cell penetration of the CNS, and enhanced apoptosis of activated immune cells. However, these drugs do not modify the disease course or degree of recovery.
  33. True or False: During MS exacerbations, corticosteroids are typically given at high doses (500-1000 mg/day) intravenously for a brief course (3-5 days), followed by a tapered dosage of oral medication for a period of 1-3 weeks.
    True

    There are a number of potential adverse side effects, including mood changes, increased blood pressure, fluid retention, hyperglycemia, acne, and insomnia. Chronic use is associated with hypertension, diabetes, aseptic femoral necrosis, osteopenia, and peptic ulcer.
  34. Plasmapheresis (plasma exchange) may be used to enhance recovery from an acute relapse in patients who fail to respond to interferons. It is used for an exacerbation of RRMS and is not recommended to PPMS or SPMS.




    B) Only the second statement is true.

    Plasmapheresis (plasma exchange) may be used to enhance recovery from an acute relapse in patients who fail to respond to corticosteroids.
  35. Which of the following is not true about interferon beta drugs?




    A) Interferon beta-1 are Betaseron and Glatiramer acetate.

    Interferon beta-1 are Betaseron and Extavia. Glatiramer acetate is also a disease-modifying drug, but not an interferon.
  36. True or False: Disease-modifying drugs used in treating multiple sclerosis are safe for pregnant and breastfeeding women.
    False

    All disease-modifying drugs used in treating multiple sclerosis are contraindicated for women who are pregnant or trying to become pregnant, or who are breastfeeding.
  37. True or False: In multiple sclerosis, botulinum toxin injections can used to provide localized relief of muscle tone and spasms; but their efficacy is short term and generally lasts up to 3 months.
    True

    Phenol injections have also been used but are more unpredictable in degree and duration of response and are associated with sensory side effects.
  38. True or False: In patients receiving disease-modifying agents, interferon beta-1b is associated with less fatigue than glatiramer acetate.
    False

    In patients receiving disease-modifying agents, glatiramer acetate is associated with less fatigue than interferon beta-1b.
  39. Most common cause of nontraumatic disability affecting young adults in the Northern Hemisphere




    B) Multiple sclerosis
  40. True or False: Infections have been linked to multiple sclerosis, but no one infection has emerged as a specific cause or precipitant of disease activity.
    True
  41. True or False: Multiple sclerosis appears to involve genetic factors with HLA-DR4 in DR-positive families—having a greater chance of developing the disease.
    False

    Multiple sclerosis appears to involve genetic factors with HLA-DR2 in DR-positive families—having a greater chance of developing the disease. HLA-DR4 is associated with rheumatoid arthritis.
  42. The hallmark of multiple sclerosis pathology is the presence of multifocal plaques of demyelination in the following areas, except:




    A) Cerebellar hemispheres

    It should be spinal cord.
  43. In multiple sclerosis, some degree of remyelination in the plaque occurs following demyelination. However, as the disease progresses, demyelination takes place in the remyelinated areas, leading to expansion of the lesion.




    A) Both statements are true.
  44. Which of the following mechanism/s explain the conduction block seen in acutely demyelinated nerve segments?




    D) Both of these

    Acutely demyelinated axolemma has a relatively low sodium channel density which may be insufficient for the action potential to be propagated effectively. In addition, pro-inflammatory cytokines, such as tumor necrosis factor-α and interferon-γ, induce nitric oxide formation. Nitric oxide has been shown to cause a dose-dependent conduction block.
  45. A classic neuropathological finding with remyelination is “shadow plaques.” These represent partial reduction of myelin staining as remyelinated axons have thicker myelin sheaths.




    A) Only the first statement is true.

    Shadow plaques represent partial reduction of myelin staining as remyelinated axons have thinner myelin sheaths.
  46. Which subtype of multiple sclerosis frequently begins with optic neuritis?




    D) Relapsing-remitting
  47. Which subtype of multiple sclerosis have the fewest MRI lesions?




    C) Primary-progressive
  48. Which subtype of multiple sclerosis frequently starts with motor symptoms, often an asymmetric paraparesis ?




