Cpd E-module MCQs - Professor C.E. Clarke
- 1.
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:
- A.
Inconsistent results with the 1 mg/d and 2 mg/d results in the two trials
- B.
Lack of clinical significance of the results
- C.
Absence of quality of life data
- D.
Absence of health economics analysis
- E.
All of the above
Correct Answer
E. All of the aboveExplanation
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.Rate this question:
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- 2.
Possible treatments for early Parkinson's disease with functional disability DO NOT include:
- A.
Levodopa preparations
- B.
Dopamine agonists
- C.
Monoamine oxidase B inhibitors
- D.
Levodopa with a catechol-O-methyl transferase inhibitor
- E.
All of the above
Correct Answer
D. Levodopa with a catechol-O-methyl transferase inhibitorExplanation
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.Rate this question:
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- 3.
Prolonged-release dopamine agonists are UNLIKELY to be useful in patients with Parkinson's disease who have:
- A.
Poor compliance
- B.
Nocturnal akinesia
- C.
Severe motor fluctuations
- D.
Early morning akinesia
- E.
All of the above
Correct Answer
C. Severe motor fluctuationsExplanation
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.Rate this question:
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- 4.
A systematic review of trials examining the efficacy and safety of treatments for advanced Parkinson's disease has NOT shown:
- A.
Any trials comparing apomorphine infusion, deep brain stimulation surgery, and intestinal levodopa gel infusion in randomised controlled trials
- B.
Positive randomised controlled trials of apomorphine infusion versus best medical therapy
- C.
Positive randomised controlled trials of deep brain stimulation surgery and intestinal levodopa gel infusion versus best medical therapy
- D.
Positive effects of deep brain stimulation surgery on quality of life
- E.
None of the above
Correct Answer
B. Positive randomised controlled trials of apomorphine infusion versus best medical therapyExplanation
The systematic review did not find any positive randomized controlled trials comparing apomorphine infusion with the best medical therapy.Rate this question:
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- 5.
Which of the following statements is true of rehabilitation therapies in Parkinson's disease:
- A.
Further trials of all rehabilitation therapies are required at all stages of the disease
- B.
There is firm evidence of the efficacy of physiotherapy and occupational therapy in the early stages of the disease
- C.
There is firm evidence of the efficacy of physiotherapy and occupational therapy in the later stages of the disease
- D.
There is firm evidence of the efficacy and cost effectiveness of Lee Silverman Voice Training in all stages of the disease
- E.
There is firm evidence of the efficacy of traditional NHS speech and language therapy in all stages of the disease.
Correct Answer
A. Further trials of all rehabilitation therapies are required at all stages of the diseaseExplanation
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.Rate this question:
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- 6.
Potential disease modifying therapies in Parkinson's disease undergoing clinical trials DO NOT include:
- A.
Creatine
- B.
Co-enzyme Q10
- C.
Isradipine
- D.
Cogane
- E.
Riluzole
Correct Answer
E. RiluzoleExplanation
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.Rate this question:
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- 7.
Potential new drug classes in Parkinson's disease DO NOT include:
- A.
Adenosine antagonists
- B.
Dopamine antagonists
- C.
Dopamine re-uptake inhibitors
- D.
Partial dopamine agonists
- E.
Alpha-2 noradrenergic antagonists
Correct Answer
B. Dopamine antagonistsExplanation
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.Rate this question:
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- 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:
- A.
Entacapone
- B.
Rasagiline
- C.
Amantadine
- D.
Selegiline
- E.
Non-ergot dopamine agonist
Correct Answer
E. Non-ergot dopamine agonistExplanation
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.Rate this question:
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- 9.
A fit 74 year old patient with newly diagnosed Parkinson's disease and significant functional disability should be treated with:
- A.
The evidence-base is poor and it is currently uncertain with what such a patient should be treated.
- B.
Non-ergot dopamine agonist
- C.
Levodopa
- D.
Monoamine oxidase B inhibitor
- E.
Amantadine
Correct Answer
A. The evidence-base is poor and it is currently uncertain with what such a patient should be treated. -
- 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:
- A.
Subthalamic deep brain stimulation surgery is inappropriate because it may aggravate his depression and trigger suicidal ideation
- B.
Apomorphine is not appropriate as he is more likely to develop skin nodules
- C.
If given intestinal levodopa gel infusion, the neuropathy should be monitored in case it deteriorates due to interference with vitamin B12 metabolism
- D.
Intestinal levodopa gel infusion is inappropriate because he has not been considered for apomorphine or surgery as per the Summary of Product Characteristics
- E.
Whichever option is chosen, his mental state should be monitored carefully in view of the risk of Parkinson's disease dementia.
Correct Answer
B. Apomorphine is not appropriate as he is more likely to develop skin nodulesExplanation
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.Rate this question:
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- 11.
Which is the only randomised controlled trial in PD that uses measures of sleep as a co-primary endpoint?
- A.
ADAGIO
- B.
EASE- PD
- C.
STRIDE – PD
- D.
RECOVER
- E.
PROUD
Correct Answer
D. RECOVERExplanation
RECOVER is the only randomised controlled trial in PD that uses measures of sleep as a co-primary endpoint.Rate this question:
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