Advancing Neurological Therapeutics 2016 | Post-test
This educational program aims to update practitioners on advances in the diagnosis and treatment of Parkinson’s disease, multiple sclerosis, stroke, dementia and related disorders. We will discuss evidence-based management, improvements in therapeutic rehabilitation, and updates on therapeutic theory and practice.
Questions and Answers
- 1.
Which of the following new agents was the first disease modifying therapy to show positive benefit in primary progressive multiple sclerosis in clinical trials?
- A.
Daclizumab
- B.
Alemtuzumab
- C.
Ocrelizumab
- D.
Siponimod
- E.
Ofatumumab
Correct Answer
C. OcrelizumabExplanation
Ocrelizumab is the correct answer because it was the first disease modifying therapy to show positive benefit in primary progressive multiple sclerosis in clinical trials.Rate this question:
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- 2.
Atrophy of which of the following layers on conventional optical coherence tomography (OCT) has been shown to mirror whole brain atrophy in patients with MS?
- A.
Outer plexiform layer
- B.
Photoreceptor inner segment
- C.
Inner nuclear layer
- D.
Ganglion cell + inner plexiform layer
- E.
Retinal pigment epithelium
Correct Answer
D. Ganglion cell + inner plexiform layerExplanation
The ganglion cell + inner plexiform layer on conventional optical coherence tomography (OCT) has been shown to mirror whole brain atrophy in patients with MS. This layer is responsible for transmitting visual information from the photoreceptors to the brain, and its atrophy can indicate damage to the axons and neurons in the optic nerve. This correlation between the atrophy of the ganglion cell + inner plexiform layer and whole brain atrophy suggests that changes in the retina can reflect the overall neurodegenerative process in MS.Rate this question:
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- 3.
What percentage of Alzheimer disease patients are not informed of their diagnosis?
- A.
10%
- B.
20%
- C.
30%
- D.
40%
- E.
50%
Correct Answer
E. 50%Explanation
Approximately 50% of Alzheimer's disease patients are not informed of their diagnosis. This means that half of the patients suffering from Alzheimer's are not made aware of their condition. This could be due to various reasons such as the stigma associated with the disease, concerns about the patient's ability to understand and cope with the diagnosis, or the family's decision to withhold the information. It is important to note that this lack of disclosure can have significant implications for the patient's well-being and access to appropriate care and support.Rate this question:
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- 4.
Which of the following is true about delivering a difficult diagnosis?
- A.
The provider should avoid betraying an emotional response
- B.
It important to “push past” the patients’ emotional expressions to focus on the facts of the case
- C.
Receiving a negative diagnosis is psychologically harmful to the patient
- D.
Medical terminology should be avoided unless necessary to promote understanding
- E.
The provider should get to the point (the diagnosis and plan) as quickly as possible
Correct Answer
D. Medical terminology should be avoided unless necessary to promote understandingExplanation
When delivering a difficult diagnosis, it is important to avoid using medical terminology unless it is necessary to ensure that the patient understands the information being conveyed. Using complex medical jargon can confuse and overwhelm the patient, making it difficult for them to fully grasp the diagnosis and its implications. Instead, the provider should use clear and simple language to promote understanding and facilitate open communication with the patient.Rate this question:
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- 5.
Which of the following is NOT a non-motor symptom associated with neurodegenerative disease:
- A.
Depression
- B.
Fatigue
- C.
Tremor
- D.
Apathy
Correct Answer
C. TremorExplanation
Tremor is not a non-motor symptom associated with neurodegenerative diseases. Non-motor symptoms are symptoms that do not involve movement and are commonly seen in neurodegenerative diseases such as Parkinson's disease. Depression, fatigue, and apathy are examples of non-motor symptoms that can occur in these diseases. Tremor, on the other hand, is a motor symptom characterized by involuntary shaking or trembling movements.Rate this question:
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- 6.
The 2015 MDS Clinical Diagnostic Criteria for Parkinson’s disease include all of the following EXCEPT:
- A.
Retained motor parkinsonism as the core feature (bradykinesia plus rest tremor or rigidity)
- B.
Postural instability
- C.
