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Neurology > Extrapiramidal diseases > Flashcards

Extrapiramidal diseases Flashcards

1
Q

How do we not treat parkinsonism?
a. L-dopa
b. anticholinergics
c. botulinum
d. amantadine
e. deep brain stimulation

A

c. botulinum

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2
Q

A 68-year-old patient with Parkinson’s disease, who is motor-regulated, presents with
symptoms of psychosis. Adjustment of dopaminergic medication has not improved
the condition. Which neuroleptic would you introduce?
a. haloperidol
b. clozapine
c. Promazine
d. risperidon
Why?
e. has the least extrapyramidal effects
f. does not cause allergic reactions
g. well tolerated by Parkinson’s patients
h. all of the above

A

b. clozapine
e. has the least extrapyramidal effects

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3
Q

A 5th year medical student cannot get:
a. Parkinson’s disease
b. multiple system atrophy
c. progressive supranuclear palsy
d. Wilson’s disease

A

b. multiple system atrophy
c. progressive supranuclear palsy

I think it’s Wilson’s because it’s the only hereditary one

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4
Q

Vertical gaze palsy is expected in:
a. Steel-Richardson-Olszewski syndrome
b. Shy-Drager syndrome
c. Mb. Huntington
d. Mb. Hallervorden-Spatz

A

a. Steel-Richardson-Olszewski syndrome

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5
Q

The basis of symptomatic treatment for Parkinson’s disease is based on deprivation:
a. serotonin
b. noradrenaline
c. dopamine
d. acetylcholine

A

c. dopamine

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6
Q

In parkinsonism, an excess is found in the striatum:
a. acetylcholine
b. dopamine
c. noradrenaline

A

a. acetylcholine

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7
Q

The aetiology of Parkinson’s disease in most cases is:
a. idiopathic

A

a. idiopathic

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8
Q

Hereditary factors for Parkinson’s include:
a. α-synuclein mutation
b. parkin mutation

A

a. α-synuclein mutation
b. parkin mutation

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9
Q

Motor dysfunction of the basal ganglia due to dopamine deficiency in the striatum
manifests as:
a. akinetic-rigid syndrome
b. chorea
c. ballism

A

a. akinetic-rigid syndrome

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10
Q

An animal model of parkinsonism?
a. kills mitochondria

A

a. kills mitochondria

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11
Q

How do we diagnose Parkinson’s disease?
a. clinically by history and clinical examination
b. with the levodopa test
c. by lumbar puncture

A

a. clinically by history and clinical examination

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12
Q
  1. What happens after long-term dopamine deficiency?
    a. hypersensitivity of striatal neurons.
A

a. hypersensitivity of striatal neurons.

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13
Q

The pathological hallmark of Parkinson’s disease is the presence of Lewy bodies
(eosinophilic intracytoplasmic inclusions) in the cytoplasm of cells:
a. substance nigre
b. subthalamic nucleus
c. paliduma
d. putamna
Depletion of dopaminergic cells in the nucleus reduces dopamine levels in:
e. substances of nigra
f. subthalamic core
g. striatum
h. available at

A

a. substance nigre
g. striatum

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14
Q

Uncoordinated movements of the tongue and lips (dyskinesias) are characteristic of:
a. Parkinson’s disease
b. vascular parkinsonism
c. tardive dyskinesia due to neuroleptics
d. All

A

c. tardive dyskinesia due to neuroleptics

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15
Q

Multiple system atrophy does not include:
a. Shy-Drager syndrome
b. striatonigral degeneration
c. corticobasal degeneration
d. olivopontocerebellar atrophy

A

c. corticobasal degeneration

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16
Q

What is not a dopamine agonist?
a. bromocriptine
b. Propanolol

A

b. Propanolol

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17
Q

Essential tremor therapy:
a. Propanolol

A

a. Propanolol

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18
Q

Who will we ask most specifically about family history?
a. a patient with behavioural changes and articulations
b. a patient with sudden haemiparesis

A

a. a patient with behavioural changes and articulations

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19
Q

How is Huntington’s chorea treated?
a. haloperidol
b. levodopa
c. dopamine agonists
d. anticholinergics

A

a. haloperidol

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20
Q

In all patients with neurological problems due to Wilson’s disease, we see:
a. Keyser-Fleisher ring

A

a. Keyser-Fleisher ring

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21
Q

The gentleman experienced a sudden cognitive decline. Myoclonic jerks followed.
The cognitive decline and the myocardial infarctions progressively worsened and the
gentleman died 8 months later. In which of the following diseases is myoclonus most
common?
a. Parkinson’s disease
b. Alzheimer’s disease
c. Creuzfeldt-Jacob disease
d. Huntington’s disease

