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MRCP PART 1 > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

Venous vs arterial vs neuropathic ulcers

A

Venous
-Shallow, painless
-Associated skin changes Eg haemosidderin desposits / eczema

Arterial
-‘Punched out’, usually deep and painful occurring at pressure points
- May have signs of chronic limb ischemia

Neuropathic
- Painless with surrounding paraesthesia
- Normal pulses present
-Usually have an underlying cause Eg diabetes

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2
Q

Poor prognostic factors in ulcers are

A

lasting >1yr
previous requirement for surgical Rx of ulcers
ABPI <0.8
Poor compliance with treatment / lifestyle advice

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3
Q

Generalised erythema, systemic symptoms and atypical t-cell invasion on skin biopsy

A

Cutaneous T-cell lymphoma

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4
Q

TTP Rx

A

Plasma exchange [+ ffp]

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5
Q

Rx of actinic keratosis - if they want gone

A

Topical 5-fluorouriacil cream

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6
Q

Which Abx is strongest P450 inhibitor

A

Erythromycin
Then Calri / azithro

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7
Q

Parkinson’s’ Sx is well controlled but having issues with dyskinesia from medication side effects. What can you prescribe?

A

Amantadine (NMDA receptor inhibitor)

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8
Q

What class of drug is entacapone? What is it good for?

A

COMT inhibitor.
Good for patients getting ‘off’ symptoms as inhibits the breakdown of dopamine and so prolongs its action

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9
Q

Allopurinol class? What does this do

A

Xanthine oxidase inhibitor
->Recudes urate production

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10
Q

Anaemia. confusion. Hepatosplenomegaly. Increased viscosity. Raised IgM =?Rx?

A

Walldenstrom macroglobulinaemia
[low grade lymphoma]

Plasmapheresis - to reduce plasma viscosity
[Will then likely need chemo]

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11
Q

Most important thing to work out if someone with AS needs replacement

A

Symptoms

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12
Q

Pontine bleed comes from which artery

A

Basilar

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13
Q

Parkinsonism, variable levels of arousal, forgetful, hallucinations, with some autonomic Sx? Rx?

A

Lew body disease

Cholinesterase inhibitors Eg Rivastigmine

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14
Q

Bipolar started on lithium but no response what next?

A

Add in valproate

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15
Q

MRSA but vanc allergic options

A

Teicoplanin or linezolid

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16
Q

Amiodarone mechanism

A

K channel blocker

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17
Q

lidocaine mechanism

A

Na channel blocker

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18
Q

Sensory supply to anterior groin

A

L1/2

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19
Q

An ulcerated nodular lesion with surrounding keratosis and paraesthesia on face

A

SCC

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20
Q

Bullous impetigo + pyrexia Rx

A

IV co-amox

[rather than fluclox]

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21
Q

Speckled appearance of LV on echo likely =

A

Amyloid

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22
Q

Left hemiparesis, right horners, left nystagmus, tongue deviates right. Where is lesion

A

R brainstem

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23
Q

Why does trimethoprim lead to raised Cr

A

COMPETITIVE inhibition of creatinine secretion

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24
Q

1st line Rx HTN in > 80

A

MR Nifedipine

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25
Q

Flat pigmented 2cm lesion on the face with an irregular border

A

Lentigo Melanoma

26
Q

Older male presenting with symptoms of bony mets probably has

A

Prostate Ca

27
Q

When would you prescribe Cef met AND amox for suspected meningitis

A

> 60 or immunocompromised to cover for listeria

28
Q

Why ongoing UTI in someone whos catheter isn’t changed but is given Abx

A

Biofilm formation

29
Q

Torsades in COPD on lots of diuretics what 2 classes Abx might he have been prescribed

A

Macrolide Eg clari
Quinolone Eg Cirpo

30
Q

Rx of hallucinations / agitation in parkinsons.

