Mehl. Parkinson and like diseases + drugs 04-14 (1)

Question 1

M. Loss of dopamine-secreting neurons in the pars compacta of the midbrain, with deposition of alpha-synuclein on biopsy. Dx?

Answer 1

Parkinson disease

Question 2

M. Presents with classic features of bradykinesia/akinesia, resting tremor, shuffling, short-steppage gait, micrographia, and cogwheel rigidity. Disease?

Answer 2

Parkinson disease

Question 2

M. Parkinson CP?

Answer 2

Presents with classic features of bradykinesia/akinesia, resting tremor, shuffling, short-steppage gait, micrographia, and cogwheel rigidity.

Question 3

M. Parkinson gene mutation?

Answer 3

Alpha-synuclein gene mutation most common; many genes implicated.

Question 4

M. Parkinson. Combo commonly used for Tx?

Answer 4

Carbidopa-levodopa

Question 5

M. Parkinson. what does levodopa?

Answer 5

Levodopa crosses the BBB to be converted to dopamine centrally. However, levodopa is subject to fast metabolism when administered alone.

Question 6

M. Parkinson. function of carbidopa?

Answer 6

The addition of carbidopa to levodopa functions as a competitive inhibitor of breakdown enzymes, resulting in increased levodopa availability for passage across the BBB.

Do not confuse this mechanism with direct COMT inhibitors (tolcapone, entacapone), which prevent breakdown of L-dopa.

Question 7

M. Parkinson. if levodopa- carbidopa administered to high doses, what CP?

Answer 7

can cause psychosis if administered in too-high a dose.

Question 8

M. This is assessed on 2CK Psych forms, where if patient gets psychotic episodes following recent addition of C-L to regimen, or following an increase in dose, the answer is simply “decrease dose of carbidopa-levodopa.” “Discontinue carbidopa-levodopa is the wrong answer.”

Answer 8

.

Question 9

M. Parkinson. mechanism of amantadine?

Answer 9

Amantadine increases presynaptic release of dopamine

Question 10

M. Parkinson. drug that increases presynaptic release of dopamine?

Answer 10

Amantadine

Question 11

M. Parkinson. Be aware of D2 agonist names – i.e., ropinirole, pramipexole, cabergoline, pergolide, and bromocriptine, which can all in theory be used as treatments.

Answer 11

.

Question 12

M. Parkinson. Ropinirole, group?

Answer 12

D2 agonist

Question 13

M. Parkinson. pramipexole, group?

Answer 13

D2 agonist

Question 14

M. Parkinson. cabergoline, group?

Answer 14

D2 agonist

Question 15

M. Parkinson. pergolide, group?

Answer 15

D2 agonist

Question 16

M. Parkinson. Bromocriptine, group?

Answer 16

D2 agonist

Question 17

M. Parkinson. Selegiline inhibits monoamine oxidase B, which is an enzyme that preferentially breaks down dopamine. USMLE wants you to know this can cause serotonin syndrome, either alone, or in combo with drugs like St John Wort or SSRIs.

Answer 17

.

Question 18

M. Parkinson. Selegiline, mechanism?

Answer 18

Selegiline inhibits monoamine oxidase B, which is an enzyme that preferentially breaks down dopamine.

Question 19

M. Parkinson. Selegiline - what complication?

Answer 19

Selegiline inhibits monoamine oxidase B, which is an enzyme that preferentially breaks down dopamine. USMLE wants you to know this can cause serotonin syndrome, either alone, or in combo with drugs like St John Wort or SSRIs.

Question 20

M. Restless leg syndrome. CP?

Answer 20

Idiopathic, irresistible urge to move legs while in bed/sleeping

Question 21

Idiopathic, irresistible urge to move legs while in bed/sleeping.

Answer 21

M. Restless leg syndrome.

Question 22

M. Restless leg syndrome. MCC?

Answer 22

Most common cause is iron deficiency anemia. First step is checking the patient’s serum iron and ferritin.

