Summary Flashcards
1
Q
Common differentials: My mum keeps forgetting things and its getting worse
A
Dementia
2
Q
Doctor my husband has been confused the last few days and hes had a temperature
A
Delirium
3
Q
Good Morning doctor my dad has been started on some new medication for his parkinsons disease and hes become confused
A
Delirium
4
Q
Ive been getting dizzy and finding myself on the floor
A
Syncope
5
Q
Ive been getting dizzy and finding myself on the floor
A
BPPV
6
Q
My mother has fallen three times this last year
A
Falls
7
Q
My mother has fallen and hurt her hip
A
Fracture neck of femur and osteoporosis
8
Q
I just sit in the chair, it’s too much effort to do anything
A
Immobility
9
Q
Yesterday my right hand went dead and I could not get my words out but I feel ok now
A
TIA
10
Q
Yesterday my right hand went dead and I could not get my words out , today my right arm still feels weak
A
Stroke
11
Q
Frailty phenotype
A
Edmonton
Rockwood
Clinical
12
Q
Mr Smith has been in hospital for a long time. He is in poor health and has been referred to palliative care.
A
DNACPR
Integrated
13
Q
My patient is confused and I dont know how to discuss treatment
A
Capacity
Lasting Power of Attorney
14
Q
Mr Jones comes in and tells you, I dont think I can cope with looking after my wife anymore
A
Supporting Carers
15
Q
When the paramedics found me they said I was stone cold
A
hypothermia
16
Q
The shaking in my hand is getting worse and no one can read my writing now
A
Parkinson’s Disease
17
Q
I have been stuck in bed for a long time now and nobody has turned me over
A
Pressure sore
18
Q
I have lost control of my waterworks
A
Urinary incontinence
19
Q
Elderly patients with depression which assessment tool
A
Brief assessment depression cards general depression scale Hamilton Cornell score
20
Q
Elderly patients requiring a proper assessment for functions which assessment tool
A
Barthel index
21
Q
Dr I suddenly started feeling dizzy
A
Vestibular neuronitis
22
Q
Doctors suddenly started feeling dizzy
A
Labyrinthitis
23
Q
Doctor I have been dizzy for a very long time now
A
Middle ear infection
24
Q
Doctor lately feels like the room has been spinning
A
Vertebrobasilar insufficiency
25
Doctor I don't know why but lately I've been feeling more dizzy than normal my medication has been changed recently could that be the cause
Yes
26
Ok. Thank you for telling me doctor what medication may potentially be causing my dizziness
Any medication targeting your blood such as blood pressure medication and blood thinners like aspirin
27
Hi doctor yesterday I felt faint and lost consciousness my friend was with me at the time and she said she saw my leg jerking does this mean I definitely have epilepsy
No
28
Oh ok Dr I thought that if you lost consciousness and your legs were jerking that definitely meant you had epilepsy if that's not the reason then what what's the cause
Syncope can present similarly to an epileptic seizure
29
A transient loss of consciousness or otherwise known as fainting is typically caused by
A temporary reduction in blood flow to the brain otherwise known as syncope
30
What is a vasovagal syncope
A transient loss of consciousness caused by emotional distress or orthostatic stress
31
Hi Dr I receiving the other day and the next thing I knew I was on the floor do you know what could have caused it
Carotid sinus hypersensitivity
32
Hi Dr it was a really hot day yesterday and I hadn't drank a lot
the next thing I knew I was on the floor it only lasted a second and then I felt fine after I had a drink of water what could have caused it
Orthostatic hypotension specifically volume depletion
33
What causes orthostatic hypotension
Volume depletion medication neurological problems
34
Hi Dr I have had problems with fainting and I was wondering if this could be to do with my heart
Could you explain to me if this is possible
The three main heart problems that may cause this
Are problems with the rhythm of your heart problems with the structure of your heart and then blood pressure and blood clots
35
The consultant asks you which investigations do you definitely want to do if you believe the patient could be having a cardiac syncope
Check blood pressure and check for heart rhythm problems with an ECG
36
Sinus node dysfunction causing cardiac syncope treatment
Remove beta blocker
37
Aortic stenosis cardiac syncope treatment
Valve replacement
38
Postural hypotension medication treatment
Fludrocortisone
39
Postural hypotension medication apart from fludrocortisone
Midodrine
40
What does midodrine do to the blood vessels in the peripheries
Causes of vasoconstriction
41
Sally has recently been diagnosed with vasovagal syncope what advice can you give her to help managed each acute episode