A

c. Creuzfeldt-Jacob disease

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22
Q

A young woman suffered from mild rigidity and akineticism. Her father died young,
was demented and had unusual full-body joints. What is the most likely diagnosis?
a. Huntington’s disease
b. Parkinson’s disease

A

a. Huntington’s disease

Choreatic movements are charateristics of Huntington’s

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23
Q

Which statement is not correct?
a. the most effective therapy for focal dystonias is botulinum
b. the most effective therapy for generalised dystonias is botulinum
c. levodopa is very effective for some dystonias
d. anticholinergics are very effective in some dystonias
e. stereotactic brain surgery is very effective for some dystonias

A

b. the most effective therapy for generalised dystonias is botulinum

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24
Q

What do we not treat dystonias with?
a. non-steroidal anti-inflammatory drugs
b. anticholinergics
c. botulinum
d. deep core stimulation
e. valproate

A

e. valproate

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25
Q

Parkinson’s disease is not a specific condition:
a. depression
b. tremor
c. Dementia
d. occasionally poorer response to levodopa in the first years of the disease
e. balance disorders

A

d. occasionally poorer response to levodopa in the first years of the disease

Always responds to levodopa in the beginning

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26
Q

In a young patient with Wilson’s disease, we are likely to find the following signs:
a. dystonia, parkinsonism, dysarthria, tremor
b. dystonia, ataxia, aphasia, tremor
c. Parkinsonism, ataxia, apraxia, typical EEG
d. ataxia, apraxia, aphasia, elevated blood Cu
e. chorea, dementia, depression, positive family history

A

a. dystonia, parkinsonism, dysarthria, tremor

We don’t see aphasia

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27
Q

A 39-year-old patient developed mild choreatic and dystonic hand flexion. He has no
other problems. His mother died of cancer at the age of 72, his father was treated by
a psychiatrist and committed suicide at the age of 42. The diagnosis is the least
helpful:
a. Ophthalmologist
b. geneticist
c. EEG
d. psychological testing
e. Abdominal ultrasound

A

e. Abdominal ultrasound

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28
Q

Which statement about DYT1 dystonia is not correct?
a. slowly progressive, generalised, the most common form of primary
dystonias
b. starts in childhood, affects the lower limbs first and then generalises
to other parts of the body
c. is an autosomal dominant inherited disease
d. in some cases dramatic responses to low doses of left dope
e. DYT1 is the gene that encodes the protein torsin A

A

a. slowly progressive, generalised, the most common form of primary
dystonias

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29
Q

What is tremor like in Wilson’s disease?
a. Myoclonic
b. fluttering
c. transient
d. Action
e. no tremor in Wilson’s disease

A

b. fluttering

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30
Q

How do we distinguish between Parkinson’s disease and Parkinsonism plus?
a. Levodopa test
b. DaTSCAN
c. SPECT with iodobenzamide
d. Clinical

A

c. SPECT with iodobenzamide

DaTSCAN is for distinguishing between essential tremor and Parkinson

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31
Q

Which disease is more common in men?
a. Parkinson’s disease

A

a. Parkinson’s disease

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32
Q

What is not characteristic of a Parkinsonian gait?
a. walking on a wide base

A

a. walking on a wide base

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33
Q

How can we make parkinsonism worse?
a. inhibiting the substantia nigra compact with highfrequency electrical stimulation
b. inhibit the subthalamic nucleus
c. dopamine agonists
d. muscarinic receptor antagonist

A

a. inhibiting the substantia nigra compact with highfrequency electrical stimulation

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34
Q

Dyskinesias are the result of:
a. elevated plasma levodopa concentrations
b. excessive levodopa concentrations in the fluid
c. altered receptor function in the CNS

A

a. elevated plasma levodopa concentrations

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35
Q

Which of the typical signs of Parkinson’s disease appears the latest:
a. tremor
b. rigidity
c. postural disturbances
d. akinesia

A

c. postural disturbances

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36
Q

Progressive supranuclear palsy is also known as:
a. Steel-Richardson-Olszewski syndrome
b. Shy-Drager syndrome
c. Pisa syndrome
d. Vodusek-Pirtosek syndrome

A

a. Steel-Richardson-Olszewski syndrome

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37
Q

We will see a fall back, especially in:
a. idiopathic Parkinson’s disease
b. multiple system atrophy
c. progressive supranuclear palsy
d. oral examination in neurology

A

c. progressive supranuclear palsy

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38
Q

In a patient with Parkinson’s disease, a wrist tone examination will reveal:
a. the toothed wheel phenomenon
b. the pocket knife phenomenon
c. the phenomenon of the inexhaustible clone
d. the normal tone phenomenon