    B) Primary-progressive
  49. Which of the following is not true about Devic's disease




    D) None of these

    Devic's disease is also known as neuromyelitis optica.
  50. True or False: In multiple sclerosis, MRI has shown that there is a limited correlation between the extent of measurable brain disease and measurable disability.
    True

    Some patients with limited MRI change have significant deficits, and some with extensive white matter and gray matter changes have limited clinical deficits.
  51. Identification of oligoclonal bands and increased IgG synthesis are associated with a positive diagnosis of multiple sclerosis. However, these findings indicate activity of the immune system in and around the central nervous system compartment, and as such as not specific for multiple sclerosis.




    A) Both statements are true.

    Other diseases such as lupus, Lyme disease, and neurosarcoidosis also may show oligoclonal banding.
  52. Studies diagnostic accuracy of MRI, evoked potentials, and CSF have shown that if two of three of these tests are positive, the third does not add significantly to the diagnosis of multiple sclerosis. Neurologists are reducing the frequency of evoked potentials in patients with otherwise typical MS and in whom MRI and CSF tests are characteristic.




    A) Only the first statement is true.

    Neurologists are reducing the frequency of CSF tests in patients with otherwise typical MS and in whom MRI and evoked potentials are characteristic.
  53. Which subtype of multiple sclerosis has no FDA-approved immunomodulating agents?




    D) Primary-progressive
  54. The following adverse effects are associated with interferons, except:




    B) Depression of liver function tests

    It should be elevation of liver function tests.
  55. Mitoxantrone is the only FDA-approved chemotherapeutic agent for multiple sclerosis.  A dose-dependent cardiotoxicity limits use of this medication to about 2 years of total dose.




    B) Both statements are true.
  56. Which of the following is a pathognomonic sign of multiple sclerosis?




    B) None of these

    Multiple sclerosis has no pathognomonic sign.
  57. The McDonald criteria defined the diagnosis of primary-progressive multiple sclerosis. Which of the following is incorrect?




    C) ≥1 T2-hyperintense lesions in the spinal cord

    It should be ≥2 T2-hyperintense lesions in the spinal cord. To be classified as PRMS, there must be a progression of disability and at least two of the remaining criteria.
  58. Which of the following is not true about McDonald criteria?




    B) With 1 lesion and 1 attack, there must be 1 year of disease progression (retrospective or prospective) and at least two of: DIS on the brain, DIS on the spinal cord, or positive CSF.

    With 1 lesion and 1 attack, there must be DIS or await further clinical attack implicating a different CNS site AND DIT or await second clinical attack.

    With no attacks since the disease onset (PRMS), there must be 1 year of disease progression (retrospective or prospective) and at least two of: DIS on the brain, DIS on the spinal cord, or positive CSF.
  59. Most common pathologic pattern in multiple sclerosis




    D) Type II

    Pattern Characteristic
    Type I cell-mediated destruction of myelin sheath by T cells
    Type II cell-mediated destruction of myelin sheath by T cells with immunoglobulins
    Type III apoptosis of oligodendrocytes
    Type IV primary degeneration of oligodendrocytes
  60. Least common pathologic pattern in multiple sclerosis




    C) Type IV

    Pattern Characteristic
    Type I cell-mediated destruction of myelin sheath by T cells
    Type II cell-mediated destruction of myelin sheath by T cells with immunoglobulins
    Type III apoptosis of oligodendrocytes
    Type IV primary degeneration of oligodendrocytes
  61. True or False: Glatiramer acetate is the drug of choice for pregnant women with multiple sclerosis.
    True

    Glatiramer acetate is classified under FDA category B, making it a safer option for pregnant women than interferon beta drugs, which are classified under FDA category C.
  62. Enumerate the sites of predilection of multiple sclerosis.
    POB CCCC
    • Periventricular white matter
    • Optic nerve
    • Brainstem
    • Cerebral cortex
    • Corticospinal tracts
    • Cerebellum
    • Cervical spinal cord (posterior white column)
  63. Which of the following is not true about the use of corticosteroids in managing multiple sclerosis?




    A) These drugs are effective in improving sensory and cerebellar symptoms.

