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Management of patients with Parkinson disease

doi: 10.1097/01.NPR.0000435479.36881.f6
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INSTRUCTIONS Management of patients with Parkinson disease


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Management of patients with Parkinson disease

General Purpose: The purpose of this learning activity is to provide information about PD and its management. Learning Objectives: After reading this article and taking the test, the learner will be able to: 1. Discuss the incidence, pathophysiology, clinical manifestations, and diagnosis of PD. 2. Describe pharmacologic and nonpharmacologic management strategies for PD.

  1. What percentage of patients is unable to live at home 10 years after PD diagnosis?
    1. more than 75%
    2. 50%
    3. 23%
    4. less than 10%
  2. The most characteristic pathologic feature of PD is the
    1. development of concentric hyaline inclusions (Lewy bodies) found in cytoplasm.
    2. loss of dopamine-containing neurons in the substantia nigra pars compacta.
    3. degeneration of serotonergic neurons.
    4. degeneration of noradrenergic neurons.
  3. Potential risk factors for PD include
    1. exposure to pesticides.
    2. drinking caffeinated beverages.
    3. genetic mutations on chromosomes 2 and 8.
    4. only genetic abnormalities.
  4. Which symptom of PD has a diagnostic sensitivity of 99%?
    1. intentional tremor
    2. cogwheel rigidity
    3. bradykinesia
    4. postural instability
  5. Which nonmotor symptoms are associated with basal ganglia involvement?
    1. mild dementia and psychosis
    2. apathy, restlessness, and impulse control
    3. depression, anxiety, and sleep disorders
    4. orthostatic hypotension, constipation, and sensory disorders
  6. Of the nonmotor symptoms, dysphagia usually
    1. occurs late in PD disease progression.
    2. occurs early in PD disease progression.
    3. occurs before dysarthria.
    4. is not associated with PD.
  7. What percentage of PD patients has clinically significant depression?
    1. 35%
    2. 50%
    3. 60%
    4. 75%
  8. When making a differential diagnosis, imaging tests can identify
    1. PD.
    2. PSP.
    3. multiple cerebral infarctions.
    4. Alzheimer disease.
  9. Which medication or drug category is most effective for managing PD symptoms?
    1. levodopa
    2. carbidopa
    3. dopamine agonists
    4. anticholinergics
  10. Bromocriptine and pramipexole are examples of drugs from which category?
    1. COMT inhibitors
    2. anticholinergics
    3. MAO-B inhibitors
    4. dopamine agonists
  11. The action of the MAO-B inhibitor selegiline is to
    1. stimulate the subthalamic nucleus.
    2. stimulate dopamine receptors in the brain.
    3. block proteins that inactivate dopamine.
    4. block cholinesterase effects at the synapse.
  12. What is the effect of anticholinergic drugs in treating PD?
    1. decrease rigidity
    2. reduce tremors
    3. decrease “wearing off” periods
    4. reduce incidence of dyskinesias
  13. Because of adverse reactions, which antidepressant should be used cautiously in older patients with PD?
    1. amitriptyline
    2. citalopram
    3. paroxetine
    4. venlafaxine
  14. Adverse reactions to DBS include
    1. risk of increasing “on-off time.”
    2. risk of unintentional pallidotomy.
    3. speech disorders and seizures.
    4. stimulation of the subthalamic nucleus.
  15. The authors advise using all these nonpharmacologic PD management strategies except
    1. patient and family education.
    2. cognitive stimulation exercises.
    3. occupational and physical therapy.
    4. support groups for the patient and family.
  16. Which was not reported as research-based for reducing motor-related symptoms?
    1. Tai Chi
    2. music
    3. exercise
    4. yoga
  17. Which organization developed the 10 Quality Measures for PD Improvement ?
    1. National Institutes of Health
    2. Movement Disorder Society
    3. Parkinson's Disease Association
    4. American Academy of Neurology
  18. What resource do the authors suggest for setting goals and advanced care planning?
    1. Parkinson's Disease Model of Care
    2. 10 Qualities for PD Improvement
    3. Unified Parkinson Disease Rating Scale
    4. Parkinson's Disease Common Data Elements Standards


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