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Test Your Knowledge with Our Parkinson's Disease Treatment Quiz

Think you can ace this Parkinson's treatment challenge? Start the quiz now!

Difficulty: Moderate
2-5mins
Learning OutcomesCheat Sheet
Paper art illustration for Parkinsons disease treatment quiz on a coral background

Think you know the ins and outs of Parkinson's care? Welcome to our Parkinson's Disease Treatment Quiz - your go-to neurological quiz for assessing medication protocols, therapy strategies, and patient support techniques. This Parkinson's treatment quiz is specifically crafted for clinicians, nursing students, and lifelong learners eager to tackle Parkinson's disease treatment questions head-on. From dopaminergic dosing nuances to multidisciplinary care planning, you'll test your skills in our movement disorder treatment quiz segments. Dive in by trying our parkinson's disease quiz and then challenge yourself with a quick-hit Parkinson's quiz . Track your progress, share your score, and boost your confidence - get started now!

What is the most effective first-line pharmacologic treatment for bradykinesia in Parkinson's disease?
Levodopa combined with carbidopa
Selegiline
Benztropine
Entacapone
Levodopa is the most potent agent for improving bradykinesia in Parkinson's disease, and carbidopa inhibits peripheral decarboxylation of levodopa, increasing central availability. This combination reduces peripheral side effects like nausea and hypotension. It remains the gold standard for symptomatic treatment of PD motor features. Mayo Clinic
What is the primary purpose of adding carbidopa to levodopa therapy?
Prevent peripheral conversion of levodopa
Directly stimulate dopamine receptors
Increase blood - brain barrier permeability
Reduce central side effects
Carbidopa inhibits the aromatic L-amino acid decarboxylase enzyme in the periphery, preventing levodopa's conversion to dopamine outside the brain. This increases CNS availability of levodopa and reduces peripheral adverse effects such as nausea and orthostatic hypotension. Carbidopa itself does not cross the blood - brain barrier. NCBI Bookshelf
Which class of medication is entacapone and what is its role in Parkinson's disease management?
Dopamine agonist that prevents motor complications
Anticholinergic that reduces tremor
COMT inhibitor that prolongs levodopa effect
MAO-B inhibitor that reduces on-off fluctuations
Entacapone is a catechol-O-methyltransferase (COMT) inhibitor that blocks peripheral metabolism of levodopa, thereby prolonging its half-life and smoothing out fluctuations in plasma levels. It is used as an adjunct to levodopa/carbidopa to manage wearing-off phenomena. It does not directly affect dopamine receptors. Parkinson's Foundation
Selegiline is classified as which type of medication in Parkinson's disease treatment?
MAO-B inhibitor
Anticholinergic
COMT inhibitor
Dopamine agonist
Selegiline selectively inhibits the monoamine oxidase B (MAO-B) enzyme, reducing the breakdown of dopamine in the brain. This leads to increased dopaminergic activity and modest symptomatic relief, particularly in early Parkinson's disease. It can be used alone or with levodopa. NCBI Bookshelf
Which motor symptom of Parkinson's disease responds best to levodopa therapy?
Gait freezing
Balance issues
Postural instability
Bradykinesia
Levodopa is most effective at improving bradykinesia and rigidity, the cardinal motor signs of Parkinson's disease, by replenishing deficient dopamine levels in the basal ganglia. It has less impact on postural instability and gait freezing, which may require additional therapies like physical therapy or deep brain stimulation. UpToDate
Which of the following is a common early side effect of levodopa/carbidopa therapy?
Nausea
Hypertension
Hyperkalemia
Bradycardia
Nausea is a common early side effect due to peripheral dopamine receptor stimulation. Carbidopa helps reduce this effect, but mild gastrointestinal side effects may still occur and can often be managed with dose adjustments or antiemetics. Other cardiovascular effects are less frequent. Mayo Clinic
Which non-pharmacologic intervention is recommended alongside medication in Parkinson's disease care?
Physical therapy focusing on balance and gait
Complete bed rest
Fluid restriction
High-protein diet
Physical therapy that emphasizes balance, strength, and gait training improves mobility, reduces fall risk, and complements pharmacologic treatment. Structured exercise programs can also enhance quality of life and may slow functional decline. High-protein diets can actually interfere with levodopa absorption. NCBI PMC
What does the "wearing-off" phenomenon refer to in Parkinson's disease treatment?
Return of motor symptoms before the next levodopa dose
Side effect of dopamine agonists
Withdrawal syndrome from MAO-B inhibitors
End-of-dose nausea
The wearing-off phenomenon describes the re-emergence of Parkinsonian motor symptoms as the effect of a levodopa dose diminishes before the next scheduled dose. It indicates that the dosing interval may need adjustment or adjunct therapy like COMT inhibitors. It is distinct from peak-dose dyskinesias. Parkinson's Foundation
