Neurology - Extrapyramidal diseases Flashcards by Elmar Lutz

NEU - 5.1
Which is NOT the sign of Parkinson’s disease?
A) resting tremor
B) a rigidity
C) hyperreflexia
D) postural instability

ANSWER
C) hyperreflexia

EXPLANATION
The hyperreflexia is not the sign of Parkinson’s disease.

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NEU - 5.3
Which territory of the brain is first of all involved in Parkinson’s disease?
A) frontal cortex
B) striatrum
C) pallidum
D) substantia nigra

ANSWER
D) substantia nigra

EXPLANATION
The main neuropathological finding in Parkinson’s disease is the progressive degeneration of the dopaminergic neurons in the sunstantia nigra.

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NEU - 5.4
Typical sign(s) of Huntington’s disease:
A) blepharospasm
B) areflexia
C) pyramidal signs
D) dementia

ANSWER
D) dementia

EXPLANATION
In Huntigton-chorea beside of the hyperkinesia, the subcortical type of dementia is the most typical neuro-psychiatrical sign.

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NEU - 5.5
The form of the inheritance of Wilson’s disease:
A) autosomal recessive
B) autosomal dominant
C) inherited with the X-chromosome
D) it is not hereditary

ANSWER
A) autosomal recessive

EXPLANATION
The Wilson’s disease is inherited by autosomal recessive way.

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NEU - 5.6
The parkinsonic tremor:
A) resting type
B) the intended movements provoke it
C) the lack of tremor excludes the Parkinson’s disease
D) it doesn’t stop during sleep

ANSWER
A) resting type

EXPLANATION
The resting tremor is one of the cardinal motor sings in Parkinson’s disease, which in the starting phase doesn’t provoked by action, intention, and stops during sleep.

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NEU - 5.7
The postural instability in Parkinson’s disease:
A) it is typical from the onset of the disease
B) it appears in the Hoehn–Yahr III. stage
C) it doesn’t happen
D) the Parkinson’s disease is excluded because of this sign

ANSWER
B) it appears in the Hoehn–Yahr III. stage

EXPLANATION
The postural instability never appears in the starting phase of Parkinson’s disease. If there are early falls down, these could be a marker of multiple system atrophy (MSA).

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NEU - 5.8
What kind of medication could be effective in essential tremor?
A) anticholinergic drugs
B) vasodilatators
C) dopamin agonists
D) propranolol

ANSWER
D) propranolol

EXPLANATION
The adequate therapy of the essential tremor are β-blockers and primidon.

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NEU - 5.9
Which drug could cause toxic Parkinsonian syndrome?
A) anilin
B) zinc
C) MPTP (heroin derivate)
D) bensol

ANSWER
C) MPTP (heroin derivate)

EXPLANATION
The regular drug usage in the population of the american young people provoked Parkinsonian –syndrome. The MPTP was a component of these drugs. Since that time the MPTP became the experimental model of provoking the parkinsonism.

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NEU - 5.10
The relative amount of acetyl-choline in the striatum in Parkinson’s disease is:
A) constant
B) elevated
C) decreased
D) there is no acetyl-choline in the striatum

ANSWER
B) elevated

EXPLANATION
The relative increment of the amount of the acetyl-choline is the consequence of the lack of dopamine, which has inhibitory effect. This causes the unbalance of these neurotransmitters.

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NEU - 5.11
The typical sign of the Wilson’s disease is:
A) dystonia
B) doll’s eye phenomenon
C) signs of meningeal irritation
D) the lack of the abdominal skin reflex

ANSWER
A) dystonia

EXPLANATION
In Wilson’s disease there could be any type of dyskinesias, we can see first of all torsinon type of dystonia.

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NEU - 5.12
The striatonigral degeneration is:
A) a form of the multisystem atrophy
B) brain infarct
C) pathological calcification
D) the cerebellar degeneration is an obligatory sing of it

ANSWER
A) a form of the multisystem atrophy

EXPLANATION
The striatonigral degeneration, the olivopontocerebellar atrophy and the Shy-Drager-syndrome are the three forms of the MSA. These three subtypes constitute one pathological entity, when there are inclusion bodies in the degenerated oligodendroglial cells.

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NEU - 5.13
The intentional tremor:
A) the basic sign of the Parkinson’s disease
B) it caused by the damage of the dentato-rubro-thalamic pathway
C) it is decreased, or constant during the intended movements
D) it could be treated with the antiparkinsonic drugs

ANSWER
B) it caused by the damage of the dentato-rubro-thalamic pathway

EXPLANATION
The intentional tremor is the consequence of a cerebellar lesion, definitely the lesion of the dentato-rubro-thalamic pathway.

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NEU - 5.14
The prevalence of the Parkinson’s disease is approximately:
A) 1–2 patients per 100 000 people
B) 5–10 patients per 100 000 people
C) 10–20 patients per 100 000 people
D) 100–200 patients per 100 000 people

ANSWER
D) 100–200 patients per 100 000 people

EXPLANATION
The prevalence of Parkinson’s disease is the same all over the World, under 65 years there are 100-200 patients in 100 000 people.

