Parkinson’s disease MCQs With Answer

Parkinson’s disease MCQs With Answer provides B. Pharm students a focused, exam-oriented review of Parkinson’s disease pharmacology, pathophysiology, clinical features, and therapeutic management. This Student-friendly post highlights key terms such as Parkinson’s disease, dopaminergic therapy, levodopa‑carbidopa, MAO‑B inhibitors, COMT inhibitors, dopamine agonists, motor and non‑motor symptoms, and deep brain stimulation to help improve retention and online discoverability. Each MCQ emphasizes drug mechanisms, adverse effects, dosing considerations, drug interactions, and clinical decision-making relevant to pharmacy practice. The questions are crafted to deepen understanding beyond basics and prepare you for university exams and competitive tests. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. What is the primary neuropathological hallmark of Parkinson’s disease?

• Loss of cholinergic neurons in the hippocampus
• Degeneration of dopaminergic neurons in the substantia nigra pars compacta
• Widespread demyelination in cortical white matter
• Autoimmune destruction of spinal motor neurons

Correct Answer: Degeneration of dopaminergic neurons in the substantia nigra pars compacta

Q2. Which neurotransmitter deficiency is mainly responsible for the classical motor symptoms of Parkinson’s disease?

• Acetylcholine
• GABA
• Dopamine
• Serotonin

Correct Answer: Dopamine

Q3. Which drug is converted to dopamine in the brain and is the most effective symptomatic treatment for Parkinson’s disease?

• Pramipexole
• Levodopa
• Selegiline
• Entacapone

Correct Answer: Levodopa

Q4. Why is carbidopa given with levodopa?

• To increase dopamine receptor sensitivity
• To inhibit peripheral aromatic L‑amino acid decarboxylase and reduce peripheral side effects
• To enhance blood–brain barrier penetration of levodopa
• To prevent hepatic metabolism by CYP enzymes

Correct Answer: To inhibit peripheral aromatic L‑amino acid decarboxylase and reduce peripheral side effects

Q5. Which class of drugs inhibits monoamine oxidase B (MAO‑B) and is used as adjunct therapy in Parkinson’s disease?

• COMT inhibitors
• Anticholinergics
• MAO‑B inhibitors
• Beta blockers

Correct Answer: MAO‑B inhibitors

Q6. Which of the following is a selective MAO‑B inhibitor commonly used in Parkinson’s disease?

• Rasagiline
• Tolcapone
• Trihexyphenidyl
• Metoclopramide

Correct Answer: Rasagiline

Q7. COMT inhibitors like entacapone act by which mechanism?

• Blocking dopamine reuptake into presynaptic neurons
• Inhibiting catechol‑O‑methyltransferase to prolong levodopa half‑life
• Stimulating D2 receptors directly
• Inhibiting peripheral decarboxylation of levodopa

Correct Answer: Inhibiting catechol‑O‑methyltransferase to prolong levodopa half‑life

Q8. Which COMT inhibitor is associated with a risk of severe hepatotoxicity and requires liver monitoring?

• Entacapone
• Tolcapone
• Selegiline
• Amantadine

Correct Answer: Tolcapone

Q9. Dopamine agonists such as pramipexole primarily stimulate which receptor subtype?

• Muscarinic M1 receptors
• D1 receptors only
• D2 family receptors (D2/D3)
• NMDA receptors

Correct Answer: D2 family receptors (D2/D3)

Q10. Which adverse effect is particularly associated with dopamine agonists in Parkinson’s disease?

• Urinary retention
• Impulse control disorders (e.g., gambling, hypersexuality)
• Severe constipation
• Ototoxicity

Correct Answer: Impulse control disorders (e.g., gambling, hypersexuality)

Q11. Which anticholinergic agent is commonly used for tremor-dominant Parkinson’s disease in younger patients?

• Trihexyphenidyl
• Triamcinolone
• Propranolol
• Benztropine

Correct Answer: Trihexyphenidyl

Q12. Amantadine exerts its antiparkinsonian effects mainly by which mechanism?