A

a. the toothed wheel phenomenon

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39
Q

You chose a dopamine agonist over L-Dopa for a 58-year-old SDS politician
with moderate Parkinson’s disease. Why?
a. the medicine has fewer side effects
b. the drug has fewer motor complications after a few years of use
c. titration of the dopamine agonist is easy
d. dopamine agonist is more effective than L dope

A

b. the drug has fewer motor complications after a few years of use

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40
Q

A 38-year-old accountant’s right hand trembles at rest. She is bradykinetic
but without rigidity - incipient Parkinson’s disease. You will treat it with:
a. amantadine
b. L dope
c. anticholinergics
d. dopamine agonists

A

c. anticholinergics

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41
Q

You will treat a 78-year-old pensioner with long-standing Parkinson’s disease
and severe motor complications with:
a. vagus stimulation
b. stimulation of the subthalamic nucleus
c. stimulation of the substantia nigra
d. hippocampal stimulation

A

b. stimulation of the subthalamic nucleus

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42
Q

Myoclonus and cortical sensitivity disturbances are expected in:
a. Parkinson’s disease
b. multiple system atrophy
c. progressive supranuclear palsy
d. corticobasal degeneration

A

d. corticobasal degeneration

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43
Q

Asymmetric atrophy of the parietal lobe on head MRI is expected in:
a. Parkinson’s disease
b. multiple system atrophy
c. progressive supranuclear palsy
d. corticobasal degeneration

A

d. corticobasal degeneration

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44
Q

Dystonia in a child who later develops idiopathic torsion dystonia will start at:
a. Legs
b. hands
c. the neck

A

a. Legs

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45
Q

What is true for Parkinson’s disease?
a. inheritance is autosomal dominant
b. the signs are due to excessive dopamine secretion from the substantia nigra
c. anticholinergics are used for treatment
d. characteristic albumin-cytosis dissociation is found in the lysate
e. always exclude it in young patients with extrapyramidal symptoms

A

c. anticholinergics are used for treatment

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46
Q

What is not one of the others?
a. blepharospasm
b. horea
c. tremor
d. hemibalism
e. hemifacial spasm

A

e. hemifacial spasm

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47
Q

It is not used in Parkinson’s therapy:
a. MAO inhibitors
b. levodopa
c. dopamine agonists
d. cholinergics
e. amantadina

A

d. cholinergics

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48
Q

A patient is least likely to see after 10 years of treatment for Parkinson’s disease:
a. Festivities
b. dementia
c. pain
d. tardive dyskinesias
e. postural disturbances

A

d. tardive dyskinesias

They manifest from 1 to 6 months after the treatment

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49
Q

How do we treat a young patient with signs of moderate Parkinson’s disease?
a. anticholinergics
b. levodopa
c. dopamine agonists

A

c. dopamine agonists

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50
Q

Why add carbidopa in the treatment of PB?
a. because this increases levodopa uptake in the CNS

A

a. because this increases levodopa uptake in the CNS

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51
Q

Parkinson’s disease is also known as:
a. akinetic rigid syndrome.

A

a. akinetic rigid syndrome.

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52
Q

Which statement is true for Parkinson’s disease:
a. dopamine inhibits the indirect pathway and promotes the direct pathway
b. dopamine stimulates the indirect pathway and inhibits the direct pathway
c. dopamine inhibits the direct and indirect pathway
d. dopamine stimulates the direct and indirect pathway

A

a. dopamine inhibits the indirect pathway and promotes the direct pathway

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53
Q

What’s not true for Parkinson’s disease:
a. the tremor disappears when you sleep
b. gait and postural disturbances respond less well to treatment than
other motor symptoms
c. anosmia can be one of the first non-motor signs
d. the thalamus over-inhibits the motor cortex

A

b. gait and postural disturbances respond less well to treatment than
other motor symptoms

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54
Q

The statue of the one huddled man is the first depiction of which disease?
a. Parkinson’s disease

A

a. Parkinson’s disease

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55
Q

What’s true for Parkinson’s disease:
a. increased acetylcholine tone in the striatum
b. increased dopamine tone in the striatum
c. fewer postsynaptic neurons
d. fewer interneurons

A

a. increased acetylcholine tone in the striatum

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56
Q

We see haemibalism in:
a. hypoglycaemia
b. hyperglycaemia
c. Hypokalaemia
d. hyperkalemia
e. hypernatremia

A

b. hyperglycaemia

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57
Q

What can cause chorea?
a. hyperthyroidism
b. hypocalcaemia
c. levodopa
d. systemic lupus erythematosus
e. all of the above

