MCQ Quiz: Neurodegenerative Disorders

Neurodegenerative disorders are a group of debilitating conditions characterized by the progressive loss of neurons, leading to cognitive and motor dysfunction. Pharmacists play a crucial role in managing the complex pharmacotherapy for diseases like Alzheimer’s, Parkinson’s, Multiple Sclerosis, and ALS. This quiz will test your knowledge on the pathophysiology and treatment of these challenging conditions.

1. The two hallmark neuropathological findings in Alzheimer’s disease are extracellular amyloid-beta plaques and:

• a. Lewy bodies
• b. Intraneuronal neurofibrillary tangles of tau protein
• c. Loss of myelin
• d. Degeneration of motor neurons

Answer: b. Intraneuronal neurofibrillary tangles of tau protein

2. The primary pathophysiology of Parkinson’s disease is the loss of dopaminergic neurons in which part of the brain?

• a. Hippocampus
• b. Cerebral cortex
• c. Substantia nigra
• d. Cerebellum

Answer: c. Substantia nigra

3. Acetylcholinesterase inhibitors like donepezil are used in Alzheimer’s disease to:

• a. Reverse the course of the disease.
• b. Increase the levels of acetylcholine in the brain to provide symptomatic improvement in cognition.
• c. Prevent the formation of amyloid plaques.
• d. Regenerate lost neurons.

Answer: b. Increase the levels of acetylcholine in the brain to provide symptomatic improvement in cognition.

4. What is the “gold standard” and most effective medication for managing the motor symptoms of Parkinson’s disease?

• a. A dopamine agonist (e.g., pramipexole)
• b. An MAO-B inhibitor (e.g., selegiline)
• c. Levodopa/carbidopa
• d. An anticholinergic (e.g., benztropine)

Answer: c. Levodopa/carbidopa

5. Multiple Sclerosis (MS) is a chronic disease of the central nervous system characterized by:

• a. The loss of dopaminergic neurons.
• b. The formation of amyloid plaques.
• c. Demyelination and inflammation.
• d. The aggregation of alpha-synuclein.

Answer: c. Demyelination and inflammation.

6. A patient with Parkinson’s disease experiences a “wearing-off” phenomenon with their levodopa. Which class of medication can be added to help prolong the effect of levodopa?

• a. A cholinesterase inhibitor
• a. A COMT inhibitor (e.g., entacapone)
• c. An NMDA antagonist
• d. A beta-blocker

Answer: b. A COMT inhibitor (e.g., entacapone)

7. A major class of disease-modifying therapies (DMTs) for relapsing forms of multiple sclerosis is:

• a. Levodopa
• b. Acetylcholinesterase inhibitors
• c. Interferon-beta preparations
• d. Atypical antipsychotics

Answer: c. Interferon-beta preparations

8. Riluzole is a medication used to slow the progression of which neurodegenerative disorder?

• a. Alzheimer’s disease
• b. Parkinson’s disease
• c. Multiple sclerosis
• d. Amyotrophic Lateral Sclerosis (ALS)

Answer: d. Amyotrophic Lateral Sclerosis (ALS)

9. Memantine is an NMDA receptor antagonist used for moderate-to-severe Alzheimer’s disease. It works by:

• a. Increasing acetylcholine levels.
• b. Reducing glutamate-mediated excitotoxicity.
• c. Increasing dopamine levels.
• d. Removing amyloid plaques.

Answer: b. Reducing glutamate-mediated excitotoxicity.

10. Which of the following are cardinal motor symptoms of Parkinson’s disease?

• a. Memory loss and confusion
• b. Vision changes and fatigue
• c. Resting tremor, bradykinesia, and rigidity
• d. Muscle weakness and spasticity

Answer: c. Resting tremor, bradykinesia, and rigidity

11. Why is carbidopa always given in combination with levodopa?

• a. It prevents the peripheral conversion of levodopa to dopamine, reducing side effects like nausea.
• b. It is also a dopamine agonist.
• c. It helps levodopa cross the blood-brain barrier.
• d. It treats the non-motor symptoms of Parkinson’s.

Answer: a. It prevents the peripheral conversion of levodopa to dopamine, reducing side effects like nausea.

12. Newer monoclonal antibody therapies for Alzheimer’s disease, such as lecanemab, work by:

• a. Increasing acetylcholine.
• b. Blocking NMDA receptors.
• c. Targeting and helping to clear amyloid-beta plaques from the brain.
• d. Inhibiting the tau protein.

Answer: c. Targeting and helping to clear amyloid-beta plaques from the brain.

13. A common side effect of acetylcholinesterase inhibitors is:

• a. Constipation
• b. Dry mouth
• c. Nausea, vomiting, and diarrhea
• d. Hypertension

Answer: c. Nausea, vomiting, and diarrhea

14. A patient on long-term levodopa therapy develops uncontrollable, jerky movements. This is known as:

• a. A “wearing-off” effect
• b. Dyskinesia
• c. Bradykinesia
• d. A freezing episode

Answer: b. Dyskinesia

15. Fingolimod is an oral disease-modifying therapy for MS. It requires monitoring of what parameter after the first dose?