• NMDA receptor antagonism and increased dopamine release
• Selective D1 receptor agonism
• Inhibition of COMT
• Peripheral decarboxylase inhibition

Correct Answer: NMDA receptor antagonism and increased dopamine release

Q13. A major long‑term complication of chronic levodopa therapy is:

• Hepatotoxicity
• Wearing‑off and dyskinesias
• Renal failure
• QT prolongation

Correct Answer: Wearing‑off and dyskinesias

Q14. “Wearing‑off” phenomenon refers to:

• A sudden allergic reaction to levodopa
• Gradual return of motor symptoms as plasma levodopa levels fall before the next dose
• Permanent loss of drug efficacy after a single dose
• Exaggerated sedation after levodopa

Correct Answer: Gradual return of motor symptoms as plasma levodopa levels fall before the next dose

Q15. Which imaging modality can help support a diagnosis of Parkinson’s disease by assessing presynaptic dopaminergic function?

• CT scan of the head
• DAT SPECT (DaTscan)
• EEG
• Chest X‑ray

Correct Answer: DAT SPECT (DaTscan)

Q16. Which of the following is NOT a typical non‑motor symptom of Parkinson’s disease?

• Constipation
• Depression and anxiety
• Visual field defects due to optic neuritis
• Sleep disturbances and REM behavior disorder

Correct Answer: Visual field defects due to optic neuritis

Q17. The UK Brain Bank clinical diagnostic criteria for Parkinson’s disease require which cardinal motor features?

• Bradykinesia plus at least one of tremor, rigidity, or postural instability
• Isolated resting tremor only
• Ataxia and spasticity
• Memory loss and aphasia

Correct Answer: Bradykinesia plus at least one of tremor, rigidity, or postural instability

Q18. Which antiemetic should be avoided in Parkinson’s patients because it blocks dopamine receptors and can worsen parkinsonism?

• Ondansetron
• Metoclopramide
• Domperidone
• Promethazine

Correct Answer: Metoclopramide

Q19. Which antiemetic is preferred in Parkinson’s disease because it does not cross the blood‑brain barrier significantly?

• Prochlorperazine
• Domperidone
• Haloperidol
• Metoclopramide

Correct Answer: Domperidone

Q20. Combining MAO‑B inhibitors with which class of drugs requires caution due to risk of serotonin syndrome?

• Anticholinergics
• SSRIs and SNRIs
• Beta agonists
• Proton pump inhibitors

Correct Answer: SSRIs and SNRIs

Q21. Which formulation delivers continuous intestinal infusion of levodopa to reduce motor fluctuations?

• Transdermal rotigotine patch
• Levodopa–carbidopa intestinal gel (LCIG)
• Oral controlled‑release levodopa only
• Intramuscular levodopa depot

Correct Answer: Levodopa–carbidopa intestinal gel (LCIG)

Q22. Deep brain stimulation (DBS) most commonly targets which brain structure in Parkinson’s disease?

• Hippocampus
• Subthalamic nucleus (STN)
• Cerebellar vermis
• Corpus callosum

Correct Answer: Subthalamic nucleus (STN)

Q23. Which symptom is more responsive to levodopa therapy: tremor, gait freezing, or postural instability?

• Postural instability improves the most
• Gait freezing is highly responsive
• Tremor and bradykinesia respond better than postural instability
• None of these respond to levodopa

Correct Answer: Tremor and bradykinesia respond better than postural instability

Q24. A pharmacist counseling a patient starting levodopa/carbidopa should advise that high‑protein meals may:

• Enhance levodopa absorption and effect
• Delay gastric emptying and reduce levodopa absorption due to competition with amino acids
• Prevent peripheral side effects
• Neutralize levodopa and render it inactive

Correct Answer: Delay gastric emptying and reduce levodopa absorption due to competition with amino acids

Q25. Which laboratory parameter should be monitored when a patient is treated with tolcapone?

• Serum creatinine
• Liver function tests (LFTs)
• Serum amylase
• Thyroid function tests

Correct Answer: Liver function tests (LFTs)

Q26. Which drug can be used to treat levodopa‑induced dyskinesia?