A

Low dose atypical antipsychotics Eg Quetiapine

31
Q

Aspergillus down a microscope

A

Septate hyphae

[If sinus infection and Septate hyphae it is aspergillus. They will likely be immunocompromised to some degree]

32
Q

Nasal stuffiness, facial pain and oedema with necrotic black nasal turbinates. Hypae [not septate] on microscopy

A

Mucor ssp.

33
Q

Hallucinations in Dementia with lewy bodies

A

Detailed and well-formed

34
Q

Why do old people get a lower dose of digoxin

A

Reduced renal clearnace

35
Q

What is the mechanism for developing a tolerance to nitrates

A

Generation of reactive oxygen species

[Chronic nitrate therapy -> vascular oxidative stress -> enhanced degradation of NO]

36
Q

Choreform movements = lesion where?

A

Caudate nucleus

37
Q

Issues with arm swing and upper limb motor control = lesion where

A

Red nucleus

38
Q

saccade eye movement, sleep wake issues = lesion where

A

Thalamus

39
Q

Symtomatic CLL in old person. Option for single agent Rx?

What is the choice for actually trying to treat it?

A

Chlorambucil
[Can add in rituximab if needed]

FCR combination chemo
[fludarabine, cyclophosphamide, rituximab]

40
Q

Digoxin why does it take a while to have an effect if you don’t load ?

A

High degree of protein binding
->Widely distributed around body tissues

41
Q

Bone pain, mildly low Ca, Raised ALP / PTH =

A

Osteomalacia

42
Q

Rx of stroke if >4.5hrs

A

Aspirin 300mg only

43
Q

Do you get neutropenia in CML

A

NO - you get a leukocytosis. But they are dysfunctional

44
Q

Which haem onc has the high assoc with autoimmune haemolytic anaemia

A

CLL

45
Q

NH resident found to be asymptomatic but MRSA positive on skin swab. Rx?

A

Needs topical decolonisation
-Usually mupirocin + chlorhexidine

46
Q

Pins and needles in hands and feet
-> Weak legs, Reduced sensation and proprioception, reduced reflexes =

A

B12 deficiency -> subacute degeneration of the spinal cord

47
Q

Left CN3 palsy + right hemiparesis where is lesion

A

Left paramedian arteries (supplying midbrain)

48
Q

Which CN pass through the jugular foramen? Symptoms of compression here?

A

IX, X, XI
Weak neck, hoarse voice, absent gaga reflex

49
Q

DVT -> treated with heparin then develops an ischemic foot. What has happened?

A

Arterial thrombus secondary to HIT

50
Q

Multiple strokes with carotid stenosis when would you perform endarterectomy? What would be the Rx otherwise?

A

> 50% stenosis with thought strokes were coming from there

Clopidogrel for long term

51
Q

AF with pauses what type of pacemaker

A

DDDR

52
Q

Artery if amaurosis fugax

A

Internal carotid

53
Q

Digoxin mechanism

A

Inhibiton of sodium-potassium ATPase

54
Q

On aspirin with slighly prolonged PT and platelets of 140. Cause of extensive bruising?

A

Aspirin related

[Platelets slightly low and slightly high PT - not enough for big bruising]

55
Q

What is most raised in a pathological fracture in prostate mets?
Key drug for Rx ?

A

ALP
[Ca often normal]

Denosumab
[Old denos with his dodgy prostate]

56
Q

Old person on antihypertensives. Which one causing hypoNa and HypoK

A

Indapamide

57
Q

Which arteries supply occiptal lobe? What is affected if bilateral cortical blindness ?

A

Posterior cerebral arteries

Basilar - if bilat

58
Q

What would make you think fronto temporal dementia on exam

A

Failure to draw interlocking shapes

59
Q

Barthol index post-stroke when are you 60% more likely to die

A

<50 = low ability to perform ADLs

60
Q

Which -stigmine in alzheimers

A

Rivastigmine

61
Q

When no ach inhibitor in dementia?

A

MMSE <10

62
Q

Early falls with parkinsonism 2 key DDs?

A

PSP
NPH

MRCP PART 1 (22 decks)

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