    These drugs are not effective in improving sensory and cerebellar symptoms.
  64. Both immunomodulator and immunosuppressive agents can reduce relapse rate in multiple sclerosis. However, immunosuppresive agents are used for first-line management because of their better side effect profile.




    D) Only the first statement is true.

    Immunomodulator agents are used for first-line management because of their better side effect profile. Examples of immunomodulator agents are Betaseron, Extavia, Avonex, Rebif, and Copaxone. Meanwhile, examples of immunosuppressive agents are Cyclosporine, Azathioprine, Methotrexate, and Mitoxantrone.
  65. Which of the following is not true regarding multiple sclerosis and pregnancy?




    D) There is a higher than normal relapse rate during the first 6 months postpartum.

    There is a higher than normal relapse rate during the first 3 months postpartum.
  66. Enumerate the functional system which can be affected in multiple sclerosis?
    Vice President Sana C Bi M By
    • Visual system
    • Pyramidal system
    • Sensory system
    • Cerebellar system
    • Brainstem
    • Mental system
    • Bowel, bladder, and sexual systems
  67. Most common presenting symptoms in multiple sclerosis?




    C) Paresthesia
  68. Most troubling and disabling symptom in multiple sclerosis?




    B) Fatigue

    However, the severity of fatigue is not related to the severity of the disease.
  69. Which of the following findings is not associated with multiple sclerosis?




    B) Hyporeflexia

    Because multiple sclerosis is an upper motor neuron lesion, it should be hyperreflexia.
  70. All of the following cranial nerves are affected in multiple sclerosis, except:




    D) CN 10

    It should be CN 7.
  71. All of the following are good prognostic indicators of multiple sclerosis, except:




    C) Sudden onset with short remission

    It should be sudden onset with long remission.
  72. All of the following are poor prognostic indicators of multiple sclerosis, except:




    B) Female sex

    It should be male sex.
  73. Kurtzke expanded disability scale: 5




    D) Fully ambulatory for 200 m

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  74. Kurtzke expanded disability scale: constant bilateral assistance required to walk for 20 m without resting




    D) 6.5

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  75. Which of the following is not true about Parkinson disease?




    A) Nonmotor symptoms may succeed the onset of motor symptoms by years.

    Nonmotor symptoms may precede the onset of motor symptoms by years.
  76. Enumerate the cardinal features of Parkinson disease.
    TRAP
    • Tremors
    • Rigidity
    • Akinesia or bradykinesia
    • Postural instability (advanced stages)
  77. All of the following are not true about the incidence of Parkinson disease, except:




    C) More than 2% of older people than 65 years of age have PD,

    Only 4-10% of patients are diagnosed with early-onset PD.

    Men are affected 1.2-1.5 times more frequently than women.
  78. Generic term used to describe a group of disorders with primary disturbances in the dopamine systems of basal ganglia




    C) Parkinsonism
  79. All of the following are true about the etiology of Parkinson disease, except:




    D) None of these
  80. Which of the following is not true about the onset of idiopathic parkinsonism?

    A) Young onset: <21 years="" br="">B) Late-onset: >40 years
    C) Late-onset: generally sporadic
    D) Early onset: often familial
    A) Young onset: <21 years

    It should be juvenile onset <21 years.

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  81. Enumerate the possible causes for secondary parkinsonism.
    PPTMDV
    • Post-infectious 
    • Posttraumatic 
    • Toxic 
    • Metabolic
    • Drugs 
    • Vascular

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  82. All of the following are examples of parkinsonism-plus syndromes, except:




    C) Disorders with prominent and often late dementia

    It should be disorders with prominent and often early dementia.

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  83. Genetic forms of Parkinson disease represent less than 10% of cases overall. In small number of families, all of the following several gene mutations have been identified, except:




    D) DJ-2

    In a small number of families, several gene mutations have been identified (e.g., PARK1, PINK1, LRRK2, DJ-1, and glucocerebrosidase, among others). 

    Genes have been grouped into two categories: (1) causal genes, which actually produce the disease; and (2) associated genes that do not cause PD but increase the risk of developing it.
  84. Two distinct clinical subgroups have been identified in Parkinson disease. One group includes individuals whose dominant symptoms are postural instability and gait disturbances, whereas the other group includes individuals with tremor as the main feature.