A

e. all of the above

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58
Q

How do we treat focal dystonias?
a. with botulinum injections

A

a. with botulinum injections

59
Q

55-year-old patient with apparent Parkinson’s, how are you going to treat?
a. dopamine agonists
b. anticholinergics
c. levodopa
d. amantadine

A

a. dopamine agonists

60
Q

PB after MPTP poisoning is caused by:
a. toxic effects on mitochondria in dopaminergic neurons

A

a. toxic effects on mitochondria in dopaminergic neurons

61
Q

What is the basic clinical difference between Parkinson’s disease tremor and
essential tremor?
a. Parkinson’s tremor occurs at rest and disappears during
movement, while essential tremor occurs during movement
(action and postural tremor)

A

a. Parkinson’s tremor occurs at rest and disappears during
movement, while essential tremor occurs during movement
(action and postural tremor)

62
Q

Where is the pathology in Parkinson’s disease?
a. subthalamic core
b. substantia nigra pars compacta
c. striatum
d. substantia nigra pars reticularis

A

b. substantia nigra pars compacta

63
Q

What doesn’t Parkinson’s medication improve?
a. Balance
b. anosmia
c. tremor
d. walking

A

b. anosmia

64
Q

Which core is not suitable for electrical stimulation in PB?
a. Meynert core

A

a. Meynert core

Core producing acetilcholine

65
Q

How is the degeneration of the head of the caudate in Huntington’s disease detected
on MRI?
a. as an enlargement of the lateral ventricle

A

a. as an enlargement of the lateral ventricle

66
Q

What do we not treat essential tremor with?
a. with levodopa
b. with primidone
c. with deep brain stimulation of the thalamus
d. with propanolol
e. with benzodiazepines.

A

a. with levodopa

67
Q

What reduces the bioavailability of levodopa?
a. simultaneous consumption of protein

A

a. simultaneous consumption of protein

68
Q

When should we choose genetic diagnosis in the clinical management of
Parkinson’s disease?
a. genetic diagnosis has a place only for research purposes.
b. when there is more than one affected person in the family or the disease
starts in a younger person.
c. when the patient himself expressly wishes to do so for the purposes of family
planning.
d. the patient can opt for the test on a self-pay basis
e. We always decide to investigate when Parkinson’s disease is suspected

A

b. when there is more than one affected person in the family or the disease
starts in a younger person.

69
Q

The drug of choice for Parkinson’s disease is levodopa. Levodopa enters the
central nervous system by:
a. does not pass into the central nervous system at all unless a
transporter is added to the pharmaceutical preparation
b. diffusion
c. active transport
d. endocytosis
e. pinocytosis

A

b. diffusion

70
Q

Dopamine receptor agonists, e.g. ropinirole, can also cause
a. Excessive appetite
b. alleviate nausea
c. hyperpyrexia
d. impulsive behaviour
e. gynaecomastia

A

d. impulsive behaviour

71
Q

The folds that can occur after prolonged treatment with levodopa are usually due to
a. reduced plasma levodopa concentrations
b. altered levodopa metabolism locally in the brain
c. increased permeability of the blood-brain barrier to levodopa
d. increased plasma levodopa concentrations
e. faster dopamine metabolism

A

d. increased plasma levodopa concentrations

72
Q

Apomorphine must be given by continuous subcutaneous infusion because:
a. is a protein
b. would not be absorbed in the intestine
c. undergoes first-pass metabolism, which converts it to morphine
d. has a short half-life
e. none of the above

A

d. has a short half-life

73
Q

Symptoms of Parkinson’s usually only appear in older patients, because:
a. the physiological decay of dopamine neurons in the brain is then
relatively faster compared to other neurons
b. postsynaptic neurons do not adapt to dopamine deprivation in the striatum
c. symptoms of Parkinson’s only appear when there is a severe dopamine
deficiency
d. in Parkinson’s disease, nigrostriatal neurons usually start to fail only in old
age
e. because the formation of Lewy bodies is accelerated in elderly patients

A

a. the physiological decay of dopamine neurons in the brain is then
relatively faster compared to other neurons
c. symptoms of Parkinson’s only appear when there is a severe dopamine
deficiency

74
Q

In Parkinson’s disease, the dopaminergic-cholinergic imbalance in the striatum is
caused by:
a. secondary degeneration of cholinergic interneurons in the striatum
b. increased release of acetylcholine from cholinergic interneurons
due to dopamine deficiency in the striatum
c. side effects of levodopa treatment of Parkinson’s disease symptoms
d. increased expression of dopamine receptors on dendrites of cholinergic
interneurons of the striatum
e. treating Parkinson’s disease symptoms with muscarinic acetylcholine
receptor antagonists