• Amantadine
• Entacapone
• Levodopa dose increase
• Metoclopramide

Correct Answer: Amantadine

Q27. Which statement about levodopa pharmacokinetics is true?

• Levodopa is active without metabolic conversion
• Levodopa is decarboxylated to dopamine by aromatic L‑amino acid decarboxylase
• Levodopa is metabolized primarily by CYP3A4
• Levodopa is excreted unchanged in the urine

Correct Answer: Levodopa is decarboxylated to dopamine by aromatic L‑amino acid decarboxylase

Q28. Which of the following drugs is a selective D3-preferring dopamine agonist used in Parkinson’s disease?

• Levodopa
• Pramipexole
• Entacapone
• Selegiline

Correct Answer: Pramipexole

Q29. Which medication is contraindicated or used with extreme caution in Parkinson’s patients due to strong D2 blockade and risk of worsening parkinsonism?

• Clozapine
• Quetiapine
• Haloperidol
• Clozapine and quetiapine are both contraindicated

Correct Answer: Haloperidol

Q30. Which therapeutic approach can be considered for severe, medication-refractory tremor in Parkinson’s disease?

• Increase dietary iron
• Deep brain stimulation (DBS)
• High‑dose benzodiazepines long‑term
• Insulin therapy

Correct Answer: Deep brain stimulation (DBS)

Q31. Which of the following best describes “freezing of gait” in Parkinson’s disease?

• Transient inability to start or continue walking despite intention
• Permanent paralysis of the lower limbs
• Excessive speed of walking
• Involuntary leg extension during sleep

Correct Answer: Transient inability to start or continue walking despite intention

Q32. Which drug class is most appropriate for managing drug‑induced parkinsonism caused by antipsychotics?

• Increase dose of antipsychotic
• Anticholinergics (e.g., benztropine) or switch to atypical antipsychotic with lower D2 blockade
• COMT inhibitors
• MAO‑B inhibitors

Correct Answer: Anticholinergics (e.g., benztropine) or switch to atypical antipsychotic with lower D2 blockade

Q33. Which of the following is a potential cardiovascular adverse effect of levodopa therapy?

• Bradycardia only
• Orthostatic hypotension and palpitations
• Hypertension crisis in all patients
• Complete heart block in every patient

Correct Answer: Orthostatic hypotension and palpitations

Q34. Safinamide’s antiparkinsonian activity includes MAO‑B inhibition and which additional action?

• Serotonin reuptake inhibition
• Glutamate release modulation (sodium channel and glutamate release inhibition)
• Beta‑adrenergic blockade
• Cholinesterase inhibition

Correct Answer: Glutamate release modulation (sodium channel and glutamate release inhibition)

Q35. Which factor increases the risk of developing levodopa‑induced dyskinesias?

• Older age at disease onset
• Younger age at disease onset and longer disease duration
• Short duration of levodopa use
• Concomitant use of anticholinergics only

Correct Answer: Younger age at disease onset and longer disease duration

Q36. Which adjunct therapy can be added to reduce wearing‑off by prolonging levodopa action?

• Anticholinergic alone
• COMT inhibitor such as entacapone
• Loop diuretics
• Oral insulin

Correct Answer: COMT inhibitor such as entacapone

Q37. Which symptom is a cardinal diagnostic motor sign of Parkinson’s disease?

• Hyperreflexia
• Bradykinesia
• Hypertonia with spasticity
• Intention tremor

Correct Answer: Bradykinesia

Q38. Which statement is true regarding the use of levodopa in early Parkinson’s disease?

• Early levodopa initiation irreversibly accelerates disease progression
• Early levodopa improves symptoms; choice to start depends on symptom severity and patient needs
• Levodopa is ineffective in early disease stages
• Levodopa should never be combined with carbidopa

Correct Answer: Early levodopa improves symptoms; choice to start depends on symptom severity and patient needs

Q39. Which of the following is a major counseling point for patients taking selegiline orally?