Increasing recognition to non-motor manifestations
Correct Answer
B. Postural instabilityExplanation
The 2015 MDS Clinical Diagnostic Criteria for Parkinson's disease include retained motor parkinsonism as the core feature (bradykinesia plus rest tremor or rigidity) and increasing recognition to non-motor manifestations. However, postural instability is not included in the criteria.Rate this question:
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- 7.
Botulinum toxin is Indicated for all of the following movement disorders EXCEPT:
- A.
Sialorrhea
- B.
Dystonia
- C.
Spasticity
- D.
Spasmodic dysphonia
- E.
Motor Neuron Disease
Correct Answer
E. Motor Neuron DiseaseExplanation
Botulinum toxin is a neurotoxin that is used to treat various movement disorders by temporarily paralyzing or weakening specific muscles. It is indicated for conditions such as sialorrhea (excessive drooling), dystonia (involuntary muscle contractions), spasticity (muscle stiffness and spasms), and spasmodic dysphonia (voice disorder). However, it is not indicated for the treatment of Motor Neuron Disease, which is a progressive neurodegenerative disorder affecting the motor neurons in the brain and spinal cord. Botulinum toxin cannot reverse the underlying damage caused by Motor Neuron Disease and is not effective in managing its symptoms.Rate this question:
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- 8.
What is the approximately time from stroke onset to catheter based intervention (thrombectomy) for effectivness?
- A.
3 hours
- B.
4.5 hours
- C.
6 hours
- D.
7 hours
- E.
12 hours
Correct Answer
D. 7 hoursExplanation
The approximately time from stroke onset to catheter-based intervention (thrombectomy) for effectiveness is 7 hours. This means that in order for the intervention to be effective, it should ideally be performed within 7 hours after the stroke has occurred. This time frame is crucial for maximizing the chances of successful removal of the blood clot and minimizing potential damage to the brain.Rate this question:
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- 9.
Which therapies are proven to improve outcomes in acute ICH?
- A.
Platelet transfusion
- B.
Acute SBP lowering < 140
- C.
Craniotomy
- D.
IV tPA
- E.
N/A
Correct Answer
E. N/AExplanation
The answer "N/A" stands for "Not applicable" in this context. It means that none of the mentioned therapies (platelet transfusion, acute SBP lowering < 140, craniotomy, IV tPA) have been proven to improve outcomes in acute ICH.Rate this question:
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- 10.
Which of the following statements is false regarding ATYPICAL forms of AD?
- A.
Patients are generally younger than 65 years
- B.
Atypical patients make up about 40% of AD cases
- C.
Hippocampal atrophy may be absent
- D.
Cortical atrophy may be more focal
Correct Answer
B. Atypical patients make up about 40% of AD casesExplanation
The statement "Atypical patients make up about 40% of AD cases" is false because atypical forms of Alzheimer's disease (AD) actually represent a small proportion of cases, estimated to be less than 5%. These atypical forms are characterized by different clinical features and may have distinct underlying causes compared to typical AD.Rate this question:
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- 11.
Amyloid imaging is appropriate in any of the following:
- A.
Patients with persistent or progressive unexplained MCI
- B.
To determine dementia severity
- C.
Patients with progressive dementia and atypically early age of onset (65 years or less in age)
- D.
Asymptomatic individuals
- E.
All of the above
- F.
A and C
- G.
B and D
Correct Answer
F. A and CExplanation
Amyloid imaging is appropriate in patients with persistent or progressive unexplained MCI (mild cognitive impairment) because it can help identify the presence of amyloid plaques in the brain, which are associated with Alzheimer's disease. It is also appropriate in patients with progressive dementia and atypically early age of onset (65 years or less in age) as this could indicate a genetic form of Alzheimer's disease. Therefore, options A and C are correct.Rate this question:
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- 12.
What is the most common early impairment in Alzheimer’s disease?
- A.
Visuospatial
- B.
Executive
- C.
Processing Speed
- D.