    A) Both statements are true.

    The clinical subgroups are known as postural instability gait disturbed and tremor predominant respectively.
  85. Most common cause of toxic parkinsonism




    A) Manganese

    Parkinsonian symptoms occur in individuals exposed to certain environmental toxins, including pesticides (e.g., permethrin, beta-HCH, paraquat, maneb, Agent Orange) and industrial chemicals (e.g., manganese, carbon disulfide, carbon monoxide, cyanide, methanol).
  86. True or False: Mild and transient parkinsonism has been inadvertently produced in individuals who injected a synthetic heroin containing the chemical MPTP (1-methyl-4-phenyl-1,2,3,6 tetrahydropyridine).
    False

    Severe and permanent parkinsonism has been inadvertently produced in individuals who injected a synthetic heroin containing the chemical MPTP (1-methyl-4-phenyl-1,2,3,6 tetrahydropyridine).
  87. All of the following drugs can produce extrapyramidal dysfunction that mimics the signs of Parkinson disease, except:




    A) Propanolol

    • 1. Neuroleptic drugs such as chlorpromazine, haloperidol, thioridazine, and thiothixene
    • 2. Antidepressant drugs such as amitriptyline, amoxapine, and trazodone
    • 3. Antihypertensive drugs such as methyldopa and reserpine
  88. True or False: Parkinsonism can be caused in rare cases by metabolic conditions, including disorders of calcium metabolism that result in basal ganglia calcification.
    True

    These include hypothyroidism, hyperparathyroidism, hypoparathyroidism, and Wilson's disease.
  89. Parkinson-plus syndromes are neurodegenerative diseases that can affect the substantia nigra and produce parkinsonian symptoms along with other neurological signs. All of the following are classified as Parkinson-plus syndrome, except:




    B) None of these

    • Other Parkinson-plus syndromes are:
    •  1. Striatonigral degeneration 
    •  2. Shy-Drager syndrome
    •  3. Progressive supranuclear palsy
    •  4. Olivopontocerebellar atrophy
    •  5. Cortical-basal ganglionic degeneration
    •  6. Alzheimer's disease
    •  7. Diffused Lewy body disease
    •  8. Normal pressure hydrocephalus
    •  9. Creutzfeldt-Jakob disease
    •  10. Wilson's disease
    •  11. Juvenile Huntington's disease
  90. Early in their course, Parkinson-plus syndromes may present with rigidity and tremors indistinguishable from Parkinson disease. These diseases typically do not show measurable improvement from administration of anti-Parkinson medications such as levodopa.




    B) Only the second statement is true

    Early in their course, Parkinson-plus syndromes may present with rigidity and bradykinesia indistinguishable from Parkinson disease.
  91. Parkinson's disease is defined by:




    A) Both of these

    Lewy bodies occur as the disease progresses and more neurons degenerate.
  92. Substantial neurodegeneration occurs in Parkinson disease before the onset of motor symptoms with clinical signs emerging at _______ % degeneration of neurons.




    D) 30-60

    Loss of the melanin-containing neurons produces characteristic changes in depigmentation in the substantia nigra with a characteristic pallor.
  93. In what stage of Parkinson disease, does involvement of the nigrostriatal system becomes apparent?




    C) Stage 3

    Stage Structures Involved
    1 Medullar oblongata (dorsal IX/X nucleus or intermediate reticular zone)
    2   Raphe nuclei, gigantocellular reticular nucleus, coeruleus-subcoeruleus complex
    3 Nigrostriatal system (pars compacta of substantia nigra)
    4 Temporal mesocortex and allocortex
    5 Sensory association areas of neocortex and prefrontal cortex
    6 Sensory association areas of neocortex and premotor areas
  94. Which of the following is not true about rigidity associated with Parkinson disease?




    A) It typically affects the distal muscles first, especially the hands and feet, then it progresses to involve the muscles of the face and neck.

