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OPIC (Y4) > OPIC past paper questions > Flashcards

OPIC past paper questions Flashcards

1
Q

Define delirium

A
  • Impairment of cognition, disturbances of attention and conscious level, abnormal psychomotor behaviour, disturbed sleep-wake cycle.
  • Onset is usually acute (hours/days).
  • Caused by a physical condition
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2
Q

define dementia

A

PERSISTENT DISABLING COGNITIVE IMPAIRMENT
- Cognitive impairment: decline in both memory and thinking sufficient to impair activities of daily living (ADLs).
- Problems with the processing of incoming information - problems with maintaining and directing attention.
- Clear consciousness.
- Above syndrome present for >= 6 months

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3
Q

common types of dementia

A
  • Alzheimers
  • Frontotemporal
  • Lewy body
  • Vascular
  • AIDS complex
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4
Q

cause of alzheimers

A
  • RF: Genetic, smoker, HTN, high cholesterol

Pathophysiologyamyloid plaques (clumps of beta-amyloid) and neurofibrillary tangles (bundles of filaments within neurons, mostly made from tau protein).

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5
Q

cause of vascular dementia

A
  • HTN
  • high cholesterol
  • smoking
  • obesity

Stepwise decline

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6
Q

cause of lewy body dementia

A

Lewy body proteins (alpha-synuclein) are deposited in the brain.

These Lewy bodies are also present in Parkinson’s disease. In Parkinson’s they are mainly deposited in the substantia nigra, whereas they are more widespread in Lewy body dementia.

  • visual hallucinations
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7
Q

Cause of frontotemporal dementia

A
  • build up of tau proteins in the frontal lobe
  • atrophy occurs due to deposition of abnormal proteins (often tau protein) within the lobes.
  • There is thought to be a genetic component in about a quarter of cases.
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8
Q

Most common causes of delirium (3)

A
  • Infection e.g. UTI, pneumonia
  • Medications
  • Withdrawal
  • Constipation/ urinary retention
  • Pain
  • Change in environment
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9
Q

how you would adapt your history taking/information giving for a patient with cognitive impairment

A
  • allow for extra time
  • do appointment at beginning/end of day to make sure its quiet
  • speka in plain way
  • draw pictures or write down
  • speak slowly
  • low pitch
  • home visit
  • collateral history
  • cognitive screening
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10
Q

Stuart is a 57 year old lorry driver who presents with a 6 month history of slowness of gait
and difficulty with writing. Fine hand movements are poor. In the past he has seen a
urologist with urgency of micturition and occasional incontinence. He is taking sildenafil
and an inhaler for asthma. On examination there is slowness of gait, facial hypomimia and
cogwheel rigidity in all 4 limbs. Bradykinesia of hand movement is present. There is no
tremor.
1) He is started on co careldopa but, when seen 4 months later, is not significantly
improved. The dosage is therefore increased. 3 months later he is still no better.
What does this suggest and what might be the reason for this?

A

Two scenarios
- Not parkinsons
- This suggests that his parkinsons is so advanced that he no longer has enough doperminergic neurones to be stimulated to release dopamaine therefore no substrate for co careldopa to work on and no change in symptoms

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11
Q

What is meant by on/off fluctuations in patients who are taking levodopa
preparations and why do they occur?

A

The “on-off” phenomenon in Parkinson’s disease (PD) refers to a switch between mobility and immobility in levodopa-treated patients, which occurs as an end-of-dose or “wearing off” worsening of motor function or, much less commonly, as sudden and unpredictable motor fluctuations

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12
Q

What is the Comprehensive Geriatric Assessment? List advantages and
disadvantages of using this approach.

A

Comprehensive geriatric assessment (CGA) is defined as a multidisciplinary diagnostic and treatment process that identifies medical, psychosocial, and functional capabilities of an older adult in order to develop a coordinated plan to maximize overall health with aging
It requires evaluation of multiple issues, including physical, cognitive, affective, social, financial, environmental, and spiritual components that influence an older adult’s health
positives
- thorough
- holistic
- patient centred

negatives
- could be hard to oprchestrate such a big MDT
- requires regular review
- expensives
- time consuming

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13
Q

main reason elderly are more prone to drug toxicity

A
  • redcued renal function
  • decreased body size, altered body composition (more fat, less water)
  • drug interactions
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14
Q

Which medications should be used with particular care in the elderly?

A
  • anticholinergics
  • benzos
  • antipsychotics
  • NSAIDs
  • SSRIs
  • opioid
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15
Q

) Why should co-prescribing NSAIDs and ACE inhibitors be avoided?

A

Both nephrotoxic- can cause AKI

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16
Q

Name 3 classes of drugs that have been found to increase the risk of falls in older
patients

A
  • rampiril
  • morphine
  • diazepam
  • diuretics
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16
Q

Name 3 classes of drugs that have been found to increase the risk of falls in older
patients

A
  • rampiril
  • morphine
  • diazepam
  • diuretics
17
Q

Describe your approach to assessment of someone who presents with recurrent
falls.

A
  • fall history: before, during, after
  • examination: gait, ecg, BP, peripheral neuroglogical
  • blood tests: FBC, UandE, etc
  • imaging: CT/MRI
  • collateral history
  • falls risk assessment
  • eye checks/ ENT
  • OT/PT assessment of at home
18
Q

4 questions should an Advanced
Care Plan address?

A

• At this time in your life, what is important to you?
• What elements of care are important to you and what WOULD you like to
happen in future?
• What would you NOT want to happen? Is there anything that you worry
about or fear happening?
• Who would speak for you - your nominated proxy spokesperson or Lasting
Power of Attorney?