The "on-off" phenomenon in Parkinson's disease is best described as:
Sudden, unpredictable fluctuations between mobility and immobility
Tolerance to dopamine agonists
Prolonged motor response after dosing
Gradual decline in levodopa efficacy
On-off fluctuations involve abrupt transitions between good mobility ("on" periods) and severe immobility ("off" periods), often without relation to timing of medication. They reflect variability in levodopa absorption and central dopamine handling and may require advanced therapeutic strategies. NCBI PMC
Which symptom is most likely to improve with anticholinergic medications in Parkinson's disease?
Gait freezing
Resting tremor
Postural instability
Bradykinesia
Anticholinergic drugs like benztropine can reduce resting tremor by restoring the balance between dopamine and acetylcholine in the striatum. However, their use is limited by cognitive side effects, especially in older patients. They have minimal effect on bradykinesia or postural instability. UpToDate
Which medication is often used as monotherapy for tremor-predominant Parkinson's disease in younger patients?
Apomorphine
Trihexyphenidyl
Amantadine
Entacapone
Trihexyphenidyl is an anticholinergic agent effective for tremor-dominant Parkinson's disease, particularly in younger patients without cognitive impairment. It helps by reducing cholinergic overactivity in the basal ganglia. Its side effects limit its use in older adults. Parkinson's Foundation
What is the primary clinical use of amantadine in Parkinson's disease?
Prevention of orthostatic hypotension
Reduction of tremor in early disease
Management of on-off fluctuations
Treatment of dyskinesias
Amantadine is used primarily to reduce levodopa-induced dyskinesias by modulating glutamatergic transmission and NMDA receptors. It offers modest benefit against motor complications but has limited effect on primary Parkinsonian symptoms. NCBI PMC
How is apomorphine typically administered for acute off episodes in Parkinson's disease?
Subcutaneous injection
Transdermal patch
Oral tablet
Intravenous infusion
Apomorphine is given via subcutaneous injection for rapid reversal of acute off periods because of its rapid onset of action. Oral formulations have poor bioavailability. It can also be delivered via infusion for continuous therapy in advanced cases. Parkinson's Foundation
Which dietary factor can interfere with levodopa absorption?
Low-fat meals
High-fiber meals
High-carbohydrate meals
High-protein meals
Dietary amino acids compete with levodopa for transport across the intestinal wall and blood - brain barrier, so high-protein meals can reduce levodopa absorption and exacerbate motor fluctuations. Protein redistribution diets can help in some patients. NCBI PMC
What is the recommended management for end-of-dose wearing-off in a patient on levodopa/carbidopa?
Switch to selegiline monotherapy
Increase protein intake
Add a COMT inhibitor such as entacapone
Discontinue levodopa and start amantadine
Adding a COMT inhibitor like entacapone prolongs the duration of levodopa's effect by inhibiting its peripheral metabolism, which reduces wearing-off episodes. Adjusting levodopa dosing intervals or using controlled-release formulations are alternative strategies. Simply increasing protein intake can worsen fluctuations. UpToDate
Which of the following is a known risk associated with dopamine agonist therapy in Parkinson's disease?
Renal failure
Hyperthyroidism
Pulmonary fibrosis
Impulse control disorders
Dopamine agonists such as pramipexole and ropinirole are associated with impulse control disorders, including pathological gambling, hypersexuality, and compulsive shopping. Monitoring and dose adjustment are essential to mitigate these risks. Parkinson's Foundation
What is the rationale for using a protein redistribution diet in Parkinson's disease?
To improve levodopa absorption by reducing competition with amino acids
To increase carbidopa bioavailability
To enhance dopamine synthesis
To reduce peripheral side effects
A protein redistribution diet concentrates protein intake in the evening so that daytime levodopa absorption is less impaired by amino acid competition at the gut and blood - brain barrier transporters. This can smooth motor fluctuations for some patients. NCBI PMC
Which drug interaction requires a washout period before starting a selective MAO-B inhibitor like rasagiline?
Amoxicillin
Losartan
Metformin
Meperidine (an opioid analgesic)
Meperidine and other opioids can precipitate serotonin syndrome or hypertensive crises when combined with MAO inhibitors. Guidelines recommend a washout period before initiating or following discontinuation of MAO-B inhibitors. Other listed drugs do not share this interaction. NCBI Bookshelf
Which of the following is the most effective treatment for levodopa-induced peak-dose dyskinesias?
Increase levodopa dose
Switch to bromocriptine
Amantadine
Add entacapone
Amantadine is effective in reducing peak-dose dyskinesias by antagonizing NMDA receptors and modulating glutamatergic activity. Adjusting levodopa doses or adding COMT inhibitors may worsen dyskinesias if not carefully balanced. Parkinson's Foundation