Memory
Correct Answer
D. MemoryExplanation
Memory impairment is the most common early impairment in Alzheimer's disease. Alzheimer's disease is a neurodegenerative disorder that primarily affects memory and cognitive functions. As the disease progresses, individuals with Alzheimer's experience difficulty in remembering recent events, names, and faces. This impairment in memory is often the first noticeable symptom and becomes more severe as the disease advances. Other cognitive functions, such as visuospatial abilities, executive functions, and processing speed, may also be affected, but memory impairment is the most prominent and characteristic early sign of Alzheimer's disease.Rate this question:
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- 13.
What is the most common early cognitive impairment in Parkinson’s disease?
- A.
Visuospatial
- B.
Executive
- C.
Processing Speed
- D.
Memory
Correct Answer
B. ExecutiveExplanation
Executive dysfunction is the most common early cognitive impairment in Parkinson's disease. This refers to difficulties in planning, organizing, problem-solving, and multitasking. It can also involve issues with attention, impulse control, and decision making. These cognitive impairments can have a significant impact on daily functioning and quality of life for individuals with Parkinson's disease. Other cognitive impairments such as visuospatial difficulties, processing speed, and memory problems may also occur, but executive dysfunction is the most prevalent.Rate this question:
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- 14.
True of False: Dual Task Testing is vital because it provides more information of real world performance and of potential for adverse events such as falls.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Dual Task Testing is vital because it provides more information about an individual's ability to perform multiple tasks simultaneously, which closely mimics real-world situations. By assessing a person's performance in dual tasking, it can provide insights into their cognitive and physical abilities, coordination, attention, and multitasking skills. Additionally, dual task testing can help identify individuals who may be at risk for adverse events such as falls, as it assesses their ability to divide attention between different tasks while maintaining balance and stability.Rate this question:
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- 15.
Caregiver stress is an under-recognized and undertreated health risk that can lead to poor outcomes for both caregivers and patients with dementia.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Caregiver stress is a significant health risk that often goes unnoticed and untreated. This stress can have negative consequences for both the caregiver and the patient with dementia. When caregivers experience high levels of stress, it can lead to physical and mental health issues, decreased quality of life, and increased risk of burnout. Additionally, the patient with dementia may also experience poorer outcomes, as the caregiver's stress can impact the quality of care provided. Therefore, recognizing and addressing caregiver stress is crucial for the well-being of both caregivers and patients with dementia.Rate this question:
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- 16.
What is considered the most common and debilitating symptom per the majority of MS patients in the research?
- A.
Weakness
- B.
Pain
- C.
Fatigue
- D.
Cognitive impairment
Correct Answer
C. FatigueExplanation
Fatigue is considered the most common and debilitating symptom according to the majority of MS patients in the research. This symptom refers to an overwhelming sense of tiredness and lack of energy, which can significantly impact daily functioning and quality of life. MS-related fatigue is often described as a deep exhaustion that is not relieved by rest and can interfere with physical and cognitive abilities. It is a pervasive symptom that affects many individuals with MS, making it a key focus of research and management strategies.Rate this question:
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- 17.
Which technology has been well documented in literature to demonstrate functional benefits in voice, articulation and intelligibility?
- A.
SpeechVive
- B.
LSVT
- C.
Expiratory Muscle Trainers
- D.
Buck Rogers Walkie Talkies
Correct Answer
B. LSVTExplanation
LSVT (Lee Silverman Voice Treatment) is a technology that has been well documented in literature to demonstrate functional benefits in voice, articulation, and intelligibility. LSVT is a speech therapy program specifically designed for individuals with Parkinson's disease and other neurological disorders. It focuses on improving vocal loudness and clarity, helping individuals with speech difficulties to be better understood. Numerous studies and research papers have been published documenting the effectiveness of LSVT in improving speech and communication abilities in individuals with Parkinson's disease.Rate this question:
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- 18.
Which of the following is an unaided communication system?
- A.
Paper and pencil
- B.
Speech generating Device
- C.
Sign Language
- D.
Smartphone
Correct Answer
C. Sign LanguageExplanation
Sign Language is considered an unaided communication system because it does not require any external tools or devices to convey messages. It relies solely on the use of hand gestures, facial expressions, and body movements to communicate. Unlike the other options listed, such as a speech generating device or a smartphone, Sign Language does not rely on technology or additional aids to facilitate communication.Rate this question:
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