- Email: [email protected]
CME Post-Test Questions
SYMPOSIUM
CME Post-Test Questions 1.
What percentage of individuals over the age of 85 exhibit signs of parkinsonism? A. 10% B. 18% C. 28% D. Over 50%
2. What process underlies the pathophysiology of PD? A. Amyloid plaques in the cerebral cortex B. Death of dopamine-producing neurons C. Progressive insensitivity to normal levels of dopamine D. Excessive output from the thalamus to the cerebral cortex 3. The “symptom triad” of PD includes: A. Tremor, rigidity, and bradykinesia B. Cognitive impairment, tremor, and muscle weakness C. Postural instability, cognitive impairment, and muscle weakness D. Bradykinesia, tremor, and reduced facial expression 4. The onset of clinical symptoms in PD usually is: A. Sudden, characterized by severe gait impairment B. Gradual, with unilateral symptoms C. Misdiagnosed as osteoarthritis D. Evident as postural instability 5. In patients with PD, the average annual rate of decline in motor function is: A. 1%–3% B. 5% C. 8%–9% D. 12%–15% 6. What is the primary goal of PD therapy? A. Improving quality of life B. Curing the disease C. Slowing disease progression D. Reversing dopaminergic insensitivity
R E P ORT E R
2005
7. When is surgical treatment for PD indicated? A. When pharmacologic therapy proves ineffective B. When elderly patients experience unacceptable drug adverse effects C. When symptoms are bilateral D. When symptoms are confined to gait impairment 8. What is the single most effective pharmacologic agent or class of agents for PD? A. Dopamine agonists B. MAO-B inhibitors C. Levodopa D. Amantadine 9. How does a COMT inhibitor affect the pharmacokinetics of levodopa? A. It increases half-life and AUC B. It increases peak concentrations C. It increases time to peak concentration D. Both A and B 10.
How do dopamine agonists differ from levodopa? A. They directly stimulate dopamine receptors B. They have shorter half-lives C. They are associated with fewer motor complications D. Both A and C
11.
Which of the following can be used for refractory levodopa-induced “off” states? A. Apomorphine B. MAO-B inhibitors C. Anticholinergics D. Amantadine
12.
What is the wearing-off phenomenon? A. A declining response to levodopa B. A declining need for pharmacologic treatment C. Decreasing efficacy of dopamine agonists D. A common effect of ablative surgical procedures
17
18
SYMPOSIUM 13.
Which of the following is/are symptom(s) of wearing-off? A. Pain syndromes, stiffness, and freezing B. Constipation C. Excessive salivation and fever D. Fatigue
14.
How does the addition of a COMT inhibitor reduce the motor complications of levodopa? A. By providing more continuous stimulation of receptors B. By increasing daily “on” time C. By decreasing “off” time D. Both B and C
15.
How is PD diagnosed? A. Medical history and physical examination B. MRI scans, lab tests C. Response to levodopa treatment D. Both A and B
16.
Patients treated with levodopa can expect: A. Decreased incidence of psychosis B. Improved postural stability late in the disease course C. Dyskinesias with long-term treatment D. Improved autonomic dysfunction
17.
Which of the following agents is a COMT inhibitor that has been shown to produce hepatotoxicity? A. Bromocriptine B. Entacapone C. Tolcapone D. Clozapine
18.
Management of early PD typically involves: A. Withholding treatment if symptoms are not disabling B. Use of amantadine in younger patients C. Monotherapy with dopamine agents D. All the above
R E P ORT E R 19.
2005
Which of the following is false regarding wearing-off? A. Affects 30% to 50% of patients within 5 years of initial levodopa therapy B. Symptoms include rigidity, morning akinesia, and “off” dystonia C. Anticholinergics typically improve symptoms D. Initial episodes are often predictable
20. Which of the following agents could be used to manage motor fluctuations? A. Entacapone B. Ropinirole C. Selegiline D. All of the above
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SYMPOSIUM
R E P ORT E R
2005
19
Clinical Aspects of the “Wearing-Off” Phenomenon in Parkinson’s Disease: New Treatment Strategies (111-46) Initial release date: July 1, 2005 Expiration date: July 1, 2006 A statement of credit (if applicable) will be issued from the following information (please print clearly): Name of Participant: _____________________________
Degree(s): _______________________
Title/Specialty: _________________________________
Affiliation: _______________________
Home Address: ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ Phone Number: _________________________________
Fax Number: _____________________
E-mail Address: ___________________________________________________________________ Last 5 digits of SS# (for record-keeping purposes only): _____________________________________ The Bimark Center for Medical Education requests your permission to contact you in the future by mail, fax, or e-mail to determine changes in your practice as a result of your participation in this CME/CE activity. If a follow-up to this activity is developed, may we contact you to request your participation? K Yes K No Number of hours claimed:_______
I am a:
K Physician
K Other ________________________
I certify that I have participated in the above-named continuing education activity in its entirety: Signature: _____________________________________ Date: ________________________________________ ANSWERS TO POST-TEST QUESTIONS (Please darken appropriate circle) A B C D
A B C D
A B C D
A B C D
1.
