Case 20 overview

Question 1

what makes up the triad for Lewy body dementia

Answer 1

dementia
Parkinsonism
visual hallucinations

Question 2

which deficit is more profound in Lewy body dementia than in Parkinson’s

a.muscarinic
b.dopaminergic
c.cholinergic
d.serotinegric
e.GABA

Answer 2

c.cholinergic

myoclonus
response to. cholinesterase therapies often marked
neuroleptic drugs can exacerbate Parkinsonism

Question 3

in which part of the brain is affected in Lewy body dementia

a.substancia nigra
b.caudate nucleus
c.cerebral cortex
d.cerebellum
e.striatum

Answer 3

c.cerebral cortex

Question 4

atypical Parkinsonism conditions

Answer 4

multiple system atrophy
progressive supranuclear palsy
corticobasal syndrome

Question 5

what distinguishes atypical Parkinsonism from Parkinson’s

Answer 5

Parkinsonism AND additional features which distinguish then from PD

Question 6

in which atypical Parkinsonism is there autonomic failure, leading to postural hypotension, erectile dysfunction, urinary incontinence and involuntary forward flexion of neck (antecollis) on auscultation there is stridor

a.MSA
b.PSP
c.CBS

Answer 6

a.MSA

Question 7

at what age is the onset of MSA

a.55-66 yrs
b.22-33 yrs
c.77-88 yrs

Answer 7

a.55-66 yrs

Question 8

what is the usual presentation for MSA

Answer 8

erectile dysfunction
urinary symptoms
features of PD
poor balance
progresses more rapidly than Parkinson’s so prognosis of 6-9 years

Question 9

what protein causes MSA

a.alpha synuclein
b.beta synuclein
c.amyloid
d.colloid

Answer 9

a.alpha synuclein

Question 10

in which atypical Parkinsonism is there early falls, severe neck stiffness and inability to move eyes vertically , slurred speech and facial weakness and frontal type dementia (change in personality and emotion)

a.MSA
b.PSP
c.CBS

Answer 10

b.PSP

inability to move eyes vertically - supranuclear gaze palsy

Question 11

what is the onset age for PSP

a.55-66 yrs
c. 63 years
d.40 years
e.80 years

Answer 11

c. 63 years

Question 12

what protein causes progressive supranuclear palsy

A.amyloid
b.a synuclein
c.tau
d.colloid

Answer 12

c.tau

Question 13

in which atypical Parkinsonism is there Parkinsonism, frontal dementia - changed personality and language difficulties , myoclonus and dystonia in affected limbs and inability to control that limb (alien limb phenomenon)

a.MSA
b.PSP
C.CBS

Answer 13

C.CBS

less common
onset age 63 years

Question 14

which protein causes corticobasal syndrome
A.amyloid
b.a synuclein
c.tau
d.colloid

Answer 14

c.tau

Question 15

an abnormal DAT scan suggests a diagnosis of what

a.parkinsons disease
b.MSA
c.nigrostriatal neurodegenerative parkinsonian syndrome
d.parkinsonism

Answer 15

c.nigrostriatal neurodegenerative parkinsonian syndrome

Question 16

Lewy bodies are pink intracytoplasmic inclusions in neurones they are composed of abnormal deposits of which protein

A.amyloid
b.a synuclein
c.tau
d.colloid

Answer 16

b.a synuclein

Question 17

which of these drugs is a directly acting dopamine antagonist that is given daily sc and is the best method for smoothing out fluctuations or managing troublesome dyskinesias in PD

a.levodopa
b.MAOi
c. apomorphine
d.duodopa

Answer 17

c. apomorphine

Question 18

which of these drugs is used to smooth out fluctuations and manage dyskinesias in advanced PD

a.levodopa
b.MAOi
c. apomorphine
d.duodopa

Answer 18

c. apomorphine

Question 19

what are the main side effects of apomorphine

Answer 19

nausea, confusion, hypotension

Question 20

which of these drugs is made up of levodopa contnuously and directly administered into the small intestine via PEJ tube for rapid uptake into the bloodstream

a.levodopa
b.MAOi
c. apomorphine
d.duodopa

Answer 20

d.duodopa

Question 21

failure of apomorphine and lack of indication for deep brain stimulation are indications for which Parkinson’s drug

a.levodopa
b.MAOi
c. apomorphine
d.duodopa

Answer 21

d.duodopa

Question 22

what is the target of deep brain stimulation in Parkinson’s disease

a.subthalmic nucelus
b.substancia nigra
c.caudate nucleus
d.cerebral cortex

Answer 22

a.subthalmic nucelus

Question 23

which part of the brain is stimulated by deep brain stimulation in tremor and dyskinesias

a.subthalmic nucelus
b.substancia nigra
c.caudate nucleus
d.cerebral cortex
e.pallidum

Answer 23

e.pallidum

Question 24

implantation of a device that sends electrical impulses to parts of the Brian that control movements

Answer 24

deep brain stimulation

Question 25

lesioning - electrical probe placed in the targeted region (usually globes pallidus interns) heated to destroy cells in that area
may relive symptoms and is most often effective at treating disabling dyskinesias

Answer 25

pallidotomy

rarely performed compared to dbs surgery

Question 26

medication side effects with developing Parkinson’s disease

Answer 26

wearing off phenomenon
on off effect quicker
dyskinesias
dose failures
slowing, gait, speech, thought
falls

Question 27

a perception in the absence of adequate peripheral stimulus

a.hallucination
b.delirium
c.delusions
d.psychosis

Answer 27

a.hallucination

Question 28

an acute fluctuating disturbance of attention and awareness accompanied by impairment in cognition

a.hallucination
b.delirium
c.delusions
d.psychosis

Answer 28

b.delirium

Question 29

fixed false beliefs not amendable tp reason eg held despite evidence to the contrary

a.hallucination
b.delirium
c.delusions
d.psychosis

Answer 29

c.delusions

Question 30

presence of delusions, hallucinations , formal though disorder or abnormal psychomotor behaviour not explained by another psychiatric / medical condition or substance misuse

a.hallucination
b.delirium
c.delusions
d.psychosis

Answer 30

d.psychosis