• Avoid foods high in tyramine at normal MAO‑B doses
• It should be taken with high‑protein meal to increase effect
• It may cause insomnia; avoid taking at night
• It causes significant QT prolongation in all patients

Correct Answer: It may cause insomnia; avoid taking at night

Q40. Which Parkinson’s medication is available as a transdermal patch providing continuous dopaminergic stimulation?

• Ropinirole oral tablet
• Rotigotine transdermal patch
• Pramipexole immediate release only
• Selegiline patch

Correct Answer: Rotigotine transdermal patch

Q41. Which drug is used as rescue therapy for sudden off‑periods and can be administered subcutaneously?

• Intravenous levodopa bolus
• Apomorphine
• Oral entacapone immediate release
• Oral selegiline sublingual only

Correct Answer: Apomorphine

Q42. Which of the following is considered a red flag suggesting an alternative diagnosis to idiopathic Parkinson’s disease?

• Asymmetric onset with tremor
• Early severe autonomic failure and poor levodopa response
• Good sustained response to levodopa
• Typical progression over years

Correct Answer: Early severe autonomic failure and poor levodopa response

Q43. In pharmacology, why are peripheral decarboxylase inhibitors (PDIs) used with levodopa?

• To increase peripheral conversion of levodopa
• To reduce peripheral conversion so more levodopa reaches the brain and to reduce peripheral side effects
• To inhibit COMT centrally
• To potentiate MAO‑B degradation of dopamine

Correct Answer: To reduce peripheral conversion so more levodopa reaches the brain and to reduce peripheral side effects

Q44. Which class of medications may worsen Parkinson’s symptoms if started in a patient with Parkinson’s disease?

• SSRIs
• Typical antipsychotics with strong D2 antagonism
• ACE inhibitors
• Statins

Correct Answer: Typical antipsychotics with strong D2 antagonism

Q45. Levodopa‑induced psychosis is often managed by:

• Increasing levodopa dose
• Reducing dopaminergic therapy if possible and using atypical antipsychotics like clozapine or quetiapine
• Starting high‑dose typical antipsychotics
• Immediate cessation of all anti‑Parkinson drugs without alternatives

Correct Answer: Reducing dopaminergic therapy if possible and using atypical antipsychotics like clozapine or quetiapine

Q46. Which biomarker or test is diagnostic for Parkinson’s disease?

• There is no single definitive biomarker; diagnosis is clinical supported by imaging when needed
• Elevated CSF amyloid-beta
• Positive anti‑dopamine receptor antibodies
• Serum creatine kinase elevation

Correct Answer: There is no single definitive biomarker; diagnosis is clinical supported by imaging when needed

Q47. Which pharmacological strategy can reduce peak‑dose dyskinesia?

• Increasing immediate‑release levodopa dose
• Splitting doses, adding amantadine, or reducing peak levodopa plasma levels
• Switching to high‑dose COMT inhibitors only
• Adding metoclopramide to every dose

Correct Answer: Splitting doses, adding amantadine, or reducing peak levodopa plasma levels

Q48. Which symptom cluster suggests involvement of non‑dopaminergic systems in Parkinson’s disease?

• Bradykinesia and rest tremor only
• Dementia, autonomic dysfunction, and gait instability
• Pure motor symptoms responding to levodopa
• Isolated peripheral neuropathy

Correct Answer: Dementia, autonomic dysfunction, and gait instability

Q49. For B. Pharm students, which key pharmacokinetic property of levodopa is important for counseling about variable response?

• High oral bioavailability unaffected by diet
• Rapid first‑pass hepatic metabolism by CYP enzymes
• Competition with dietary amino acids for intestinal absorption and BBB transport
• Complete renal excretion with no metabolism

Correct Answer: Competition with dietary amino acids for intestinal absorption and BBB transport

Q50. Which emerging or advanced therapy is used for advanced Parkinson’s disease with severe motor fluctuations and allows continuous subcutaneous infusion?

• Oral controlled‑release dopamine only
• Continuous subcutaneous apomorphine infusion
• Intravenous levodopa infusion in outpatient setting
• Daily high‑dose oral selegiline only

Correct Answer: Continuous subcutaneous apomorphine infusion

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