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CME Questions for Grand Round:
"Medical Management of Parkinson's Disease"

IPMA designates this education activity for a maximum of 0.5 Category 1 credits toward the Physician's Recognition Award of the American Medical Association. Each physician should claim only those credits he or she actually spent in the activity.

Instructions
To earn credit online, you must listen to the CME lectures carefully, print out the quiz page and answer both the quiz and lecture evaluation questions, obtain a passing score (a minimum of 75% when 4 questions are present), and complete the credit evaluation form. Your certificate will be e-mailed to you at the e-mail address provided within 3 weeks. Please mail or fax your completed quiz, along with your full mailing information to the following address:

Interstate Postgraduate Medical Association
PO Box 5474, Madison, WI 53705
Fax: (877) 292-4489

If you have questions, please contact IPMA at cmehelp@ipmameded.org.


1.  Which of the following is a reasonable therapeutic approach to a patient with mild Parkinson's disease, where symptoms are not yet affecting quality of life:
  1. Encourage exercise and cognitive stimulation.
  2. Prescribe a MAO-B inhibitor or coenzyme Q10.
  3. Hold off on all pharmacologic therapy until symptoms worsen.
  4. All of the above.
2.  Which of the following best reflects our current understanding of how chronic levodopa affects the rate of neurodegeneration in Parkinson's disease:
  1. Levodopa accelerates underlying disease progression.
  2. Levodopa slows the rate of underlying disease progression.
  3. The effects of levodopa on underlying disease progression remain unknown.
  4. Levodopa has no effect on underlying disease progression.
3.  Which of the following would NOT be an appropriate therapy for a patient with Parkinson's disease who is experiencing nausea from levodopa:
  1. Trial of supplemental carbidopa.
  2. Trial taking levodopa with food.
  3. Trial of compazine for nausea.
  4. Trial of domperidone for nausea.
4.  A patient with advanced Parkinson's disease notices that his movement speed decreases 1 hour before each of his levodopa doses. He currently takes two tablets of carbidopa/levodopa (25/100) three times per day. Which of the following would NOT be an appropriate intervention:
  1. Increase the frequency of carbiodopa/levodopa dosing to four times per day.
  2. Add amantadine 100 mg, two times per day.
  3. Supplement each carbidopa/levodopa dose with a COMT inhibitor.
  4. Adjust levodopa dosing to avoid meals.

Lecture Evaluation Questions
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