finals

Question 1

parkinson’s - investigations

Answer 1

clinical diagnosis

MRI - rule out rare causes of parkinsonism

Question 2

1st line management of PD

Answer 2

severe/elderly - levodopa + dopa decarboxylase inhibitor (co-beneldopa)

moderate - dopamine agonist (ropinirole, pramipexole)

physio, OT, SALT

Question 3

stroke - management

Answer 3

CT to exclude haemorrhagic
aspirin 300mg
thrombolyse if <4.5h

Question 4

stroke - secondary prevention

Answer 4

statin after 48h
aspirin or clopi 300mg 2wk
then clopi 75mg lifelong
carotid endarterectomy if approp

warfarin over clopi if AF (start 2wk later)

Question 5

osteoporosis - management

Answer 5

alendronate
women - vit D + calcium
falls risk assessment

Question 6

osteoporosis - investigations

Answer 6

FBC, U+Es, LFTs
DEXA
calcium + vit D
bone profile + TFTs

exclude mimics - myeloma + osteomalacia

Question 7

bisphosphonates - SEs

Answer 7

oesophagitis + ulcers
osteonecrosis of the jaw
atypical femoral shaft fractures

Question 8

bisphosphonates - how to take

Answer 8

water +++
empty stomach - 30+ min before breakfast
upright 30min after

Question 9

falls - secondary prevention

Answer 9

treat cause
medication review
lighting + tidy
eye + ear test
continence assessment
footwear

Question 10

TIA - management

Answer 10

aspirin 300 for 2 weeks, then 75 + dipyridamole MR (or warfarin if AF)
ABCD2 score + quick TIA clinic
no driving 4wk
never forget lifestyle changes!

Question 11

TIA - investigations

Answer 11

FBC, U+E, glucose
lipids + ESR
CXR
ECG + echo
carotid doppler +- angiography
\+- MRI brain

Question 12

what conditions should you look for after someone’s had a TIA?

Answer 12

carotid artery stenosis - bruit
HTN
AF
valvular disease