Question 23

M. Restless leg syndrome. First thing to do = check iron levels. if normal, next step???

Answer 23

If iron studies are normal, gabapentin and D2 agonists (ropinirole, pramipexole) can be used.

Question 24

M. Restless leg syndrome. USMLE wants you to know that patients with RLS have increased risk of developing Parkinson disease, which makes sense since D2 agonists help, indicating a potential problem with dopamine signaling or production in some patients.

Answer 24

.

Question 25

M. Normal pressure hydrocephalus, CP?

Answer 25

“wet, wobbly, wacky” +/- Parkinsonism. The parkinsonism is the most overlooked detail by students, who will usually only know the wet, wobbly, wacky part.

Question 26

“wet, wobbly, wacky” +/- Parkinsonism?

Answer 26

M. Normal pressure hydrocephalus

Question 27

M. Normal pressure hydrocephalus. What the USMLE will do is give you an older male who has WWW triad + they give you 2-3 more sentences describing what sounds like Parkinson disease, where you’re like “What the hell? Is this Parkinson disease?” No. It’s just NPH, which is a Parkinson-plus disorder, where it can look like Parkinson disease but it ain’t.

Answer 27

.

Question 28

M. Normal pressure hydrocephalus. Mechanism of urinary incontinence?

Answer 28

Once again, due to impingement on the corona radiata, and the mechanism they want for urinary incontinence = “failure to inhibit the voiding reflex.”

Question 29

M. Wilson disease. Cp, in what patients?

Answer 29

Parkinsonism in a young patient is Wilson disease till proven otherwise.

Question 30

M. Wilson disease. mechanism?

Answer 30

Excessive copper accumulation in tissues, including the basal ganglia and liver, due to inability to excrete it into bile.

Question 31

M. Lewy body dementia. CP?

Answer 31

The patient will have dementia + visual hallucinations + Parkinsonism.

Question 32

M. The patient will have dementia + visual hallucinations + Parkinsonism. Dx?

Answer 32

Lewy body dementia

Question 33

M. Progressive supranuclear palsy. Obscure condition that gets asked on 2CK.

Answer 33

.

Question 34

M. Progressive supranuclear palsy. You just need to know that 100% of questions will say what CP?

Answer 34

axial dystonia + Parkinsonism they’ll just ask for diagnosis straight-up.

Question 35

M. Progressive supranuclear palsy. what is axial dystonia?

Answer 35

Axial dystonia is a type of muscle condition resulting in abnormal posture and movement of the spine and torso.

Question 36

M. type of muscle condition resulting in abnormal posture and movement of the spine and torso.?

Answer 36

Axial dystonia which is a part of Progressive supranuclear palsy (axial dystonia + parkinsonism)

Question 37

M. MPTP = synthetic heroin.

Answer 37

- Just know it is a cause of Parkinsonism. - Shows up on a 2CK Psych form. Students are like wtf?

Question 38

M. drugs. Bromocriptine - group, also in what condition can be used?

Answer 38

D2 receptor agonist Bromocriptine classic agent used for prolactinoma (dopamine agonism ̄ prolactin).

Question 39

M. drugs. Ropinirole + pramipexole classically show up as .... Tx for what?

Answer 39

as restless leg syndrome treatment

Question 40

M. drugs. Ropinirole + pramipexole classically show up as restless leg syndrome treatment. First step - check iron. is normal, then Tx with these drugs.

Answer 40

New literature suggests gabapentin is first-line over D2 agonists now for RLS, but USMLE won’t play trivia. They will give patient with RLS + say, “In addition to ropinirole, what else could be added?” And gabapentin will be the only answer listed that works.

Question 41

M. drugs. Ropinirole + pramipexole. What could be added for RLS Tx?

Answer 41

New literature suggests gabapentin is first-line over D2 agonists now for RLS, but USMLE won’t play trivia. They will give patient with RLS + say, “In addition to ropinirole, what else could be added?” And gabapentin will be the only answer listed that works.

Question 42

M. Selegiline - irgi for Parkinson disease

Answer 42

.