Which surgical target is most commonly used in deep brain stimulation for advanced Parkinson's disease?
Ventral intermediate nucleus of thalamus
Subthalamic nucleus (STN)
Substantia nigra pars compacta
Globus pallidus externus (GPe)
The subthalamic nucleus (STN) is the most common target for deep brain stimulation in Parkinson's disease because its modulation improves motor symptoms and allows for reduced medication doses. Alternative targets include the globus pallidus internus (GPi). NCBI PMC
Which of the following strategies helps manage orthostatic hypotension in Parkinson's patients on levodopa?
Restrict dietary sodium
Add a beta-blocker
Increase fluid and salt intake
Advise rapid standing
Orthostatic hypotension can be mitigated by increasing fluid and salt intake to expand intravascular volume. Compression stockings and slow positional changes also help. Beta-blockers may worsen hypotension. Parkinson's Foundation
Which of the following therapies is indicated for refractory tremor in Parkinson's disease not responding to medications?
High-dose amantadine
Focused ultrasound thalamotomy
Switch to rasagiline monotherapy
Add cholinesterase inhibitor
MRI-guided focused ultrasound thalamotomy is a noninvasive surgical option for medication-refractory tremor, targeting the ventral intermediate nucleus of the thalamus. It can significantly reduce tremor without craniotomy. FUS Foundation
When switching from immediate-release to controlled-release levodopa preparations, what is a common concern?
Worse gastrointestinal absorption
Delayed onset of motor benefit
Higher risk of impulse control disorders
Increased peak-dose dyskinesias
Controlled-release levodopa may have a delayed onset of action compared to immediate-release formulations, leading to difficulty managing morning akinesia. It can smooth plasma levels but is less useful for rapid symptom control. UpToDate
Which adjunctive therapy can be added to levodopa to reduce off-time by continuous infusion?
Intravenous entacapone drip
Subcutaneous amantadine infusion
Transdermal rasagiline patch
Duodopa (levodopa/carbidopa intestinal gel)
Duodopa delivers levodopa/carbidopa gel directly into the small intestine via a pump, providing continuous drug delivery and reducing motor fluctuations and off-time. It is indicated for advanced Parkinson's disease with severe motor complications unresponsive to oral therapy. National MS Society
For a patient experiencing severe dyskinesias at peak levodopa levels, which dosing strategy might be tried?
Add an anticholinergic at bedtime
Divide the total daily dose into smaller, more frequent doses
Switch to once-daily high-dose regimen
Eliminate carbidopa from regimen
Fractionating levodopa doses into smaller, more frequent administrations can reduce peak plasma concentrations and ameliorate peak-dose dyskinesias while preserving overall dopamine exposure. Larger infrequent doses tend to produce higher peaks and worsen dyskinesias. UpToDate
Which nonmotor symptom in Parkinson's disease may improve with cholinesterase inhibitors?
Constipation
Cognitive impairment
Excessive sweating
Restless legs
Cholinesterase inhibitors like rivastigmine can provide modest benefit for Parkinson's disease dementia by enhancing cholinergic transmission in cortical areas. They have limited effects on other nonmotor symptoms such as autonomic or sleep disturbances. Parkinson's Foundation
What is the typical target amplitude setting (in microcoulombs) used initially for subthalamic nucleus deep brain stimulation in Parkinson's disease?
0.2 - 0.5 mA
3.0 - 4.0 mA
1.5 - 2.0 mA
5.0 - 6.0 mA
Initial DBS programming for the subthalamic nucleus often begins at amplitudes of 1.5 - 2.0 mA (approximately 60 - 90 µs pulse width at 130 Hz) to balance symptom control with side effects. Settings are titrated based on motor response and tolerability. Higher currents may cause stimulation-induced side effects. NCBI PMC
Which of the following advanced therapies requires a percutaneous endoscopic gastrostomy with jejunal extension (PEG-J)?
Intravenous levodopa infusion
Transdermal rotigotine patch
Subcutaneous apomorphine infusion
Duodopa intestinal gel infusion
Duodopa therapy involves continuous infusion of levodopa/carbidopa gel into the proximal small intestine through a PEG-J tube to achieve stable plasma concentrations and reduce motor fluctuations in advanced PD. Subcutaneous and transdermal therapies do not require this access. National MS Society
Which genetic mutation is most commonly associated with familial Parkinson's disease and may influence future targeted therapies?
PSEN1
APP
HTT
LRRK2
Mutations in the LRRK2 gene are the most common genetic cause of autosomal dominant familial Parkinson's disease. These mutations influence kinase activity and are a target for novel LRRK2 inhibitors currently in clinical trials. Other listed genes are related to Alzheimer's or Huntington's disease. NCBI PMC
Which of the following is a recognized contraindication to subthalamic nucleus deep brain stimulation in Parkinson's disease?
History of stable well-controlled hypertension
Levodopa-induced dyskinesias
Younger age (<50 years)
Significant cognitive impairment
