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
- 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
- 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
- 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
- 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.
- 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
- 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
- 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
- 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
- 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.
- 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
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