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NEU - 5.15
The focal dystonias (e.g.: blepharospasm):
A) typical in adulthood
B) typical in childhood
C) there are a lot of patients in both of these groups
D) inherited with the X-chromosome

ANSWER
A) typical in adulthood

EXPLANATION
Focal dystonias can be seen in adulthood

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NEU - 5.16
The signs of the Parkinson’s disease:
1) rigidity
2) ataxic gait
3) hypersalivation
4) saccadic speech

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

ANSWER
B) 1st and 3rd answers are correct

EXPLANATION
According to the international diagnostic criteria, the rigor and salivation are typical for Parkinson’s disease among the answers listed here.

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NEU - 5.17
Used as antiparkinson medication:
1) piracetam
2) selegilin
3) alprazolam
4) bromocriptin

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

ANSWER
C) 2nd and 4th answers are correct

EXPLANATION
The MAO-B inhibitor selegilin and the dopamin-receptor agonist bromocriptin belong to the antiparkinson medication.

NEU - 5.18
Protein intake changes levodopa absorption:
1) facilitates
2) doesn’t influence it
3) doesn’t influence the absorption, but slowes the peristalsis
4) worsen because of competitive antagonism

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

ANSWER
D) only 4th answer is correct

EXPLANATION
The large neutral proteins inhibit the absorption of levodopa through competitive antagonism.

NEU - 5.19
May be the symptom of Huntington’s chorea:
1) chorea
2) dementia
3) agression
4) muscle hypotonia

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

ANSWER
E) all of the answers are correct

EXPLANATION
Huntington-chorea is characterized by both motor and psychiatric symptoms, so all the solutions may occur.

NEU - 5.20
Essential tremor:
1) frequently familial
2) usually occurs in old age
3) characterized by action tremor
4) improves to antiparkinson treatment

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

ANSWER
A) 1st, 2nd and 3rd answers are correct

EXPLANATION
Essentialis tremor is frequently inheritable. In this case it is called as familial tremor.

NEU - 5.21
Symptomatic orthostatic hypotonia occurs in:
1) Parkinson’s disease
2) Tourette syndrome
3) Shy–Drager syndrome
4) generalized dystonia

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

ANSWER
B) 1st and 3rd answers are correct

EXPLANATION
Orthostaticus hypotonia occurs in the late phase of Parkinson’s disease and is typical in the early phase of MSA.

NEU - 5.22
May not cause parkinsonism as a side effect:
1) haloperidol
2) chlorpromazin
3) levomepromazin
4) clozapin

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

ANSWER
D) only 4th answer is correct

EXPLANATION
Clozapin is selectively effective on the dopamin receptors type 4 in the mesolimbic system, so it doesn’t cause parkinsonism.

NEU - 5.23
Ballism:
1) may be a symptom of Parkinson’s disease
2) hypertonic hyperkinesis
3) lesion of the fronto-ponto-cerebellar tract is etiological
4) caused by the lesion of subthalamic nucleus

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

ANSWER
D) only 4th answer is correct

EXPLANATION
The lesion of the subthalamic nucleus results in contralateral (hemi)ballism

NEU - 5.24
Typical in Wilson’s disease:
1) hepatosplenomegalia
2) Kayser-Fleischer ring
3) decrease of the coeruloplasmin activity
4) myoclonus

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

ANSWER
A) 1st, 2nd and 3rd answers are correct

EXPLANATION
Myoclonus is not typical in Wilson’s disease.

NEU - 5.25
Rigor may occur in:
1) Parkinson’s disease
2) vascular parkinsonism
3) Wilson’s disease
4) in the late phase of Huntington’s disease

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

ANSWER
E) all of the answers are correct

EXPLANATION
All of the listed disorders may be accompanied by rigidity, cause either the striatum or particular parts of the motor circuits are injured in these disorders.

NEU-5.26-5.30 Make pairs! Match the diseases and the statements typical to them! A) Parkinson’s disease B) Wilson’s disease C) torticollis D) chorea minor E) subacute sclerosing panencephalitis (SSPE)\ NEU - 5.26 - botulinum toxin is used in the treatment of this disease NEU - 5.27 - rheumatic fever causes it NEU - 5.28 - resting tremor is characteristic NEU - 5.29 - myoclonic jerks are characteristic NEU - 5.30 - there is a decrease of coeruloplasmin ativity in this disease

ANSWER NEU - 5.26 - botulinum toxin is used in the treatment of this disease - C) NEU - 5.27 - rheumatic fever causes it - D) NEU - 5.28 - resting tremor is characteristic - A) NEU - 5.29 - myoclonic jerks are characteristic - E) NEU - 5.30 - there is a decrease of coeruloplasmin ativity in this disease - B)

NEU - 5.31 There is a lack of dopamin in Parkinson’s disease, therefore this can be compensated by levodopa treatment. A) both the statement and the explanation are true and a causal relationship exists between them; B) both the statement and the explanation are true but there is no causal relationship between them; C) the statement is true, but the explanation is false; D) the statement is false, but the explanation itself is true E) both the statement and the explanation are false

ANSWER A) both the statement and the explanation are true and a causal relationship exists between them; EXPLANATION The main pathological characteristic of Parkinson’s disease is dopamin secreting cell death in the substantia nigra wich results in dopamin lack in the striatum. Levodopa is the precursor of dopamin, which can substitute the dopamin.

