Questions Flashcards
What are the three 3Ws of normal pressure hydrocephalus? [3]
Wet: Urinary incontinence
Wobbly: ataxia
Whacky: memory loss
A 75-year-old female with metastatic breast cancer is admitted to the hospice for ongoing care. She complains that, at night, strange men enter her room and move her belongings and that staff talk about her during the day. In addition, she sometimes sees a vision of her deceased sister in her room, and this has caused her anxiety and distress.
Which of the following medications would be most appropriate to treat her symptoms?
Lorazepam
Diazepam
Midazolam
Haloperidol
Hyoscine bromide
Haloperidol (an anti-psychotic) is the treatment of choice for hallucinations and agitation associated with delirium. Delirium is common in elderly and unwell patients and should be actively diagnosed and managed.
A 63-year-old female is on the Respiratory Ward. She has end-stage chronic obstructive pulmonary disease (known T2RF) and metastatic lung cancer. She is very breathless and complaining of some pain. Her obs are as follows: sats 89%, RR 34, BP 127/94, HR 96, temp 36.2°C. On the ward round with the consultant in the morning, it is decided that she should be made end-of-life (EOL).
Which of the following anticipatory medications will help with her symptoms?
Glycopyrronium 200 mcg SC
Haloperidol 0.5 mg PO
Levomepromazine 12.5 mg SC
Midazolam 2.5 mg SC
Morphine 2.5 mg PO
Morphine PO (Oromorph) can be used to help with pain and breathless due to it being an opioid. In this case, the patient has a very high respiratory rate, with normal saturations for her as she is a T2RF patient. The oromorph should help to reduce her respiratory rate and therefore the feelings of breathlessness alongside helping with her pain. Small doses should always be used to start with and titrate them up.
For what type of pain is ketamine used as a second-line treatment in palliative care?
Acute
Chronic
Neuropathic
Nociceptive
Radicular
Neuropathic
Which of the following painkillers can be used in palliative care when opioids are no longer as effective?
Buprenorphine
Ketamine
Methadone
Oxycodone
Pethidine
#49501
Ketamine
A 33-year-old male presents with a 10-year history of arm tremor. However, it has become worse recently, such that he now finds it embarrassing at work and is worried about losing his job. His father had a similar problem, although this was mild and always put down to benign tremulous Parkinson’s disease. On examination, he has a fine postural tremor but normal tone. Fine finger movements are normal, as is his gait.
What is the most likely diagnosis?
Essential tremor
Familial cerebellar degeneration
Familial Parkinson’s disease
Severe anxiety
Wilson’s disease
The fine postural tremor is typical of an essential tremor. It is often familial. The absence of other neurological signs helps to support this diagnosis.
What is an analgesic options would be most specific for metastatic bone pain? [1]
Intravenous administration of bisphosphonate (such as ibandronate) is a recognised treatment for patients who suffer from uncontrolled pain from bony metastases.
An 85-year-old female who recently moved to a nursing home complains of feeling lonely, not sleeping well and having lost her appetite over the past month. She is suspected to be suffering from depression. She has declined psychological interventions.
What would be the preferred treatment of choice?
Lithium
Monoamine oxidase inhibitor
No treatment
Selective serotonin-reuptake inhibitor antidepressant
Tricyclic antidepressant
#49387
Selective serotonin-reuptake inhibitor antidepressant:
- Newer SSRIs such as sertraline have fewer cardiotoxic effects, while tricyclics such as amitriptyline and imipramine should be avoided because of their cardiotoxic effects.
What factors do you think influnece decisions on resus status? [+]
There are 3 major mimics of dementia. What are they? [3]
Name 4 reversible causes of dementia
Hypothydroidism
B12 or Folate deficiency
Alcoholism
Normal pressure hydrocephalus
Eosinophilic intracytoplasmic neuronal inclusion bodies the brainstem and cortex would indicate which type of dementia? [1]
Lewy Body Dementia
What examination findings might help indiate a patient has fronto-temporal dementia? [2]
Which tests do you perform for a confusion screen? [1]
B12 and folate levels
CT head
LFTs
TFTs
LP
U&Es and creatinine
GGT
