CPD E-Module MCQS - Professor C.E. Clarke

1. Possible treatments for early Parkinson's disease with functional disability DO NOT include:

Levodopa preparations

Dopamine agonists

Monoamine oxidase B inhibitors

Levodopa with a catechol-O-methyl transferase inhibitor

All of the above

The correct answer is Levodopa with a catechol-O-methyl transferase inhibitor. Levodopa preparations, dopamine agonists, and monoamine oxidase B inhibitors are all possible treatments for early Parkinson's disease with functional disability. However, levodopa with a catechol-O-methyl transferase inhibitor is not a recommended treatment option.

Explanation

The correct answer is Levodopa with a catechol-O-methyl transferase inhibitor. Levodopa preparations, dopamine agonists, and monoamine oxidase B inhibitors are all possible treatments for early Parkinson's disease with functional disability. However, levodopa with a catechol-O-methyl transferase inhibitor is not a recommended treatment option.

2. Which of the following statements is true of rehabilitation therapies in Parkinson's disease:

Further trials of all rehabilitation therapies are required at all stages of the disease

There is firm evidence of the efficacy of physiotherapy and occupational therapy in the early stages of the disease

There is firm evidence of the efficacy of physiotherapy and occupational therapy in the later stages of the disease

There is firm evidence of the efficacy of traditional NHS speech and language therapy in all stages of the disease.

The given correct answer states that further trials of all rehabilitation therapies are required at all stages of Parkinson's disease. This suggests that there is still a need for additional research and evidence to determine the effectiveness of rehabilitation therapies in managing the disease. It implies that the current knowledge and evidence regarding rehabilitation therapies may not be sufficient, and more studies are needed to fully understand their impact on Parkinson's disease patients at different stages.

Explanation

The given correct answer states that further trials of all rehabilitation therapies are required at all stages of Parkinson's disease. This suggests that there is still a need for additional research and evidence to determine the effectiveness of rehabilitation therapies in managing the disease. It implies that the current knowledge and evidence regarding rehabilitation therapies may not be sufficient, and more studies are needed to fully understand their impact on Parkinson's disease patients at different stages.

3. Potential disease modifying therapies in Parkinson's disease undergoing clinical trials DO NOT include:

Creatine

Co-enzyme Q10

Isradipine

Cogane

Riluzole

Riluzole is not a potential disease modifying therapy in Parkinson's disease undergoing clinical trials. The other options mentioned - Creatine, Co-enzyme Q10, Isradipine, and Cogane - are all being studied as potential treatments for Parkinson's disease. However, Riluzole is not currently being investigated as a disease modifying therapy for this condition.

Explanation

Riluzole is not a potential disease modifying therapy in Parkinson's disease undergoing clinical trials. The other options mentioned - Creatine, Co-enzyme Q10, Isradipine, and Cogane - are all being studied as potential treatments for Parkinson's disease. However, Riluzole is not currently being investigated as a disease modifying therapy for this condition.

4. Potential new drug classes in Parkinson's disease DO NOT include:

Adenosine antagonists

Dopamine antagonists

Dopamine re-uptake inhibitors

Partial dopamine agonists

Alpha-2 noradrenergic antagonists

Dopamine antagonists are not potential new drug classes in Parkinson's disease. This is because Parkinson's disease is characterized by a lack of dopamine in the brain, and dopamine antagonists work by blocking the effects of dopamine. Therefore, using dopamine antagonists would further reduce dopamine levels, worsening the symptoms of Parkinson's disease. Instead, potential new drug classes include adenosine antagonists, dopamine re-uptake inhibitors, partial dopamine agonists, and alpha-2 noradrenergic antagonists, which aim to increase dopamine levels or modulate other neurotransmitters involved in the disease.

Explanation

Dopamine antagonists are not potential new drug classes in Parkinson's disease. This is because Parkinson's disease is characterized by a lack of dopamine in the brain, and dopamine antagonists work by blocking the effects of dopamine. Therefore, using dopamine antagonists would further reduce dopamine levels, worsening the symptoms of Parkinson's disease. Instead, potential new drug classes include adenosine antagonists, dopamine re-uptake inhibitors, partial dopamine agonists, and alpha-2 noradrenergic antagonists, which aim to increase dopamine levels or modulate other neurotransmitters involved in the disease.

5. The TEMPO and ADAGIO delayed-start design trials raised the prospect that rasagiline has a disease modifying effect in Parkinson's disease. Arguments against this include:

Inconsistent results with the 1 mg/d and 2 mg/d results in the two trials

Lack of clinical significance of the results

Absence of quality of life data

Absence of health economics analysis

All of the above

The given answer, "All of the above," is correct because it encompasses all the arguments against the notion that rasagiline has a disease modifying effect in Parkinson's disease. The inconsistent results with different dosages in the TEMPO and ADAGIO trials, the lack of clinical significance, the absence of quality of life data, and the absence of health economics analysis all contribute to the arguments against rasagiline's disease modifying effect.

Explanation

The given answer, "All of the above," is correct because it encompasses all the arguments against the notion that rasagiline has a disease modifying effect in Parkinson's disease. The inconsistent results with different dosages in the TEMPO and ADAGIO trials, the lack of clinical significance, the absence of quality of life data, and the absence of health economics analysis all contribute to the arguments against rasagiline's disease modifying effect.