6.
11.
16.
2.
7.
12.
17.
3.
8.
13.
18.
4.
9.
14.
19.
5.
10.
15.
20. (continued on next page)
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Page 1
SYMPOSIUM
R E P ORT E R
2005
ACTIVITY EVALUATION: Please evaluate the effectiveness of this CME activity. Your input and comments are encouraged and appreciated. (Please circle the appropriate answer) Poor
Average
Excellent
1. Overall, how would you rate this CME activity?
1
2
3
4
5
2. Please evaluate the educational level of this CME activity.
1
2
3
4
5
3. The learning objectives of this activity were met:
Not at all
Partially
Completely
• Review the pathophysiology and diagnosis of Parkinson's disease (PD).
1
22
3
4
5
• Discuss the available pharmacologic treatments for PD, including levodopa, dopamine agonists, DDC and COMT inhibitors, and amantadine.
1
2
3
4
5
• Describe the differences in the approach to managing early versus late disease.
1
2
3
4
5
• Demonstrate a comprehensive understanding of the “wearing-off” phenomenon associated with levodopa-based treatment of patients with PD.
1
2
3
4
5
• Identify safe and effective treatment strategies for circumventing the “wearing-off” of levodopa therapy to improve patient outcomes.
1
2
3
4
5
1
2
3
4
5
4. Based on content, how well did the activity meet your expectations?
5. Do you believe the subject matter was presented objectively and with fair balance, and was free of commercial bias? K Yes K No 6. Approximately how much of the content from this continuing education activity was new to you? K Almost none K About 25% K About 50% K About 75% K Almost all 7. As a result of participating in this educational activity, I will do the following: K Change my practice K Seek additional information before making changes to my practice K Confirm my current practice 8. What related topics would you like to be offered as CME activities in the future? _________________ _____________________________________________________________________________ To receive CME credit and a certificate, please mail/fax this completed form to: Bimark Center for Medical Education One University Plaza, Suite 512 Hackensack, NJ 07601 Fax: (201) 498-7227
CME Post-Test Questions 1.
What percentage of individuals over the age of 85 exhibit signs of parkinsonism? A. 10% B. 18% C. 28% D. Over 50%
2. What process underlies the pathophysiology of PD? A. Amyloid plaques in the cerebral cortex B. Death of dopamine-producing neurons C. Progressive insensitivity to normal levels of dopamine D. Excessive output from the thalamus to the cerebral cortex 3. The “symptom triad” of PD includes: A. Tremor, rigidity, and bradykinesia B. Cognitive impairment, tremor, and muscle weakness C. Postural instability, cognitive impairment, and muscle weakness D. Bradykinesia, tremor, and reduced facial expression 4. The onset of clinical symptoms in PD usually is: A. Sudden, characterized by severe gait impairment B. Gradual, with unilateral symptoms C. Misdiagnosed as osteoarthritis D. Evident as postural instability 5. In patients with PD, the average annual rate of decline in motor function is: A. 1%–3% B. 5% C. 8%–9% D. 12%–15% 6. What is the primary goal of PD therapy? A. Improving quality of life B. Curing the disease C. Slowing disease progression D. Reversing dopaminergic insensitivity
R E P ORT E R
2005
7. When is surgical treatment for PD indicated? A. When pharmacologic therapy proves ineffective B. When elderly patients experience unacceptable drug adverse effects C. When symptoms are bilateral D. When symptoms are confined to gait impairment 8. What is the single most effective pharmacologic agent or class of agents for PD? A. Dopamine agonists B. MAO-B inhibitors C. Levodopa D. Amantadine 9. How does a COMT inhibitor affect the pharmacokinetics of levodopa? A. It increases half-life and AUC B. It increases peak concentrations C. It increases time to peak concentration D. Both A and B 10.
How do dopamine agonists differ from levodopa? A. They directly stimulate dopamine receptors B. They have shorter half-lives C. They are associated with fewer motor complications D. Both A and C
11.
Which of the following can be used for refractory levodopa-induced “off” states? A. Apomorphine B. MAO-B inhibitors C. Anticholinergics D. Amantadine
12.
What is the wearing-off phenomenon? A. A declining response to levodopa B. A declining need for pharmacologic treatment C. Decreasing efficacy of dopamine agonists D. A common effect of ablative surgical procedures
17
18
SYMPOSIUM 13.
Which of the following is/are symptom(s) of wearing-off? A. Pain syndromes, stiffness, and freezing B. Constipation C. Excessive salivation and fever D. Fatigue
14.