    It typically affects proximal muscles first, especially the shoulders and neck, and it progresses to involve muscles of the face and extremities.
  95. Cogwheel rigidity is a jerky-ratchet-like resistance to passive movement as muscle alternately tense and relax. Meanwhile, lead pipe rigidity is a sustained resistance to passive movement, with no fluctuations.




    A) Both statements are true.

    Cogwheel rigidity occurs when tremor coexists with rigidity.
  96. One of the disabling symptoms of Parkinson disease




    A) Bradykinesia

    Bradykinesia is one of the most disabling symptoms of Parkinson's disease, with prolonged movement and reaction times resulting in increased time on task and dependence in daily activities.
  97. Which of the following is not true about tremor associated with Parkinson disease?




    A) In the early stages of the disease, about 70% of the patients experience slight tremor of the jaw or tongue

    In the early stages of the disease, about 70% of the patients experience slight tremor of the hand or foot on one side of the body, or less commonly in the jaw or tongue.
  98. Which of the following is not a characteristic of gait of patients with Parkinson disease?




    B) Progressive decrease in speed with shortening of stride

    An abnormal stooped posture contributes to development of a festinating gait pattern, characterized by a progressive increase in speed with shortening of stride. Gait can be anteropulsive (forward) or retropulsive (backward). 

    In early disease, freezing of gait is generally short in duration and rarely leads to falls. With disease progression, FOG becomes more common and disabling, often leading to falls.
  99. True or False: Back pain may accompany a prolonged, stooped, kyphotic posture in patients with Parkinson disease.
    True

    Discomfort and pain can result from postural stress syndrome secondary to faulty posture, ligamentous strain, lack of movement, and muscle rigidity.
  100. True or False: Most patients with Parkinson disease report a decline or loss of sense of smell, often years after motor symptoms develop.
    False

    Most patients with Parkinson disease report a decline or loss of sense of smell, often years before motor symptoms develop.
  101. Individuals with Parkinson disease experience problems in which phase/s of swallowing?




    B) All of these

    Individuals with Parkinson disease experience problems in all four phases of swallowing: oral preparatory, oral, pharyngeal, and esophageal. Thus, the patient demonstrates abnormal tongue control and problems with chewing, bolus formation, delayed swallow response, and peristalsis.
  102. Speech impairment in patients with Parkinson disease is the result of rigidity, bradykinesia, hypokinesia, and tremor. Patient with this disease experience hypokinetic dysarthria, which is characterized by all of the following except:




    B) Precise articulation

    It should be imprecise and distorted articulation.
  103. True or False: Obstructive lung disease is common in patients with Parkinson disease.
    False

    Restrictive lung dysfunction is common in patients with Parkinson disease. It is linked to decreased chest expansion that occurs as a result of rigidity of the trunk muscles, loss of musculoskeletal flexibility, and kyphotic posture.
  104. REM sleep behavior disorder (RBD) occurs late in Parkinson disease and affects as many as 50 to 60% of patients. In a patient with RBD, the paralysis that normally occurs during REM sleep is incomplete or absent, allowing him/her to "act out" dreams that are vivid, intense, and violent.




    B) Only the second statement is true.

    REM sleep behavior disorder (RBD) occurs early in Parkinson disease and affects as many as 50 to 60% of patients.
  105. True or False: There is no single definitive test or group of tests used to diagnose Parkinson disease.
    True

    The diagnosis of Parkinson disease is made on the basis of history and clinical examination. Handwriting samples, speech analysis, interview questions that focus on developing symptoms, and physical examination are used.
  106. All of the following are symptoms that are present many years before an official diagnoses of Parkinson disease is made, except:




    D) Anopsia

    It should be anosmia.
  107. A diagnosis of Parkinson disease is typically made if at least ____ out of the four cardinal motor features are present.




    B) Two

    Exclusion of Parkinson-plus syndromes is necessary. The presence of extrapyramidal signs that are bilaterally symmetrical and do not respond to levodopa and dopamine agonists (apomorphine test) is suggestive of these syndromes, not Parkinson disease.
  108. True or False: In vivo functional imaging using chemical markers to identify dopaminergic deficits can discriminate between Parkinson disease and other causes of parkinsonism.
    False

    In vivo functional imaging using chemical markers to identify dopaminergic deficits cannot discriminate between Parkinson disease and other causes of parkinsonism.
  109. Which of the following is not true about the clinical course of Parkinson disease?