6. Prolonged-release dopamine agonists are UNLIKELY to be useful in patients with Parkinson's disease who have:

Poor compliance

Nocturnal akinesia

Severe motor fluctuations

Early morning akinesia

All of the above

Prolonged-release dopamine agonists are unlikely to be useful in patients with Parkinson's disease who have severe motor fluctuations. This is because prolonged-release dopamine agonists are designed to provide a steady and continuous release of dopamine, which may not effectively address the rapid and unpredictable fluctuations in motor symptoms experienced by these patients. Other treatment options, such as levodopa or deep brain stimulation, may be more appropriate for managing severe motor fluctuations in Parkinson's disease.

Explanation

Prolonged-release dopamine agonists are unlikely to be useful in patients with Parkinson's disease who have severe motor fluctuations. This is because prolonged-release dopamine agonists are designed to provide a steady and continuous release of dopamine, which may not effectively address the rapid and unpredictable fluctuations in motor symptoms experienced by these patients. Other treatment options, such as levodopa or deep brain stimulation, may be more appropriate for managing severe motor fluctuations in Parkinson's disease.

7. Which is the only randomised controlled trial in PD that uses measures of sleep as a co-primary endpoint?

ADAGIO

EASE- PD

STRIDE – PD

RECOVER

PROUD

RECOVER is the only randomised controlled trial in PD that uses measures of sleep as a co-primary endpoint.

Explanation

RECOVER is the only randomised controlled trial in PD that uses measures of sleep as a co-primary endpoint.

8. A 63 year old with Parkinson's disease for 7 years has severe off periods. He is otherwise healthy, with no symptoms of dementia. The most effective adjuvant agent is likely to be:

Entacapone

Rasagiline

Amantadine

Selegiline

Non-ergot dopamine agonist

The most effective adjuvant agent for a 63-year-old with severe off periods in Parkinson's disease is likely to be a non-ergot dopamine agonist. Non-ergot dopamine agonists, such as pramipexole or ropinirole, can help improve motor symptoms and reduce off periods in Parkinson's disease. These medications work by stimulating dopamine receptors in the brain, compensating for the loss of dopamine-producing cells. They are often used as an add-on therapy in patients who are already taking levodopa but experiencing fluctuations in their response to the medication.

Explanation

The most effective adjuvant agent for a 63-year-old with severe off periods in Parkinson's disease is likely to be a non-ergot dopamine agonist. Non-ergot dopamine agonists, such as pramipexole or ropinirole, can help improve motor symptoms and reduce off periods in Parkinson's disease. These medications work by stimulating dopamine receptors in the brain, compensating for the loss of dopamine-producing cells. They are often used as an add-on therapy in patients who are already taking levodopa but experiencing fluctuations in their response to the medication.

9. A fit 74 year old patient with newly diagnosed Parkinson's disease and significant functional disability should be treated with:

The evidence-base is poor and it is currently uncertain with what such a patient should be treated.

Non-ergot dopamine agonist

Levodopa

Monoamine oxidase B inhibitor

Amantadine

not-available-via-ai

Explanation

not-available-via-ai

10. You are asked to see a 59 year old patient with Parkinson's disease for 15 years with severe motor fluctuations. He is taking Stalevo® 100 strength tablets five daily, rotigotine patch 16 mg per day, and amantadine 100 mg three daily. He has a history of severe depression and an early neuropathy with type 2 diabetes. Which of the following statements is NOT true about his possible treatment options:

Subthalamic deep brain stimulation surgery is inappropriate because it may aggravate his depression and trigger suicidal ideation

Apomorphine is not appropriate as he is more likely to develop skin nodules

Whichever option is chosen, his mental state should be monitored carefully in view of the risk of Parkinson's disease dementia.

The statement that apomorphine is not appropriate due to the risk of developing skin nodules is not true. Apomorphine is a dopamine agonist that can be used to treat motor fluctuations in Parkinson's disease. While it is true that apomorphine can cause subcutaneous nodules at the injection site, this side effect can be managed by rotating injection sites and using proper injection techniques. Therefore, apomorphine can still be a viable treatment option for this patient.

Explanation

The statement that apomorphine is not appropriate due to the risk of developing skin nodules is not true. Apomorphine is a dopamine agonist that can be used to treat motor fluctuations in Parkinson's disease. While it is true that apomorphine can cause subcutaneous nodules at the injection site, this side effect can be managed by rotating injection sites and using proper injection techniques. Therefore, apomorphine can still be a viable treatment option for this patient.

11. A systematic review of trials examining the efficacy and safety of treatments for advanced Parkinson's disease has NOT shown:

Any trials comparing apomorphine infusion, deep brain stimulation surgery, and intestinal levodopa gel infusion in randomised controlled trials

Positive randomised controlled trials of apomorphine infusion versus best medical therapy

Positive randomised controlled trials of deep brain stimulation surgery and intestinal levodopa gel infusion versus best medical therapy

Positive effects of deep brain stimulation surgery on quality of life

None of the above

The systematic review did not find any positive randomized controlled trials comparing apomorphine infusion with the best medical therapy.

Explanation

The systematic review did not find any positive randomized controlled trials comparing apomorphine infusion with the best medical therapy.

Cpd E-module MCQs - Professor C.E. Clarke