• a. Liver function tests
• b. Heart rate, due to risk of bradycardia
• c. Serum creatinine
• d. White blood cell count

Answer: b. Heart rate, due to risk of bradycardia

16. Amyotrophic Lateral Sclerosis (ALS) is a disease that primarily affects:

• a. Sensory neurons
• b. Dopaminergic neurons
• c. Motor neurons
• d. Cholinergic neurons

Answer: c. Motor neurons

17. What is the primary goal of current pharmacotherapy for Alzheimer’s disease?

• a. To cure the disease.
• b. To provide symptomatic treatment to improve cognition and function.
• c. To reverse brain atrophy.
• d. To prevent the disease in all individuals.

Answer: b. To provide symptomatic treatment to improve cognition and function.

18. A “drug holiday” may be considered for patients on levodopa to:

• a. Save money on the medication.
• b. Resensitize the patient to the effects of the drug and manage motor fluctuations.
• c. Prevent the non-motor symptoms.
• d. Increase the risk of dyskinesias.

Answer: b. Resensitize the patient to the effects of the drug and manage motor fluctuations.

19. Natalizumab, a treatment for MS, has a significant risk of what serious adverse effect, requiring a REMS program?

• a. Severe liver injury
• b. Progressive multifocal leukoencephalopathy (PML)
• c. Cardiotoxicity
• d. Agranulocytosis

Answer: b. Progressive multifocal leukoencephalopathy (PML)

20. The mechanism of action of riluzole is thought to involve:

• a. Inhibition of glutamate release.
• b. Increasing dopamine levels.
• c. Blocking acetylcholine receptors.
• d. Enhancing GABA transmission.

Answer: a. Inhibition of glutamate release.

21. A common non-motor symptom of Parkinson’s disease is:

• a. Constipation
• b. Loss of smell (anosmia)
• c. Depression
• d. All of the above

Answer: d. All of the above

22. An “MS relapse” or “exacerbation” is typically treated with:

• a. A short course of high-dose corticosteroids.
• b. An increase in the patient’s disease-modifying therapy dose.
• c. Levodopa.
• d. A cholinesterase inhibitor.

Answer: a. A short course of high-dose corticosteroids.

23. The APOE ε4 allele is a major genetic risk factor for which disease?

• a. Parkinson’s disease
• b. Multiple Sclerosis
• c. Late-onset Alzheimer’s disease
• d. ALS

Answer: c. Late-onset Alzheimer’s disease

24. The pharmacist’s role in managing neurodegenerative disorders includes:

• a. Counseling on complex medication regimens and side effects.
• b. Monitoring for adherence.
• c. Identifying and managing drug interactions.
• d. All of the above.

Answer: d. All of the above.

25. A key counseling point for a patient starting a dopamine agonist for Parkinson’s disease is the risk of:

• a. Severe hypertension.
• b. A dry, hacking cough.
• c. Impulse control disorders (e.g., gambling, compulsive shopping).
• d. Weight loss.

Answer: c. Impulse control disorders (e.g., gambling, compulsive shopping).

26. Edaravone is a medication for ALS that is thought to work by:

• a. Inhibiting glutamate.
• b. Increasing dopamine.
• c. Acting as a free radical scavenger to reduce oxidative stress.
• d. Enhancing acetylcholine transmission.

Answer: c. Acting as a free radical scavenger to reduce oxidative stress.

27. The most common form of multiple sclerosis is:

• a. Primary progressive MS (PPMS)
• b. Secondary progressive MS (SPMS)
• c. Progressive relapsing MS (PRMS)
• d. Relapsing-remitting MS (RRMS)

Answer: d. Relapsing-remitting MS (RRMS)

28. An anticholinergic agent like benztropine is most effective for which symptom of Parkinson’s disease?

• a. Bradykinesia
• b. Rigidity
• c. Tremor
• d. Postural instability

Answer: c. Tremor

29. The ultimate goal of disease-modifying therapy in MS is to:

• a. Cure the disease.
• b. Only treat acute relapses.
• c. Reduce the frequency and severity of relapses and slow the accumulation of disability.
• d. Manage symptoms like fatigue and spasticity.

Answer: c. Reduce the frequency and severity of relapses and slow the accumulation of disability.

30. A patient with Alzheimer’s disease is prescribed memantine. This medication is most appropriate for which stage of the disease?

• a. Pre-clinical
• b. Mild
• c. Moderate to severe
• d. It can be used in all stages.

Answer: c. Moderate to severe

31. Deep brain stimulation (DBS) is a surgical option for which disorder?

• a. Alzheimer’s disease
• b. Parkinson’s disease with intractable motor fluctuations.
• c. Multiple Sclerosis
• d. ALS

Answer: b. Parkinson’s disease with intractable motor fluctuations.

32. A pharmacist counsels a patient taking an interferon for MS about what common side effect?

• a. Severe nausea and vomiting
• b. Flu-like symptoms (fever, chills, myalgias)
• c. Weight gain
• d. Hair loss

Answer: b. Flu-like symptoms (fever, chills, myalgias)

33. The use of antipsychotics to manage behavioral symptoms in dementia patients carries a black box warning for:

• a. Severe liver injury
• b. An increased risk of death in elderly patients.
• c. Agranulocytosis
• d. QT prolongation

Answer: b. An increased risk of death in elderly patients.

