Abnormally small, cramped handwriting that shrinks further as a person keeps writing is a Parkinson's sign called micrographia.
Missing Word
micrographia
Micrographia reflects the reduced size and speed of movement in Parkinson's disease. It is often one of the early signs noticed by patients and families.
Category: Parkinson's Basics
Question 2
Slowness in starting and carrying out voluntary movement, a cardinal motor sign of Parkinson's disease, is called bradykinesia.
Missing Word
bradykinesia
Bradykinesia causes a shuffling gait, reduced blinking and a masked face. Together with resting tremor, rigidity and postural instability it forms the core motor picture of the disease.
Category: Parkinson's Basics
Question 3
In Parkinson's disease, degeneration of neurons in the substantia nigra depletes the neurotransmitter dopamine in the striatum.
Missing Word
dopamine
Dopamine from the substantia nigra normally balances acetylcholine in the basal ganglia. Most antiparkinson drugs work by restoring this neurotransmitter's effect or by reducing the excess cholinergic activity.
Category: Parkinson's Basics
Question 4
The irreversible MAO-B inhibitor that, unlike selegiline, is not metabolized to amphetamines is rasagiline.
Missing Word
rasagiline
Rasagiline blocks MAO-B so dopamine lasts longer in the brain. Because it has no amphetamine metabolites, it lacks the amphetamine-related stimulation that makes selegiline more likely to cause insomnia.
Category: MAO-B and COMT Inhibitors
Question 5
The antiviral drug that is also used in Parkinson's disease to reduce levodopa-induced dyskinesias is amantadine.
Missing Word
amantadine
Amantadine acts through several mechanisms, including increased dopamine release and blockade of NMDA glutamate receptors. It is less potent than levodopa but useful for dyskinesias, and it needs dose reduction in renal impairment.
Category: Other Antiparkinson Drugs
Question 6
The progressive loss of the insulating sheath around axons in the brain, spinal cord and optic nerves, the hallmark injury of multiple sclerosis, is called demyelination.
Missing Word
demyelination
Demyelination strips axons of the sheath that lets impulses travel quickly, so signals slow or fail and symptoms such as weakness, numbness and vision loss appear. Scarred areas called plaques form where the damage occurs and can be seen on MRI.
Category: Multiple Sclerosis Basics
Question 7
By blocking muscarinic receptors in the eye, benztropine causes mydriasis, a widening of the pupil that can raise intraocular pressure.
Missing Word
mydriasis
Mydriasis is pupil dilation; with anticholinergics it can trigger angle-closure glaucoma and cause photophobia. Patients are taught to wear dark glasses outdoors and have regular eye exams.
Category: Anticholinergics
Question 8
Because levodopa use has been linked to a higher risk of the skin cancer melanoma, patients are taught to check their skin regularly.
Missing Word
melanoma
Melanoma arises from pigment-producing skin cells. Patients taking levodopa and some other antiparkinson drugs are taught to examine their skin and report changing moles.
Category: Levodopa Therapy
Question 9
In the central nervous system, myelin is made by glial cells called oligodendrocytes, which repair it poorly in multiple sclerosis.
Missing Word
oligodendrocytes
Oligodendrocytes wrap axons in the brain and spinal cord with myelin. In multiple sclerosis they cannot effectively rebuild damaged myelin, so scarred plaques form and block conduction.
Category: Multiple Sclerosis Basics
Question 10
When teriflunomide must be cleared from the body quickly, an accelerated elimination procedure uses activated charcoal or the bile acid sequestrant cholestyramine.
Missing Word
cholestyramine
Teriflunomide can remain in the body for months. Cholestyramine binds it in the gut and interrupts its recycling, which is done after liver injury or when pregnancy is planned or occurs.
Category: MS Disease-Modifying Drugs
Question 11
The GABA-B agonist muscle relaxant that can be delivered straight into the spinal fluid by an implanted intrathecal pump is baclofen.
Missing Word
baclofen
Baclofen acts in the spinal cord to reduce spasticity in multiple sclerosis and spinal cord injury. Intrathecal delivery allows lower doses with fewer sedative effects, but interruption can cause dangerous withdrawal.
Category: MS Symptom Drugs
Question 12
The COMT inhibitor that is taken with every carbidopa/levodopa dose and is also sold in a combination tablet with both drugs is entacapone.
Missing Word
entacapone
Entacapone is a selective, reversible COMT inhibitor that prolongs each levodopa dose. A triple combination tablet simplifies the regimen and improves adherence.
Category: MAO-B and COMT Inhibitors
Question 13
The COMT inhibitor reserved for patients who cannot use safer drugs, because it can cause severe and sometimes fatal liver injury, is tolcapone.
Missing Word
tolcapone
Tolcapone requires informed consent and baseline and periodic liver function testing. Patients report jaundice, dark urine, clay-colored stools or right upper quadrant pain at once.
Category: MAO-B and COMT Inhibitors
Question 14
The monoclonal antibody that targets CD52 on lymphocytes and carries boxed warnings for autoimmune disease, infusion reactions, stroke and cancer is alemtuzumab.
Missing Word
alemtuzumab
Alemtuzumab destroys lymphocytes carrying CD52, after which the immune system slowly rebuilds. Its serious risks mean it is given in limited courses with premedication and long-term monitoring.
Category: MS Disease-Modifying Drugs
Question 15
The gabapentinoid used for neuropathic pain in multiple sclerosis that is classified federally as a Schedule V controlled substance is pregabalin.
Missing Word
pregabalin
Pregabalin reduces neurotransmitter release by binding calcium channels and is used for neuropathic pain and as an add-on for focal seizures. Its scheduling reflects a potential for misuse and dependence, so it is tapered rather than stopped abruptly.
Category: MS Symptom Drugs