Integrative

Question 1

Which type of dementia is most likely to present with complex visual hallucinations?

Answer 1

Lewy body dementia

Question 2

What type of dementia may occur in Parkinson’s disease?

Answer 2

Lewy body dementia

Question 3

Which type of dementia has a stepwise progression?

Answer 3

Vascular dementia

Question 4

What are some reversible causes of dementia?

Answer 4

Depression
Alcohol
Vitamin deficiency (B12, folate)
Hypothyroid 
Trauma

Question 5

Which class of antidepressants are first line in demented patients?

Answer 5

SSRIs (TCAs should be avoided due to worsening of cognition)

Question 6

What is the mechanism of action of memantine?

Answer 6

NMDA antagonist

Question 7

Alzheimer’s dementia predominantly affects which lobes of the brain?

Answer 7

Temporal (memory) and parietal (visuospatial)

Question 8

What is Mild Cognitive Impairment?

Answer 8

Thought of as a pre dementia state

Patient has mild cognitive decline but not enough to impact their activities of daily living

Question 9

What is the inverse care law?

Answer 9

Describes the fact that those who need medical care most are least likely to receive it
(And conversely those with the least need of health care tend to use services more and more effectively)

Question 10

What 4 questions are important to ask with regards to advance car planning gold standards framework?

Answer 10

What is important to you right now?
What do you want to happen in the future?
What do you not want to happen?
Who will speak on your behalf?
E.g. diet preferences, home or hospice, DNAR, family arrangements

Question 11

What questions can be asked in a spiritual history?

Answer 11

Hope, what gives you hope?
Organised religion?
Personal spirituality outside of religion?
Effect on health care: what can I do for you to help you access this?

Other q’s: what gives your life meaning? Who supports you? What’s your greatest worry? Where do you get your strength from?

Question 12

Why are the elderly more prone to drug toxicity?

Answer 12

As they have reduced renal clearance

Drugs can easily accumulate and cause adverse events

Question 13

How would you instruct a patient to take a bisphosphonate?

Answer 13

Weekly dose

Take in the morning on empty stomach with glass of water whilst standing up and 30 minutes before eating

Question 14

What are some side effects of amiodarone?

Answer 14

Thyroid (hyper and hypo) so 6monthly TFTs
Hepatitis and liver fibrosis: 6monthly LFTs
Pulmonary fibrosis
Slate grey appearance
Peripheral neuropathy
Prolonged QTc
Photosensitivity

Question 15

What should be co prescribed alongside steroids in an elderly px?

Answer 15

Bone protection (bisphosphone/ vitamin D and calcium)

Question 16

What is the toxic trio?

Answer 16

Factors that increase the risk of harm coming to a family

= domestic violence, substance misuse, parental ill health

Question 17

What are the 5 types of child abuse?

Answer 17

Physical
Emotional 
Sexual 
Neglect
Illness fabrication

Question 18

What are some risk factors for child abuse?

Answer 18

Child: “wrong” gender, disabilities, difficult child
Parent/ family: substance misuse, step parents, domestic violence, young parental age, social isolation, parental intolerance
Environment: poverty, poor housing

Question 19

What tool can be used to identify adults at risk of malnutrition?

Answer 19

MUST

Question 20

What factors does the MUST nutrition tool look at?

Answer 20

BMI
Unintended weight loss (over last 3 months)
Acutely ill and has/ likely to have no nutritional intake for 5 or more days

Question 21

What conservative management strategies can be implemented for a patient with constipation?

Answer 21

Dietary (increase fibre, high sorbitol fruits)
Adequate fluid intake
Keep mobile
Toilet regime (regular, not busy, use a step for feet)

Question 22

What causes J waves on an ECG?

Answer 22

Hypothermia