A

b. increased release of acetylcholine from cholinergic interneurons
due to dopamine deficiency in the striatum

75
Q

Wilson’s disease is an autosomal recessive disorder caused by a defect in function:
a. ceruloplasmin
b. ferritin
c. ATP7B protein
d. cytochrome oxidase
e. superoxide dismutase

A

a. ceruloplasmin

76
Q

Huntington’s disease is:
a. an autosomal dominant disease caused by a mutation in the frataxin gene on
chromosome 4
b. an autosomal dominant disorder caused by a mutation in the
huntingtin gene on chromosome 4
c. an autosomal dominant disorder caused by a mutation in the
huntingtin gene on chromosome 13
d. an autosomal recessive disorder caused by a mutation in the huntingtin
gene on chromosome 4
e. X-linked disease caused by a mutation in the huntingtin gene

A

b. an autosomal dominant disorder caused by a mutation in the
huntingtin gene on chromosome 4

77
Q

Circle the two incorrect statements for Parkinson’s disease:
a. Hypomimia occurs early in the course of the disease
b. Rigidity is more often bilateral than unilateral in early disease
c. Older patients are more often prescribed levodopa than dopamine
antagonists
d. Deep brain stimulation for the treatment of this disease targets the
subthalamic nucleus
e. It is the most common neurodegenerative disease in terms of prevalence

A

b. Rigidity is more often bilateral than unilateral in early disease
e. It is the most common neurodegenerative disease in terms of prevalence

78
Q

Circle the combination of diagnostic procedures for idiopathic Parkinson’s disease,
indicating in the most appropriate order and range their importance and
appropriateness for the diagnosis; from the most important/appropriate procedure
(first method listed) to the least important/appropriate (last method listed):
a. clinical presentation, MRI, PET, EEG
b. MRI, clinical presentation, DATscan, liver diagnostics
c. clinical presentation, MRI, DATscan
d. clinical presentation, levodopa test, MRI
e. clinical presentation, levodopa test, MRI, DATscan

A

d. clinical presentation, levodopa test, MRI

79
Q

Circle the therapeutic options for blepharospasm that are appropriately ranked
according to their likely efficacy/invasiveness ratio; from those to be tried first, to
those to be tried latest in the patient’s management:
a. botulinum toxin injection, pharmacological treatment, surgery
b. psychiatric treatment, pharmacological treatment, botulinum toxin
c. pharmacological treatment, surgery, botulinum toxin
d. pharmacological treatment, botulinum toxin, surgery
e. psychosocial intervention and support groups, pharmacological
treatment, botulinum toxin

A

a. botulinum toxin injection, pharmacological treatment, surgery

80
Q

A 59-year-old patient describes “restlessness” in his right hand when writing. He
reports that his hand trembles mainly at work and when he is “nervous”. On
examination: mild increased rigidity in both arms, right arm tremor disappears at rest.
The finger-nose test can be performed with both hands, the amplitude of the right
hand tremor is greatly increased during the test but does not change during the task.
The patient reports that his mother had a similar problem in her old age. A very mild
right arm tremor is observed when holding the arms raised with the eyes closed.
Given the above, circle the option that appropriately ranks the possible diagnoses
from most to least likely:
a. Parkinson’s disease, essential tremor, multiple sclerosis, Wilson’s
disease
b. essential tremor, Parkinson’s disease, Wilson’s disease, cerebellar
tremor
c. essential timor, Parkinson’s disease, cerebellar timor
d. essential tremor, Wilson’s disease, multiple sclerosis, Parkinson’s
disease
e. Parkinson’s disease, essential tremor, cerebellar tremor

A

c. essential timor, Parkinson’s disease, cerebellar timor

81
Q

For walking in neurological patients, everything
applies except:
a. is an important part of the neurological examination
b. some diseases can be identified from the way you walk
c. walking is affected relatively late in the course of the disease in patients
with normotensive hydrocephalus
d. Parkinson’s patients walk hunched forward, with shorter steps on a narrow
base, with their arms less able to follow their gait
e. observe the width of the base of the gait, symmetry, length of steps,
hand tracking, specific gait patterns that are characteristic of the
impairment of particular structures.