    B) Patients with a young age at onset or who are tremor predominant typically demonstrate a more rapid progression.

    Patients with a young age at onset or who are tremor predominant typically demonstrate a more benign progression. Meanwhile, patients who present with postural instability and gait disturbances tend to have more pronounce deterioration with a more rapid disease progression.
  110. All of the following are characteristics of Hoehn-Yahr Classification of Disability stage III, except:




    A) Minimal bilateral or midline involvement

    Minimal bilateral or midline involvement is seen in stage II.

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  111. Hoehn-Yahr Classification of Disability: All symptoms are present and severe.




    D) Stage 4

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  112. Gold standard drug therapy for Parkinson disease




    D) Sinemet

    Sinemet is a combination of levodopa and carbidopa.
  113. True or False: Most of levodopa (almost 99%) is metabolized before reaching the brain, requiring administration of high doses that can produce numerous side effects.
    True

    Today, levodopa is commonly administered with carbidopa, a decarboxylase inhibitor that allows a higher percentage of levodopa to enter the brain. Thus, lower doses of levodopa can be used with fewer side effects.
  114. True or False: Controlled-release form of Sinemet is more effective than the immediate-release form.
    False

    The immediate-release form of Sinemet has a short half-life requiring multiple oral dosing throughout the day, whereas the controlled-release form is a long-acting, sustained release preparation. Both forms are equally effective.
  115. For many patients with Parkinson disease, the typical therapeutic window for dopamine replacement therapy is _____ years before optimal benefit wears off.




    C) 4-6

    At this point, most patients experience disabling dyskinesias, dystonia, and motor fluctuations.
  116. Which of the following is not true about dyskinesias associated with dopamine replacement therapy in patients with Parkinson disease?




    A) They are dynamic uncontrolled or involuntary movements that typically occur at low levodopa dose or when transitioning between "on" and "off" states.

    Dyskinesias are dynamic uncontrolled or involuntary movements that typically occur at peak levodopa dose or when transitioning between "on" and "off" states.
  117. "On-off" phenomenon refers to abrupt, random fluctuations in motor performance and responses. Meanwhile, wearing off refers to end-dose deterioration, a worsening of symptoms toward the end of the expected timeframe of medication effectiveness.




    B) Both statements are true.
  118. Drug which can be administered with levodopa/carbidopa to control mild wearing-off phenomena




    B) Deprenyl

    Deprenyl is also known as selegiline.
  119. Which of the following is not true about dopamine agonists?




    C) The greatest benefit of these medications is reducing rigidity, bradykinesia, and motor fluctuations.
  120. Which of the following is not true about anticholinergic agents when used to manage Parkinson disease?




    D) Adverse affects include blurred vision, dry mouth, dizziness, and urinary frequency.

    Adverse affects include blurred vision, dry mouth, dizziness, and urinary retention.
  121. True or False: Patients with Parkinson disease are advised to follow a high-calorie, high-protein diet.
    False

    Patients with Parkinson disease are advised to follow a high-calorie, low-protein diet. A high-protein diet can block the effectiveness of levodopa because the dietary amino acids in protein compete with levodopa absorption.
  122. In patients with Parkinson disease, generally no more than 30% of their calories should come from protein. It is also recommended to shift the intake of protein to the morning meal when patients are more active.




    D) Both statements are false.

    Proteins can cause motor fluctuations in patients with Parkinson disease as they compete with levodopa absorption. Generally no more than 15% of their calories should come from protein. It is also recommended to shift the intake of protein to the evening meal when patients are less active.
  123. Which of the following is not true about deep brain stimulation (DBS) when used in managing Parkinson disease?




    A) In DBS, brain electrodes are placed in the globus pallidus (GPi) or less frequently in the subthalamic nucleus (STN).

    In DBS, brain electrodes are placed in the subthalamic nucleus (STN) or less frequently in the globus pallidus (GPi).
Author
carminaorlino
ID
355531
Card Set
PD, MS, and TBI
Description
Updated