34. The “on-off” phenomenon in Parkinson’s disease refers to:

• a. The patient’s sleep-wake cycle.
• b. Unpredictable shifts between good mobility (“on”) and immobility/stiffness (“off”).
• c. The patient turning lights on and off.
• d. The patient’s response to an antidepressant.

Answer: b. Unpredictable shifts between good mobility (“on”) and immobility/stiffness (“off”).

35. Glatiramer acetate is a non-interferon injectable for MS that works by:

• a. A currently unknown mechanism, but it is thought to act as a “decoy” for the immune system.
• b. Blocking dopamine receptors.
• c. Inhibiting acetylcholinesterase.
• d. Targeting amyloid plaques.

Answer: a. A currently unknown mechanism, but it is thought to act as a “decoy” for the immune system.

36. A key challenge in treating all neurodegenerative disorders is:

• a. The lack of effective medications.
• b. The difficulty of getting drugs across the blood-brain barrier.
• c. The progressive nature of the diseases.
• d. All of the above.

Answer: d. All of the above.

37. A patient with ALS often requires what type of supportive care as the disease progresses?

• a. Nutritional support (e.g., feeding tube).
• b. Respiratory support (e.g., non-invasive ventilation).
• c. Physical and speech therapy.
• d. All of the above.

Answer: d. All of the above.

38. The use of an MAO-B inhibitor like selegiline is intended to:

• a. Increase dopamine levels by preventing its breakdown in the brain.
• b. Increase serotonin levels.
• c. Increase acetylcholine levels.
• d. Decrease glutamate levels.

Answer: a. Increase dopamine levels by preventing its breakdown in the brain.

39. A patient taking an MAO-B inhibitor should be counseled about potential interactions with:

• a. Dairy products
• b. Certain antidepressants (SSRIs, SNRIs) and sympathomimetic drugs.
• c. Statin medications.
• d. Acetaminophen.

Answer: b. Certain antidepressants (SSRIs, SNRIs) and sympathomimetic drugs.

40. A rivastigmine patch for Alzheimer’s disease offers what advantage over the oral formulation?

• a. It is more effective.
• b. It has a lower incidence of gastrointestinal side effects.
• c. It only needs to be applied once a month.
• d. It is a curative therapy.

Answer: b. It has a lower incidence of gastrointestinal side effects.

41. The primary treatment for Amyotrophic Lateral Sclerosis (ALS) is:

• a. Curative
• b. Focused on symptomatic management and slowing progression.
• c. Based on acetylcholinesterase inhibitors.
• d. A surgical intervention.

Answer: b. Focused on symptomatic management and slowing progression.

42. Which of the following is NOT a classic feature of Alzheimer’s disease?

• a. Memory loss
• b. Apathy
• c. Language difficulties
• d. Resting tremor

Answer: d. Resting tremor

43. The management of neurodegenerative disorders requires a multidisciplinary team approach.

• a. True
• b. False

Answer: a. True

44. A key part of managing Parkinson’s disease is optimizing the timing of levodopa doses to:

• a. Minimize “off” time.
• b. Minimize dyskinesias.
• c. Both a and b.
• d. Neither a nor b.

Answer: c. Both a and b.

45. Which of the following is NOT a disease-modifying therapy for MS?

• a. Interferon-beta
• b. Dalfampridine
• c. Natalizumab
• d. Dimethyl fumarate

Answer: b. Dalfampridine

46. Dalfampridine is a potassium channel blocker used in MS to:

• a. Reduce relapses.
• b. Improve walking ability.
• c. Treat depression.
• d. Prevent cognitive decline.

Answer: b. Improve walking ability.

47. The overall goal of current pharmacotherapy for neurodegenerative disorders is to:

• a. Cure the underlying disease.
• b. Manage symptoms, slow progression, and improve quality of life.
• c. Regenerate lost neurons.
• d. Prevent all side effects of treatment.

Answer: b. Manage symptoms, slow progression, and improve quality of life.

48. A pharmacist’s role in counseling a patient with early Alzheimer’s disease involves:

• a. Speaking only to the caregiver.
• b. Simplifying medication regimens as much as possible.
• c. Using memory aids like pill boxes.
• d. Both b and c.

Answer: d. Both b and c.

49. Nuedexta, a combination of dextromethorphan and quinidine, is used to treat what symptom in some patients with ALS?

• a. Muscle weakness
• b. Pseudobulbar affect (involuntary laughing or crying)
• c. Spasticity
• d. Pain

Answer: b. Pseudobulbar affect (involuntary laughing or crying)

50. The ultimate reason for a pharmacist to learn about neurodegenerative disorders is to:

• a. Be able to safely and compassionately manage complex medication regimens for these challenging diseases.
• b. Pass the neurology exam.
• c. Memorize a list of all available treatments.
• d. Be able to diagnose these conditions.

Answer: a. Be able to safely and compassionately manage complex medication regimens for these challenging diseases.