A

c. walking is affected relatively late in the course of the disease in patients
with normotensive hydrocephalus

82
Q

In a 47-year-old Parkinson’s patient, treatment would start with:
a. dopamine agonists
b. levodopa in combination with a DOPA decarboxylase inhibitor
c. levodopa only
d. levodopa in combination with a COMT inhibitor
e. no treatment required

A

a. dopamine agonists

83
Q

Which statement about Wilson’s disease is true?
a. inheritance is autosomal dominant
b. always exclude it in elderly patients with extrapyramidal symptomatology
c. patients’ fluid is characterised by albumin-cytologic dissociation
d. penicillamine is used for treatment
e. signs of the disease are due to impaired excretion of lead in the bile

A

d. penicillamine is used for treatment

84
Q

Which of the following findings argues in favour of a diagnosis of idiopathic
Parkinson’s disease versus a diagnosis of one of the Parkinsonism plus syndromes?
a. good response to levodopa treatment
b. downward gaze paresis
c. signs of pyramid line failure
d. balance problems early in the course of the disease
e. symmetrical right and left-wing affliction

A

a. good response to levodopa treatment

85
Q

Why do dopamine agonists, when injected, cause first deterioration then
improvement?
a. dopaminergic denervation hypersensitivity

A

a. dopaminergic denervation hypersensitivity

86
Q

Why does L-dopa cause folding after years of treatment?
a. due to denervation hypersensitivity

A

a. due to denervation hypersensitivity

87
Q

Which motor effects are not side effects of L-dopa treatment?
a. dystonias
b. Myoclonisms
c. choreaform movements
d. motor fluctuations

A

b. Myoclonisms

88
Q

How does levodopa work?
a. as a precursor to dopamine
b. as a partial D2 receptor agonist
c. as a full D2 receptor agonist

A

a. as a precursor to dopamine

89
Q

L-dopa uptake into the brain without dopa carboxylase inhibitors is:
a. 1%
b. 10%
c. 70%

A

a. 1%

90
Q

The striatum is where most of the carrier is located:
a. dopamine
b. serotonin
c. GABA

A

a. dopamine

91
Q

How does amantadine affect me?
a. increases the release of endogenous dopamine
b. is a D2 receptor agonist
c. is a D1 receptor agonist
d. acts as a precursor for dopamine

A

a. increases the release of endogenous dopamine

92
Q

Which drugs can cause neuroleptic malignant syndrome:
a. levodopa
b. dopamine agonists
c. abrupt cessation of dopamine agonists
d. all of the following

A

c. abrupt cessation of dopamine agonists

93
Q

Apomorphine claims:
a. acts on the presynaptic membrane and increases dopamine release
b. is a precursor for dopamine synthesis
c. is a postsynaptic dopamine receptor agonist
d. anticholinergic

A

c. is a postsynaptic dopamine receptor agonist

94
Q

Inheritance of Huntington’s disease - father had the disease, son also genetically
proven. What do you tell him about the children?
a. half of a woman’s offspring will have the disease
b. half of male offspring will have the disease
c. half your offspring will have the disease
d. one quarter of offspring will have the diseas

A

c. half your offspring will have the disease

95
Q

Inheriting Wilson’s disease:
a. autosomal dominant
b. autosomal recessive
c. X-linked
d. Y-vezano

A

b. autosomal recessive

96
Q

Eye with Keyser-Fleischer ring. What do you expect in a patient?
a. hepatopathy

A

a. hepatopathy

97
Q

In the case of the MSA, we see:
a. Parkinsonism, ataxia, urinary incontinence
b. Parkinsonism, ataxia, urinary incontinence, paraparesis

A

b. Parkinsonism, ataxia, urinary incontinence, paraparesis

98
Q

Where is the defect in the dopamine pathway in multiple system atrophy?
a. Presynaptic
b. Postsynaptic
c. Pre and postsynaptic
d. Supranuclear

A

c. Pre and postsynaptic

99
Q

The most common tremor is:
a. Essential
b. Cerebellar
c. Parkinson’s

A

a. Essential

100
Q

How do we distinguish Parkinsonism plus from Parkinson’s disease?
a. Levodopa test
b. hypokinesia
c. Hypomimia
d. all of the above

A

a. Levodopa test

101
Q

Treatment of choreatic joints in Huntington’s disease:
a. haloperidol
b. acetylcholinesterase inhibitors

A

a. haloperidol

102
Q

Focal dystonias include:
a. spastic torticollis
b. blepharospasm
c. Meigs syndrome
d. L-dopa-responsive dystonia
e. all of the above

A

e. all of the above

103
Q

The man has tremor when he is active and maintaining his posture. My
mother also has a tremor. What does she have?
a. essential tremor
b. Huntington’s disease
c. Parkinson’s disease

A

a. essential tremor

104
Q

In Wilson’s disease, we find:
a. elevated serum ceruloplasmin
b. Keyser-Fleisher rings
c. basal ganglia damage
d. recessive mutation on chromosome 7
e. recessive mutation on cormosome 13

A

b. Keyser-Fleisher rings
c. basal ganglia damage
e. recessive mutation on cormosome 13