Moderate to severe cognitive impairment is a contraindication to DBS because stimulation may worsen cognitive function and psychiatric symptoms. Good levodopa responsiveness, younger age, and dyskinesias are not contraindications and can actually predict a favorable surgical outcome. UpToDate
What is the mechanism by which amantadine reduces levodopa-induced dyskinesias?
NMDA receptor antagonism
Dopamine reuptake blockade
MAO-B inhibition
COMT inhibition
Amantadine reduces dyskinesias primarily through antagonism of NMDA-type glutamate receptors, which modulates excitatory neurotransmission and reduces motor complications. It does not inhibit COMT or MAO-B and has minimal effect on dopamine reuptake. NCBI PMC
Which hallmarks on ultrasound imaging guide MRI?guided focused ultrasound thalamotomy in tremor-predominant PD?
Globus pallidus size
Localization of the ventral intermediate nucleus (VIM)
Substantia nigra echogenicity
Putaminal signal changes
Focused ultrasound thalamotomy targets the ventral intermediate nucleus (VIM) of the thalamus for precise lesioning to control tremor. MRI guidance identifies anatomical landmarks and real-time thermometry. Substantia nigra imaging is used diagnostically, not for thalamotomy targeting. FUS Foundation
In continuous subcutaneous apomorphine infusion, what adjunctive medication is often required to prevent severe nausea?
Domperidone
Ondansetron
Prochlorperazine
Metoclopramide
Domperidone, a peripheral dopamine antagonist that does not cross the blood - brain barrier significantly, is used to manage apomorphine-induced nausea without diminishing central dopaminergic effects. Ondansetron and metoclopramide have CNS effects or interactions that limit their use in PD. Parkinson's Foundation
Which biomarker is under investigation for tracking disease progression and therapeutic response in Parkinson's disease?
CSF tau proteins
Plasma amyloid-beta
Serum creatinine kinase
Alpha-synuclein levels in cerebrospinal fluid
Alpha-synuclein aggregation is central to Parkinson's pathology, and CSF alpha-synuclein levels are being studied as a biomarker for disease progression and response to therapies targeting protein aggregation. Other markers are more specific to Alzheimer's disease. NCBI PMC
Which device-aided therapy requires patient training in pump management and catheter care?
Duodopa intestinal gel infusion
Transdermal rotigotine patch
Deep brain stimulation
Oral selegiline
Duodopa therapy involves a portable pump and PEG-J tube that patients or caregivers must manage, including pump operation and catheter site hygiene. DBS requires programming but no daily device care. Transdermal patches and oral medications have minimal device training needs. National MS Society
Which advanced PD therapy is associated with potential weight gain and peripheral edema?
COMT inhibitors
Anticholinergics
Dopamine agonists
MAO-B inhibitors
Dopamine agonists such as pramipexole and ropinirole can cause fluid retention leading to peripheral edema and sometimes weight gain. COMT inhibitors and MAO-B inhibitors have different side effect profiles that rarely include edema. Parkinson's Foundation
According to current guidelines, what is the optimal levodopa dose reduction (percentage) following successful bilateral STN-DBS to minimize side effects?
5 - 10%
30 - 50%
60 - 80%
No reduction is recommended
After successful bilateral STN-DBS, levodopa doses are often reduced by 30 - 50% to lower stimulation-induced side effects and dyskinesias while maintaining motor benefit. Larger reductions risk off periods; minimal reductions may not mitigate side effects. UpToDate
Which LRRK2 kinase inhibitor passed phase II trials demonstrating modulation of biomarker pathways in PD?
DNL201
Elotuzumab
Preladenant
Nilotinib
DNL201 is an oral LRRK2 kinase inhibitor that has shown target engagement and modulation of downstream pathways in phase I/II trials for Parkinson's disease with LRRK2 mutations. Nilotinib and others target different mechanisms. NCBI PMC
Which patient selection criterion is most critical for offering MRI?guided focused ultrasound pallidotomy in PD?
Significant cognitive impairment
Unilateral, medication-refractory tremor
Bilateral severe dyskinesias
Advanced postural instability
MRI?guided focused ultrasound pallidotomy is indicated primarily for unilateral, medication-refractory tremor in Parkinson's disease. Bilateral lesions pose higher risk, and cognitive impairment is a contraindication. Dyskinesias and postural instability are less responsive to this approach. FUS Foundation
In gene therapy trials for PD delivering AAV2-neurturin (CERE-120), what was the primary endpoint that failed to show significant improvement?
Quality-of-life questionnaire
UPDRS motor-off score at 12 months
Nonmotor symptom scale
Cognitive test scores
The phase II trial of AAV2-neurturin gene therapy did not show a statistically significant improvement in the Unified Parkinson's Disease Rating Scale (UPDRS) motor-off scores at 12 months compared to sham surgery. Secondary endpoints also failed to meet prespecified thresholds. NCBI PMC
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Study Outcomes

