neurology

Question 1

list 3 findings of this non-contrast CT brain showing an axial slice.

Answer 1

• large irregular left hyperdense lesion or intracranial haemorrhage.
• significant midline shift/mass effect with surrounding oedema
• effacement of left/ipsilateral sulcal and ipsilateral lateral ventricle

Question 2

state the 3 most likely causes for this finding

Answer 2

• spontaneous hypertensive intracranial bleed
• spontaneous bleed secondary to arteriosclerosis
• spontaneous bleed secondary to amyloid angiopathy

Question 3

in palliation of elderly with significant intracerebral haemorrhage list 4 medications, dose, route and indication

Answer 3

Morphine | 2.5–5 mg | SC hourly prn| Pain or dyspnea
Midazolam | 2.5–5 mg | SC hourly prn | Agitation or anxiety
Hyoscine butylbromide | 20 mg | SC 4 hourly prn| Reduce secretions
Metaclopramide | 10mg |IV/SC tds prn| Nausea or vomiting

Question 4

in palliation of elderly give 3 medications and doses and routes for pain

Answer 4

• Morphine 2.5-5mg sc hourly prn
  +/- 10 mg/24h via CSCI (can give up to 4 prn doses as above/24h)
  or
  Fentanyl 25-50 mcg hourly prn
  +/- 100 mcg/24h vis CSCI (can give up to 4 prn doses as above/24h)
  Or
  Oxycodone 1.25 mg sc hourly prn
  +/- 5 mg/24h via CSCI (can give up to 4 prn doses as above/24h)

Question 5

in palliation of elderly give 3 medications and doses and routes for anxiety/aggitation

Answer 5

Clonazepam 0.25-0.5 mg sc prn BD
or
Midazolam 2.5 mg sc hourly prn or 10 mg/24h via CSCI
Haloperidol 0.5-1 mg sc 2-4h prn (or droperidol) or 1-3 mg/24h via CSCI

Question 6

in palliation of elderly give 3 medications and doses and routes for secretions

Answer 6

Hyoscine butylbromide 20mg sc 4h prn or 60-120 mg/24h via CSCI
or
glycopyrrolate 200-400mcg s/c q2h prn
or
hyoscine hydrobromide 400 mcg

Question 7

in palliation of elderly give 3 medications and doses and routes for nausea/vomitting.

Answer 7

Metoclopramide 10 mg sc TDS prn or 30 mg/24h via CSCI
Or
Cyclizine 25 mg sc q8h/prn
+/- 75mg/24h via CSCI (can give prn doses as well)
or
Haloperidol 0.5-1 mg sc 2-4h prn (or droperidol) or 1-3mg/24h via CSCI

Question 8

State four (4) measures that would facilitate good end of life care for the imminently dying patient and their next of kin other than meds

Answer 8

• Provide a quiet, private room for family presence and comfort.
• Offer clear communication about prognosis and care plan to next of kin.
• Cease regular vital signs observation and remove monitoring.
• Arrange spiritual or psychological support (e.g., chaplain, counselor) if requested.