A 63-year-old man is prescribed ropinirole for Parkinson's disease.
What is the mechanism of action?
Correct Answer C: Ropinirole - dopamine receptor agonist.
Parkinson's disease: management:
Currently accepted practice in the management of patients with Parkinson's disease (PD) is to delay treatment until the onset of disabling symptoms and then to introduce a dopamine receptor agonist. If the patient is elderly, levodopa is sometimes used as an initial treatment.
Dopamine receptor agonists:
Levodopa:
MAO-B (Monoamine Oxidase-B) inhibitors:
Amantadine:
COMT (Catechol-O-Methyl Transferase) inhibitors:
Antimuscarinics:
*Pergolide was withdrawn from the US market in March 2007 due to concern regarding increased incidence of valvular dysfunction.
A 59-year-old man with no significant past medical history is admitted to hospital following an ischaemic stroke. He presented outside of the thrombolysis window and is treated with aspirin for the first few days. His blood pressure is 130/80 mmHg, fasting glucose is 5.6 mmol/l and fasting cholesterol is 3.9 mmol/l. He makes a good recovery and has regained nearly all of his previous functions upon discharge.
Following recent NICE guidelines, which of the following medications should he be taking upon discharge (i.e. after 14 days)?
Correct Answer C:
Stroke: management:
The Royal College of Physicians (RCP) published guidelines on the diagnosis and management of patients following a stroke in 2004. NICE also issued stroke guidelines in 2008, although they modified their guidance with respect to antiplatelet therapy in 2010.
Selected points relating to the management of acute stroke include:
Thrombolysis:
Thrombolysis should only be given if:
Secondary prevention:
NICE also published a technology appraisal in 2010 on the use of clopidogrel and dipyridamole.
Recommendations from NICE include:
With regards to carotid artery endarterectomy:
*the 2009 Controlling hypertension and hypotension immediately post-stroke (CHHIPS) trial may change thinking on this but guidelines have yet to change to reflect this
**SIGN recommend a window of 4.5 hours
***European Carotid Surgery Trialists' Collaborative Group
****North American Symptomatic Carotid Endarterectomy Trial
Which one of the following infections is most strongly associated with the development of Guillain-Barre syndrome?
Correct Answer E: Campylobacter jejuni is strongly associated with the development of Guillain-Barre syndrome.
Guillain-Barre syndrome:
Guillain-Barre syndrome describes an immune mediated demyelination of the peripheral nervous system often triggered by an infection (classically Campylobacter jejuni).
Pathogenesis:
Miller Fisher syndrome:
Lateral medullary syndrome is caused by occlusion of which one of the following blood vessels?
Correct Answer E: Lateral medullary syndrome - PICA lesion - cerebellar signs, contralateral sensory loss & ipsilateral Horner's.
Lateral medullary syndrome:
Lateral medullary syndrome, also known as Wallenberg's syndrome, occurs following occlusion of the posterior inferior cerebellar artery.
Cerebellar features:
Brainstem features:
A 29-year-old female presents complaining of weakness in her arms, leading to increasing difficulties at work. On examination she has a bilateral ptosis and loss of the red-reflex in both eyes. Urine testing also reveals glycosuria.
What is the most likely diagnosis?
Correct Answer A:
These features are typical of myotonic dystrophy. The red-reflex is lost due to bilateral cataracts.
Myotonic dystrophy: Myotonic dystrophy (also called dystrophia myotonica) is an inherited myopathy with features developing at around 20-30 years old. It affects skeletal, cardiac and smooth muscle. There are two main types of myotonic dystrophy, DM1 and DM2.
Genetics:
The key differences are listed in table below:
General features:
Other features:
Click to expand