105
Q

What is not affected in Wilson’s disease?
a. basal ganglia
b. Pyramid system
c. liver
d. eyes

A

b. Pyramid system

106
Q

VIDEO: Patient with hand tremor at rest. What is the best treatment?
a. dopamine agonist
b. levodopa
c. propranolol
d. anticholinergics

A

a. dopamine agonist
b. levodopa
d. anticholinergics

107
Q

Which marker would you point researchers towards for diagnosing PB?
a. β-amyloid
b. α-synuclein
c. tau protein

A

b. α-synuclein

108
Q

In Parkinson’s disease, the prefrontal cortex is impaired due to a defective cortexbasal ganglia-thalamus-cortex pathway. Which impairment in Parkinson’s is present
as a result?
a. affective
b. Cognitive
c. Sensomotor
d. oculomotor
e. vegetative

A

a. affective

Because the emotion circuit is impaired

109
Q

Where is dopamine produced?
a. substantia nigra pars reticulata
b. substantia nigra pars compacta
c. Meynert core
d. nucl. raphe magnus

A

b. substantia nigra pars compacta

110
Q

One gentleman shivering and bent over in the picture. Typical picture. What does
he have?
a. rigidity and tremor

A

a. rigidity and tremor

111
Q

In Parkinson’s dementia, in addition to dopaminergic pathways, the following are
impaired:
a. noradrenergic pathways
b. serotonergic pathways
c. cholinergic routes

A

c. cholinergic routes

112
Q

Essential tremor does not improve after:
a. alcohol
b. benzodiazepine
c. propranolol (a.k.a. primidone)
d. levodopa

A

d. levodopa

113
Q

It helps us to distinguish between essential tremor and Parkinson’s:
a. SPECT imaging of the dopamine transporter

A

a. SPECT imaging of the dopamine transporter

114
Q

Parkinson’s disease is caused by:
a. presynaptic
b. postsynaptic
c. pre- and post-synaptic
d. supranuclear
impairment of dopamine
pathways.

A

a. presynaptic

115
Q

Essential tremor:
a. is often hereditary

A

a. is often hereditary

116
Q

There is no L-dopa side effect:
a. ON-OFF phenomenon
b. myoclonus
c. discines
d. motor fluctuations

A

b. myoclonus

117
Q

Premotor symptoms in Parkinson’s:
a. sensory strange sensations
b. indifference
c. all of the above
d. none of the above

A

b. indifference

118
Q

What is not the case with L-DOPA?
a. It is a pre-medication
b. Selegiline reduces its degradation outside the CNS
c. Carbidopa reduces its degradation outside the CNS
d. Entacapone increases its effects
e. Acts on dopamine transporters

A

e. Acts on dopamine transporters

119
Q

Where are Lewy bodies found (three correct answers)?
a. nucleus dorsalis nervi vagi
b. Lower Olive Core
c. locus coeruleus
d. substantia nigra
e. nucleus ruber

A

a. nucleus dorsalis nervi vagi
c. locus coeruleus
d. substantia nigra

120
Q

How do we treat choreatic dyskinesias after levodopa?
a. taking lower doses of levodopa more often
b. quickly abolish levodopa
c. increase levodopa doses
d. add another drug to levodopa for the treatment of parkinsonism

A

a. taking lower doses of levodopa more often

121
Q

What is not true for Parkinson’s disease?
a. Hypotonia early in the course of the disease
b. Rigidity is more often bilateral than unilateral in the beginning
c. Older people are more often prescribed levodopa than dopamine antagonists
d. Deep brain stimulation targets the subthalamic nucleus
e. It is the second most common neurodegenerative disease in terms of
prevalence

A

b. Rigidity is more often bilateral than unilateral in the beginning

122
Q

What is the treatment for painful leg dystonia that occurs in the early morning
hours after several years of levodopa treatment?
a. botulinum injections into the affected muscle
b. with levodopa
c. with neuroleptics
d. with dopamine antagonists

A

a. botulinum injections into the affected muscle

123
Q

Which gene mutation is associated with the onset of early Parkinson’s
disease?
a. α-synuclein

A

a. α-synuclein

124
Q

Dyskinesias develop with levodopa treatment due to:
a. Short half-lives

A

a. Short half-lives??