How does the addition of a COMT inhibitor reduce the motor complications of levodopa? A. By providing more continuous stimulation of receptors B. By increasing daily “on” time C. By decreasing “off” time D. Both B and C
15.
How is PD diagnosed? A. Medical history and physical examination B. MRI scans, lab tests C. Response to levodopa treatment D. Both A and B
16.
Patients treated with levodopa can expect: A. Decreased incidence of psychosis B. Improved postural stability late in the disease course C. Dyskinesias with long-term treatment D. Improved autonomic dysfunction
17.
Which of the following agents is a COMT inhibitor that has been shown to produce hepatotoxicity? A. Bromocriptine B. Entacapone C. Tolcapone D. Clozapine
18.
Management of early PD typically involves: A. Withholding treatment if symptoms are not disabling B. Use of amantadine in younger patients C. Monotherapy with dopamine agents D. All the above
R E P ORT E R 19.
2005
Which of the following is false regarding wearing-off? A. Affects 30% to 50% of patients within 5 years of initial levodopa therapy B. Symptoms include rigidity, morning akinesia, and “off” dystonia C. Anticholinergics typically improve symptoms D. Initial episodes are often predictable
20. Which of the following agents could be used to manage motor fluctuations? A. Entacapone B. Ropinirole C. Selegiline D. All of the above
111-46 JAMDA ü guts.qxd
7/6/05
8:27 AM
Page 20
SYMPOSIUM
R E P ORT E R
2005
19
Clinical Aspects of the “Wearing-Off” Phenomenon in Parkinson’s Disease: New Treatment Strategies (111-46) Initial release date: July 1, 2005 Expiration date: July 1, 2006 A statement of credit (if applicable) will be issued from the following information (please print clearly): Name of Participant: _____________________________
Degree(s): _______________________
Title/Specialty: _________________________________
Affiliation: _______________________
Home Address: ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ Phone Number: _________________________________
Fax Number: _____________________
E-mail Address: ___________________________________________________________________ Last 5 digits of SS# (for record-keeping purposes only): _____________________________________ The Bimark Center for Medical Education requests your permission to contact you in the future by mail, fax, or e-mail to determine changes in your practice as a result of your participation in this CME/CE activity. If a follow-up to this activity is developed, may we contact you to request your participation? K Yes K No Number of hours claimed:_______
I am a:
K Physician
K Other ________________________
I certify that I have participated in the above-named continuing education activity in its entirety: Signature: _____________________________________ Date: ________________________________________ ANSWERS TO POST-TEST QUESTIONS (Please darken appropriate circle) A B C D
A B C D
A B C D
A B C D
1.
6.
11.
16.
2.
7.
12.
17.
3.
8.
13.
18.
4.
9.
14.
19.
5.
10.
15.
20. (continued on next page)
111-46 JAMDA ü guts.qxd
20
7/6/05
8:27 AM
Page 1
SYMPOSIUM
R E P ORT E R
2005
ACTIVITY EVALUATION: Please evaluate the effectiveness of this CME activity. Your input and comments are encouraged and appreciated. (Please circle the appropriate answer) Poor
Average
Excellent
1. Overall, how would you rate this CME activity?
1
2
3
4
5
2. Please evaluate the educational level of this CME activity.
1
2
3
4
5
3. The learning objectives of this activity were met:
Not at all
Partially
Completely
• Review the pathophysiology and diagnosis of Parkinson's disease (PD).
1
22
3
4
5
• Discuss the available pharmacologic treatments for PD, including levodopa, dopamine agonists, DDC and COMT inhibitors, and amantadine.
1
2
3
4
5
• Describe the differences in the approach to managing early versus late disease.
1
2
3
4
5
• Demonstrate a comprehensive understanding of the “wearing-off” phenomenon associated with levodopa-based treatment of patients with PD.
1
2
3
4
5
• Identify safe and effective treatment strategies for circumventing the “wearing-off” of levodopa therapy to improve patient outcomes.
1
2
3
4
5
1
2
3
4
5
4. Based on content, how well did the activity meet your expectations?
5. Do you believe the subject matter was presented objectively and with fair balance, and was free of commercial bias? K Yes K No 6. Approximately how much of the content from this continuing education activity was new to you? K Almost none K About 25% K About 50% K About 75% K Almost all 7. As a result of participating in this educational activity, I will do the following: K Change my practice K Seek additional information before making changes to my practice K Confirm my current practice 8. What related topics would you like to be offered as CME activities in the future? _________________ _____________________________________________________________________________ To receive CME credit and a certificate, please mail/fax this completed form to: Bimark Center for Medical Education One University Plaza, Suite 512 Hackensack, NJ 07601 Fax: (201) 498-7227