Parkinson

[Cerebrium]

1. A 50 year old man attends his doctor with a tremor in his left hand. It has been present for six months and is getting worse. It is present at rest and disappears on movement. He also says that he has become slow in dressing and walking. What is the most likely diagnosis?
   1. Essential tremor
   2. Parkinson's disease
   3. Lewy body dementia
   4. Arteriosclerotic pseudoparkinsonism
   5. Multisystem atrophy
2. A 65 year old woman complains of shaking in her hands that often upsets her tea. This has been worsening over the last year. She says it is worse when she is in company and she has become anxious about it. However she still enjoys going out and meeting her friends. She thinks her father had a similar tremor. Alcohol is the only thing that relieves the tremor. Examination is normal apart from an intention tremor. What is the most likely diagnosis?
   1. Thyrotoxicosis
   2. Multiple sclerosis
   3. Social anxiety disorder
   4. Progressive supranuclear palsy
   5. Essential tremor
3. A 75 year old man attends his doctor with three falls in the past three months. His wife says his gait was normal three months ago. He has a history of hypertension and has had a few small strokes in the past. He is taking aspirin and bendrofluazide. On examination he has a shuffling gait and mask-like facies. He has no tremor. His left plantar is upgoing. Blood pressure is 180/100 lying and 180/100 standing. What is the most likely diagnosis?
   1. Parkinson's disease
   2. Multisystem atrophy
   3. Alzheimer's disease
   4. Arteriosclerotic pseudoparkinsonism
   5. Drug induced parkinsonism
4. A 40 year old woman complains of feeling "slowed down." She is also quite low in mood. She says she is gaining weight despite a poor appetite. Examination reveals an expressionless face. Which is the most appropriate next step in diagnosis?
   1. A CT brain scan
   2. Thyroid function tests
   3. Blood glucose
   4. MRI brain scan
5. A 50 year old man complains of a tremor in both his hands. His friends have also commented on his shuffling gait. He has a past history of hypertension, hypercholesterolaemia, and Ménière's disease. He is taking aspirin, atenolol, amlodipine, pravastatin, and metoclopramide. Which medication is most likely causing his symptoms?
   1. Aspirin
   2. Atenolol
   3. Amlodipine
   4. Pravastatin
   5. Metoclopramide
6. An 80 year old man is diagnosed as having Parkinson's disease. His worst symptom is bradykinesia and this is now affecting his quality of life. Which is the most appropriate next step in management?
   1. Refer for physiotherapy
   2. Start rivastigmine
   3. Start levodopa
   4. Start entacapone
   5. Continue close observation
7. A 50 year old man has had Parkinson's disease for five years. He is taking sinemet (levodopa + carbidopa). He has recently started to feel depressed. He cannot sleep at night and has no interest in any of his usual activities. His symptoms of parkinsonism are under reasonable control but he does complain of a dry mouth. Which is the most appropriate next step in management?
   1. Explain that his low mood is a reaction to his physical condition and that there is nothing to be done
   2. Start a dopamine agonist
   3. Start tricyclic antidepressant
   4. Reduce dose of sinemet
   5. Start a selective serotonin reuptake inhibitor
8. A 70 year old man has had Parkinson's disease for 12 years. He is taking sinemet and bromocriptine. His wife is concerned that he says he sees people in his room when there is nobody there. Which is the most appropriate next step in management?
   1. Start chlorpromazine
   2. Start aspirin
   3. Reduce dose of levodopa
   4. Reduce dose of bromocriptine
   5. Start amitryptiline
9. A 69 year old man goes to his doctor as his memory is worsening. He also describes visual hallucinations. His wife says that these symptoms have worsened over the past six months. On examination his movements are slowed down and he has cogwheel rigidity in his arms. What is the most likely diagnosis?
   1. Vascular dementia
   2. Lewy body dementia
   3. Alzheimer's disease
   4. Creutzfeld-Jacob disease
   5. Wilson's disease
10. A 70 year old man comes to see you as he has had recurrent falls. He also has developed occasional incontinence of urine and is quite slowed down. On examination he has a resting tremor and a mask-like face. His left plantar is upgoing. His blood pressure is 160/100 lying and 110/80 standing. You also notice that he has a slight intention tremor. His eye movements are normal. What is the most likely diagnosis?
    1. Parkinson's disease
    2. Multisystem atrophy
    3. Normal ageing
    4. Progressive supranuclear palsy
11. You diagnose a 60 year old woman with Parkinson's disease. She is surprised and says that no one in her family ever had the disease. What percentage of patients with Parkinson's disease have a first degree relative with the disease?
    1. About 1%
    2. About 15%
    3. About 30%
    4. About 45%
12. Which of the following drugs inhibits the breakdown of levodopa by catechol-O-methyl transferase?
    1. Selegeline
    2. Carbidopa
    3. Entacapone
    4. Pramipexole
13. A 65 year old man with Parkinson's disease comes to see you as he has a cough and left sided chest pain. His ESR is elevated at 80 and a chest x ray reveals a left sided pleural fibrotic reaction. Which of the following medications may have caused this?
    1. Levodopa
    2. Ropinorole
    3. Bromocriptine
    4. Entacapone
14. A 60 year old man comes to see you as he feels slowed down. His wife has noticed that his personality has changed and that he has become socially withdrawn. Another doctor started him on sinemet for this symptom but this has not helped. He has fallen a number of times in the past few months. On examination he has rigidity which is equal in both arms. He has no tremor. His speech is difficult to understand and he has a supranuclear gaze palsy. What is the most likely diagnosis?
    1. Parkinson's disease
    2. Multisystem atrophy
    3. Lewy body dementia
    4. Progressive supranuclear palsy