  1. Understand Pharmacological Treatments -

    Identify the mechanisms, indications, and dosing considerations of key Parkinson's medications, including levodopa, dopamine agonists, and MAO-B inhibitors.

  2. Differentiate Medication Protocols -

    Compare initiation, titration, and combination strategies for common drug classes to optimize individual patient regimens.

  3. Analyze Patient Scenarios -

    Interpret real-world case questions to select appropriate treatment pathways and adjust therapy based on clinical presentation.

  4. Apply Care Plan Strategies -

    Integrate medication management with therapeutic interventions and lifestyle modifications to support comprehensive symptom control.

  5. Evaluate Side Effects and Interactions -

    Assess potential adverse effects, contraindications, and drug - drug interactions to enhance patient safety.

  6. Assess Knowledge with the Parkinson's Disease Treatment Quiz -

    Use the Parkinson's disease treatment quiz to pinpoint gaps in your understanding and reinforce essential treatment concepts through our interactive Parkinson's treatment quiz.

Cheat Sheet

  1. Levodopa-Carbidopa Basics -

    For the Parkinson's disease treatment quiz, recall that levodopa crosses the blood - brain barrier and is decarboxylated to dopamine, while carbidopa inhibits peripheral metabolism (Movement Disorder Society). Initiate therapy at approximately 300 mg of levodopa daily in three divided doses to minimize "wearing-off" phenomena. Use the mnemonic "LDOPA" (Levodopa, Dopamine precursor, Onset ~1 hr, Peripheral decarboxylase inhibitor, Adjust dose) to lock in the concept.

  2. Dopamine Agonists and Side Effects -

    When tackling Parkinson's treatment questions, remember that agonists like pramipexole and ropinirole directly stimulate D2 receptors and can delay levodopa initiation (NINDS). Starting doses often range from 0.125 mg to 0.5 mg daily, titrated every week to reduce nausea and orthostatic hypotension. Watch for impulse control disorders - "PAWA" (Pramipexole, Addiction Warning, Assess behavior).

  3. COMT Inhibitors Extend Levodopa Action -

    In the Parkinson's disease treatment quiz, know that entacapone and tolcapone block catechol-O-methyltransferase, extending levodopa's half-life by 30 - 50 minutes (Journal of Parkinson's Disease). A typical adjunct dose is 200 mg of entacapone with each levodopa dose. Remember "COMT the Gate" - inhibit COMT to gatekeep dopamine availability.

  4. Deep Brain Stimulation (DBS) Criteria -

    For movement disorder treatment quiz questions, note that DBS targeting the subthalamic nucleus (STN) or globus pallidus interna (GPi) can reduce "on-off" fluctuations by ~40% (American Academy of Neurology). Ideal candidates have motor complications refractory to optimized meds and disease duration >5 years. A handy tip: "STN for Speed, GPi for Gait; DBS can both stabilize and liberate."

  5. Non-Pharmacologic Therapies & Care Plans -

    In neurological quiz sections, emphasize multidisciplinary care: LSVT LOUD for speech, 150 minutes/week of aerobic exercise for gait, and occupational therapy for ADLs (Parkinson's Foundation). A simple memory phrase is "SPEAK UP": Speech, Posture, Exercise, Activities, Kinetics, Understanding, Plan. These strategies bolster quality of life alongside medications.

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