125
Q

What are not common side effects of dopamine agonist treatment?
a. weakness
b. itchy skin
c. vomiting
d. orthostatic hypotension

A

b. itchy skin

126
Q

The neurodegenerative changes characteristic of progressive
supranuclear palsy are:
a. Globoid neurofibrillary tangles and tufted, tau-positive astricites

A

a. Globoid neurofibrillary tangles and tufted, tau-positive astricites

127
Q

How to distinguish essential tremor from Parkinson’s disease:
a. DaTSCAN
b. EEG
c. MRI
d. EMG

A

a. DaTSCAN

128
Q

How would you distinguish between parkinsonisms at an early stage of
development?
a. MRI
b. CT
c. SPECT of dopamine transporters (DaTSCAN)
d. none of the above

A

d. none of the above

129
Q

Which drug would you not give to a 70-year-old Parkinson’s patient with
psychosis?
a. classical antipsychotic
b. anticholinergic
c. amantadine
d. dopamine agonists
e. none of the above

A

a. classical antipsychotic

130
Q

In Parkinson’s disease, which system is excised?
a. cholinergic
b. glutaminergic
c. dopaminergic
d. noradrenergic

A

b. glutaminergic

131
Q

Progressive supranuclear palsy is:
a. presynaptic impairment of dopaminergic synapses
b. pre- and postsynaptic impairment of dopaminergic synapses
c. postsynaptic impairment of dopaminergic synapses
d. postsynaptic serotonergic synapses

A

b. pre- and postsynaptic impairment of dopaminergic synapses

132
Q

Parkinson’s patient experiences psychosis. What is the correct
sequence of action?
a. clinical examination and basic tests
b. reducing the dose of dopamine therapy
c. introduce an atypical antipsychotic
d. one step further

A

There’s not an answer, but it would be clinical examination, tests to exclude other psychosis factors, than remove Parkinson drugs but not levo dopa (just reduce), then clozapine

133
Q

What applies to parkinsonism plus?
a. progress is slow
b. respond well to levodopa treatment
c. respond poorly to treatment with dopamine agonists
d. respond well to deep brain stimulation

A

c. respond poorly to treatment with dopamine agonists

134
Q

What is the trio of symptoms characteristic of multiple system atrophy?
a. Parkinsonism, gait apraxia, incontinence
b. Parkinsonism, gait ataxia, incontinence
c. Parkinsonism, paraparesis, incontinence
d. spasticity, incontinence

A

b. Parkinsonism, gait ataxia, incontinence

135
Q

Which of the signs would you not expect if the SPECT signal of the dopamine
transporter DAT in the striatum was reduced by 90%?
a. akinesia
b. mountains
c. muscle rigidity
d. tremor at rest
e. none of the following

A

b. mountains??

136
Q

What is a sensory trick?
a. a diagnostic procedure for tremors, to momentarily distract the patient and
see if the tremor subsides - this is how psychogenic tremor is identified
b. a diagnostic procedure in multiple sclerosis to elicit sensory evoked potentials
and test the conduction velocity across nerve fibres
c. a physical gesture or position that a dystonia patient can adopt that
relieves or eliminates dystonic symptoms
d. a physical gesture or position that a person with multiple sclerosis can take
that relieves or eliminates the symptoms of multiple sclerosis
e. a physical gesture or position that a patient with focal epilepsy can adopt that
relieves or eliminates symptoms of the condition

A

c. a physical gesture or position that a dystonia patient can adopt that
relieves or eliminates dystonic symptoms

137
Q

Dopamine deficiency does not cause:
a. akinesia
b. bradykinesia
c. tremor
d. stereotypes

A

d. stereotypes

138
Q

How can we make Parkinson’s worse?
a. muscarinic receptor antagonists
b. dopamine receptor antagonists
c. inhibition of subthalamus
d. inhibition of the nigrostriatal pathway

A

d. inhibition of the nigrostriatal pathway

139
Q

What is not true for Parkinsonism plus?
a. falls occur early in the course of the disease
b. the only effective treatment is levodopa
c. severe autonomic dysfunction is common
d. the disease progresses rapidly
e. dementia occurs early in the course of the disease

A

b. the only effective treatment is levodopa

140
Q

Parkinson’s disease is:
a. savings
b. prion diseases
c. synucleinopathies
d. glycogen storage diseases

A

c. synucleinopathies

141
Q

What is Wilson’s disease?
a. inheritance is autosomal dominant
b. affects mainly older people, after the age of 70
c. treated with penicillamine
d. it is a disease in which iron accumulates excessively in the body

A

c. treated with penicillamine

142
Q

There is no preclinical sign of Parkinson’s disease:
a. mood disorder
b. memory impairment
c. gastrointestinal disorder
d. sleep disturbance
e. olfactory disturbance

A

b. memory impairment

143
Q

Which test will we perform on a young patient with Parkinsonism?
a. measure copper in urine
b. measure vitamin B12 blood levels
c. measure vitamin D blood levels
d. all of the above
e. none of the above

A

a. measure copper in urine

Neurology (22 decks)

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