Parkinson's disease motor symptoms usually do not appear until a large share of the dopamine neurons in the substantia nigra have already been lost.
Correct Answer
True
True. Because the brain compensates for some time, tremor, rigidity and bradykinesia typically appear only after most dopamine neurons in the substantia nigra are gone. This is one reason the disease is often well established by diagnosis.
Category: Parkinson's Basics
Question 2
Lewy bodies found in the neurons of patients with Parkinson's disease are clumps of the protein amyloid-beta.
Correct Answer
False
False. Lewy bodies are aggregates of the protein alpha-synuclein, which impair dopamine transport and contribute to neuron death. Amyloid-beta plaques are associated with Alzheimer's disease.
Category: Parkinson's Basics
Question 3
Carbidopa crosses the blood-brain barrier and is converted to dopamine in the brain.
Correct Answer
False
False. Carbidopa does not cross the blood-brain barrier and has no antiparkinson effect alone. It works outside the brain, blocking peripheral breakdown of levodopa so more levodopa reaches the brain.
Category: Levodopa Therapy
Question 4
Levodopa is contraindicated in patients with narrow-angle glaucoma.
Correct Answer
True
True. Levodopa can raise intraocular pressure and is contraindicated in narrow-angle glaucoma. Patients with glaucoma need eye monitoring and review by the provider before therapy.
Category: Levodopa Therapy
Question 5
Levodopa-induced dyskinesias become less common the longer a patient takes the drug.
Correct Answer
False
False. Dyskinesias, which are involuntary twisting or writhing movements, become more common with years of levodopa therapy and are frequent in advanced disease. New facial or mouth movements should be reported.
Category: Levodopa Therapy
Question 6
The rotigotine transdermal patch can cause skin reactions at the application site.
Correct Answer
True
True. Application-site redness and itching are common with the rotigotine patch, so sites are rotated. Like other dopamine agonists it can also cause peripheral edema and sudden sleep episodes.
Category: Dopamine Agonists
Question 7
Apomorphine may be given intravenously when faster relief of an off episode is needed.
Correct Answer
False
False. Apomorphine must never be given intravenously because it can cause thrombus formation and pulmonary embolism. It is given by subcutaneous injection or under the tongue.
Category: Dopamine Agonists
Question 8
Patients starting pramipexole are taught to change positions slowly because dopamine agonists can cause orthostatic hypotension.
Correct Answer
True
True. Dopamine agonists blunt the noradrenergic response to standing, so blood pressure can drop on rising, especially early in therapy. Lying and standing blood pressure checks and slow position changes reduce fall risk.
Category: Dopamine Agonists
Question 9
COMT inhibitors such as entacapone relieve Parkinson's symptoms when taken alone without levodopa.
Correct Answer
False
False. COMT inhibitors have no antiparkinson effect of their own. They only prolong and strengthen the effect of levodopa, so they are always given with carbidopa/levodopa.
Category: MAO-B and COMT Inhibitors
Question 10
Amantadine can cause livedo reticularis, a purplish, net-like mottling of the skin.
Correct Answer
True
True. Livedo reticularis is a benign skin mottling, usually on the legs, that can appear after weeks of amantadine therapy. Amantadine is also cleared by the kidneys, so it can accumulate in renal impairment.
Category: Other Antiparkinson Drugs
Question 11
The Beers Criteria list benztropine as an appropriate first choice for adults over 65.
Correct Answer
False
False. The Beers Criteria list anticholinergics such as benztropine as potentially inappropriate for older adults because they cause confusion, sedation, urinary retention, constipation and falls.
Category: Anticholinergics
Question 12
Patients taking interferon beta should be screened for depression and suicidal thoughts.
Correct Answer
True
True. Interferon beta can cause or worsen depression, including suicidal ideation, so mood is assessed before and during therapy. Liver enzymes, blood counts and thyroid function are also monitored.
Category: MS Disease-Modifying Drugs
Question 13
Primary-progressive multiple sclerosis is marked by distinct relapses followed by full recovery.
Correct Answer
False
False. Primary-progressive MS worsens steadily from onset without distinct relapses. Distinct attacks with full or nearly full recovery describe relapsing-remitting MS.
Category: Multiple Sclerosis Basics
Question 14
Patients receiving ocrelizumab are premedicated with a corticosteroid and an antihistamine to reduce infusion reactions.
Correct Answer
True
True. Infusion reactions are common with ocrelizumab, so a corticosteroid and an antihistamine are given before each infusion. Patients are monitored during the infusion and for a period afterward.
Category: MS Disease-Modifying Drugs
Question 15
Glatiramer should be injected into the same site each day to reduce skin reactions.
Correct Answer
False
False. Injection sites must be rotated, because repeated use of one site can cause lipoatrophy, a permanent loss of fat under the skin. The prefilled syringe is warmed to room temperature before use.
Category: MS Disease-Modifying Drugs
Question 16
Siponimod therapy requires eye examinations because the drug can cause macular edema.
Correct Answer
True
True. S1P receptor modulators can cause macular edema, so a fundus exam is done before therapy and again after a few months or whenever vision changes. Diabetes and uveitis raise the risk.
Category: MS Disease-Modifying Drugs
Question 17
Natalizumab is taken as a daily oral tablet.
Correct Answer
False
False. Natalizumab is a monoclonal antibody, a protein that would be digested if swallowed, and it is given by IV infusion through a restricted program.
Category: MS Disease-Modifying Drugs
Question 18
Ropinirole should be tapered rather than stopped abruptly.
Correct Answer
True
True. Stopping a dopamine agonist suddenly can cause confusion, rigidity and high fever resembling neuroleptic malignant syndrome, so the dose is reduced gradually under the provider's direction.
Category: Dopamine Agonists
Question 19
Patients who have finished a course of alemtuzumab no longer need laboratory monitoring for autoimmune disorders.
Correct Answer
False
False. Autoimmune problems such as immune thrombocytopenia, kidney disease and thyroid disorders can appear long after an alemtuzumab course, so blood counts, kidney tests, urine studies and thyroid function are checked regularly for several years after the last infusion. Patients are taught to report bruising, bleeding or symptoms of thyroid change.
Category: MS Disease-Modifying Drugs
Question 20
Heat exposure, such as a fever or a hot bath, can temporarily worsen symptoms of multiple sclerosis.
Correct Answer
True
True. Higher body temperature slows conduction in demyelinated nerves, so heat, fever and stress can bring on or worsen symptoms. Patients are taught to avoid overheating.
Category: Multiple Sclerosis Basics