NEU - 5.32 There is no tremor during voluntary treatment in Parkinson’s disease, because it is ceased by the cerebellar inhibitory pathways. A) both the statement and the explanation are true and a causal relationship exists between them; B) both the statement and the explanation are true but there is no causal relationship between them; C) the statement is true, but the explanation is false; D) the statement is false, but the explanation itself is true E) both the statement and the explanation are false

ANSWER C) the statement is true, but the explanation is false; EXPLANATION There is no intention tremor in Parkinson’s disease, but not because of the activation of inhibitory cerebellar tracts. Intention tremor is caused by the injury of another (dentato-rubro-thalamic) tract.

NEU - 5.33 Parkinson's disease is predominantly hereditary, as evidenced by the concordance test of monozygotic twins. A) both the statement and the explanation are true and a causal relationship exists between them; B) both the statement and the explanation are true but there is no causal relationship between them; C) the statement is true, but the explanation is false; D) the statement is false, but the explanation itself is true E) both the statement and the explanation are false

ANSWER E) both the statement and the explanation are false EXPLANATION Although genetic factors play a role in the development of Parkinson's disease, it is not inherited by Mendelian rules and this was neither proven by twin studies.

NEU - 5.34 Essential tremor is not reduced by alcohol, therefore alcohol-containing products are not used for treatment. A) both the statement and the explanation are true and a causal relationship exists between them; B) both the statement and the explanation are true but there is no causal relationship between them; C) the statement is true, but the explanation is false; D) the statement is false, but the explanation itself is true E) both the statement and the explanation are false

ANSWER D) the statement is false, but the explanation itself is true EXPLANATION Essential tremor is reduced by alcohol, but we never administer alcohol as a medicine.

NEU - 5.35 Essential tremor is associated with disturbance of writing, this subgroup of the essential tremor is the so called writer's cramp. A) both the statement and the explanation are true and a causal relationship exists between them; B) both the statement and the explanation are true but there is no causal relationship between them; C) the statement is true, but the explanation is false; D) the statement is false, but the explanation itself is true E) both the statement and the explanation are false

ANSWER C) the statement is true, but the explanation is false; EXPLANATION Writer’s cramp is not a tremor, it is a form of focal dystonias.

NEU - 5.36 Based on the history, what is the most likely diagnosis? Resting tremor in the right hand and rigidity in the wrist and elbow has developed in the last few months in a 60-year-old man. A) essential tremor B) multiple system atrophy C) Parkinson's disease D) multiple sclerosis E) cerebellar tumor

ANSWER C) Parkinson's disease EXPLANATION Based on international criteria, the basic symptoms of Parkinson's disease include rigor and resting tremor in addition to hypo/bradykinesis and postural instability. Two basic symptoms provide the diagnosis.

NEU - 5.37 The CT, MR, SPECT and EEG examinations were negative. Based on these findings: Resting tremor in the right hand and rigidity in the wrist and elbow has developed in the last few months in a 60-year-old man. A) Parkinson's disease can be excluded B) Parkinson's disease can not be excluded C) essential tremor is probable D) multiple system atrophy can be proven E) multiple sclerosis is probable

ANSWER B) Parkinson's disease can not be excluded EXPLANATION Neither imaging studies nor electrophysiological studies prove the Parkinson's disease.

NEU - 5.38 Based on the history, what is the most likely diagnosis? An 80-year-old woman has complained of hand tremor for years. The tremor occurs during voluntary movement of the hand, therefore she can not write and eat without help. A) Parkinson's disease B) cortical atrophy C) multiple system atrophy D) essential tremor E) based on the symptoms, diagnosis can not be established

ANSWER D) essential tremor EXPLANATION Tremor that appears at guided, voluntary movement (e.g. eating, writingetc.) is characteristic for essential tremor.

NEU - 5.39 The tremor improved after administration of a low-dose propranolol. This confirms the suspicion of the following disease: An 80-year-old woman has complained of hand tremor for years. The tremor occurs during voluntary movement of the hand, therefore she can not write and eat without help. A) Parkinson's disease B) cortical atrophy C) multiple system atrophy D) essential tremor E) based on the symptoms diagnosis can not be deduced

ANSWER D) essential tremor EXPLANATION Tremor that is improved by administration of β-blocker is characteristic for essential tremor.

NEU - 5.40 What are the characteristics of the disease that is associated with tremor during voluntary movement and responds well to propranolol treatment? An 80-year-old woman has complained of hand tremor for years. The tremor occurs during voluntary movement of the hand, therefore she can not write and eat without help. A) it is often a familial, hereditary disease (the disease runs very often in the family) B) it appears only over 60 years C) anticholinergic drugs can improve the symptoms of the disease D) physiotherapy is necessary E) CT result is always negative

ANSWER A) it is often a familial, hereditary disease (the disease runs very often in the family) EXPLANATION The essential tremor is often hereditary.