19
Q

Give 3 barriers to carers accessing support

A

time
funding
lack of knowledge of service
guilty

20
Q

Mr Lang is 83-year-old with a known diagnosis of vascular dementia. His wife died three
years ago and he was unable to cope alone at home. The couple had no other close family.
There is little doubt that his dementia has worsened. In particular, it affects his speech: he
has expressive dysphasia with obvious word-finding problems. Nevertheless, it is felt that
he can understand most things said to him. The GP is called in because Mr Lang looks
unwell: he is thin and is somewhat unkempt having spent a day in bed. During this time
he has developed urinary incontinence. Mr Lang is quite apathetic but complies with an
examination and the GP confirms that he has a chest infection. He is still able to swallow
and has been compliant with taking his medication.

What legal and ethical factors must the GP consider when developing a management
plan for this patient?

A

1) consideration of patients advanced plan and wishes
2) talk to patient and understand their wishes
3) least restrictive options
2) personal judgement of what you feel would be appropriate

21
Q

Name 3 types of urinary incontinence and state how you would differentiate
between them.

A

1) Stress- on increase in pressure in abdomen e.g. coughing laughing
2) Urge- ‘key in the door scenario’
3) Mixed- features of both
4) neurological e.g. other neurological features- complete loss of continence and sensory loss in area

22
Q

Name 3 types of urinary incontinence and state how you would differentiate
between them.

A

1) Stress- on increase in pressure in abdomen e.g. coughing laughing
2) Urge- ‘key in the door scenario’
3) Mixed- features of both
4) neurological e.g. other neurological features- complete loss of continence and sensory loss in area

23
Q

pharcological approach to constipation

A

osmotic or stimulant laxative

23
Q

pharcological approach to constipation

A

osmotic or stimulant laxative or bulk forming

24
Q

non pharmacological treatment of constipation

A
  • increase activity
  • high fibre diet
  • increase hydration
25
Q

3 MUST score factors

A

BMI
Weight loss
current illness

25
Q

3 MUST score factors

A

BMI
Weight loss
current illness

26
Q

management plan for someone identified as high risk on the MUST score.

A

> 2 refer
1) encourage eating/ tailor diet to desire
2) Dietician referral
3) high calorie drinks such as fortisips
3) NG feeding

26
Q

management plan for someone identified as high risk on the MUST score.

A

> 2 refer
1) encourage eating/ tailor diet to desire
2) Dietician referral
3) high calorie drinks such as fortisips
3) NG feeding

27
Q

How would you differentiate between an upper and lower motor neurone lesion?

A

upper
- hypertonia
- hyperreflexia (babinski sign)
- spatisity
- babinski positive

lower
- hypotonia
- hyporrefexia
- fasiculation

27
Q

How would you differentiate between an upper and lower motor neurone lesion?

A

upper
- hypertonia
- hyperreflexia (babinski sign)
- spatisity
- fasciculation
lower
- hypotonia
- hyporrefexia
- fasiculation

28
Q

How do you differentiate a total from partial anterior circulation infarct?

A

TACS (all 3 of)
- homonomous hemianopia
- Contralateral motor or sensory deficit
- higher cortical dysfunction
PACs (2 of the above)

29
Q

What clinical signs would you expect when examining a patient who has had a
posterior circulation infarct?

A
  • Cerebellar symptoms: DANISH
  • Visual defects due to ischaemia of occipital lobe
  • Brainstem death- no breathing or heart beat
30
Q

What is the inverse care law?

A

the principle that the availability of good medical or social care tends to vary inversely with the need of the population served

31
Q

acute confusion vs delirium

A

• Acute confusion = acute deficit in thinking, short-term memory and orientation in
time/place with reduced awareness

• Delerium = acute onset confusion with hallucinations or illusions

32
Q

Give 3 questions that you might use as part of a spiritual history

A

• What support do you have?
• Do you have people you can talk to?
• What is your greatest worry?
• What is the most important issue in your life?
• What would be the most helpful thing for you?
• What do we need to know about you to give you the best care?
• What gives your life meaning?
• Where do you get your strength from?
• Is religion or faith important to you?

33
Q

Bulk forming laxatives e.g. Fybogel

A

Pharmacodynamics – Increase the bulk of stools by enabling fluid to be retained within the
faeces. Increasing the mass increases peristalsis. Must have adequate fluid hydration to
prevent intestinal obstruction. Caution with frail. Not suitable for those taking opioids.

34
Q

Osmotic laxatives

A

– Lactulose/Macrogels/Phosphate enemas
Pharmacodynamics – soften the stool makes them easier to pass by increasing the amount
of water in your bowels. Lactulose causes increased bloating and colic symptoms. Movicol /
Laxido volume can be difficult for those to drink or those who are fluid restricted (125mls
per sachet) typical dose would be 2-4 sachets. Movicol-half is available (60mls per sachet).
Can affect medication absorption

35
Q

Stimulant

A

Bisacodyl/Senna
Pharmacodynamics – stimulating nerves that control the muscles lining the digestive tract.
Senna – Short term license only.

36
Q

Stool softener laxatives

A

– Docusate (stimulant activity also)
Pharmacodynamics – ‘Surface wetting agent’. Makes the surface of the stools permeable,
water can be absorbed, which increases the fluid content of hard stools. Glycerin
Suppositories work mostly by hyperosmotic action, but the sodium stearate in the
preparation also causes local irritation to the colon

37
Q

how to tell if UMN or LMN by looking at the face

A

In UMN lesions the forehead is spared.

OPIC (Y4) (20 decks)

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