Each one of the following is associated with the development of chorea, except:
Correct Answer A:
Chorea:
Chorea describes involuntaru, rapid, jerky movements which often move from one part of the body to another. Slower, sinuous movement of the limbs is termed athetosis. Chorea is caused by damage to the basal ganglia, especially the caudate nucleus.
Causes of chorea:
A 34-year-old man presents with headache and blurred vision for a few weeks. Investigations reveal: Prolactin 21,500 mu/l CT brain Large pituitary mass encroaching on the optic chiasm with evidence of midline shift.
What is the most appropriate treatment?
Correct Answer A: Prolactinoma management - medical therapy is almost always first-line.
Prolactinomas are unusual as medical therapy is first line, even if visual field defects are present. The main indications for surgery are tumours resistant to dopamine agonists.
Pituitary tumours:
Hormones secreted:
Which one of the following antibiotics is most likely to exacerbate myasthenia gravis?
Correct Answer E:
Myasthenia gravis: exacerbating factors:
The most common exacerbating factor is exertion resulting in fatigability, which is the hallmark feature of myasthenia gravis . Symptoms become more marked during the day.
The following drugs may exacerbate myasthenia:
A 51-year-old man with a history of schizophrenia is reviewed. He has developed parkinsonism secondary to his antipsychotic medication.
Which one of the following drugs is most useful in the management of tremor?
Correct Answer E: Benzhexol is now more commonly referred to as trihexyphenidyl. It is now mainly used for drug induced parkinsonism rather than idiopathic Parkinson's disease.
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*Pergolide was withdrawn from the US market in March 2007 due to concern regarding increased incidence of valvular dysfunction.
Which one of the following is least associated with myotonic dystrophy?
Correct Answer B:
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:
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