Avoid standing for prolonged periods of time in overheated conditions also try slow deep breaths when the symptoms start and then try passive counter pressure manoeuvres such as Crossing your legs
42
Hi Dr I recently fainted and I've been given a diagnosis of syncope does this mean I can't drive
Yes
43
Hi Dr do I need to tell the DVLA that I recently had an episode of syncope if I do what will happen
Yes you will not be allowed to drive for a month
44
As a 4th year medical student how can you ensure that you cover broadly the potential causes for a fall in an elderly person
Make sure to include a thorough systems review and thorough past medical history
45
If you could only do an examination of one system on a Falls patient which one should you choose and why
Neurological examination
| To rule out any neurological problems
46
Which special test to do you need to add to your neurological examination of a Falls patient
Timed get up and go test to assess balance and gait
47
Doctor what do you want me to do for this get up and go test
From a sitting position get up and walk 3Metres then turn around and come back to the chair
48
How long should a normal get up and go test take
Less than 13.5 seconds
49
What should you do if a Falls patient takes longer than 13.5 seconds to complete a timed get up and go test
Refer to physiotherapy
50
What special tests do you need to add on to your cardiovascular examination for somebody who you suspect may have postural hypotension
Take a lying and standing blood pressure
51
Doctor can you talk me through what you want me to do for this test for my postural hypotension
I need you to lie down for 10 minutes then I'll take your blood pressure then I need you to stand up after 3 minutes I'll take your blood pressure again
52
How do you know if a patient definitely has postural hypotension
If they're lying to standing blood pressure shows a drop of greater than 20 mm Mercury systolic
53
Even if a patient who has had a fall states that they haven't hurt their hip if they are elderly what investigation should you definitely order
X-ray of the hip
54
What investigations do you need to order to check for osteoporosis
Liver function tests calcium and phosphate estimated glomerular filtration rate vitamin D level and parathyroid hormone level
55
X-ray shows extracapsular fracture normal management for this type of hip fracture
Reduction and internal fixation another word for dynamic hip screw
56
You suspect patient may have osteoporosis which type of scan do you need to refer them to to check
DXA scan
57
Which osteoporosis medication has the best evidence
Denosumab given subcutaneously every 6 months or zoledronic acid given as an annual infusion
58
What would you expect to see on inspection of a patient with a hip fracture
Shortened and externally rotated hip
59
You strongly suspect that a patient has a hip fracture however because she has severe osteoporosis you can't see any abnormality in the x-ray what should be your next line investigation
MRI
60
Alternative to MRI for suspected hip fracture which doesn't appear on X-ray
CT scan of the hip
61
What is a transient ischaemic attack
Describe the situation where blood flow to the brain is cut off for sufficient time such that you see symptoms that typically resolve within 24 hours
Symptoms may include lim weakness or problems with Vision
Poor blood flow to the brain is typically secondary to some kind of clot
62
What is a stroke in simple terms
A stroke describes the situation whereby your brain suddenly doesn't receive enough oxygen and as a result of that certain parts of the brain get damaged depending on the part of the brain that gets damaged will affect which symptoms you present with
63
Apart from stroke what are the conditions may explain sudden onset neurological symptoms
Migraine brain tumour Todd's paresis hypoglycemia
64
DANISH P stroke presentation suggest what type of stroke
Cerebellar stroke
65
Doctor what age am I more at risk of having a stroke
65 years or older
66
Hi Dr was sitting watching TV when suddenly I noticed I couldn't move my left leg or my left arm my partner said that my speech was slurred
Total anterior circulation ischemia which correlates to the internal carotid artery or middle cerebral artery
67
Hi Dr I was out walking the dog when suddenly I noticed I can move my right arm and my friend who was with me at the time noticed that my speech was slurred
Partial anterior circulation ischemia correlating to an occlusion of a branch of the middle cerebral artery
68
Isolated homonymous hemianopia
POCI
| Posterior circulation infarct
69
Lacunar syndrome subdivisions
Purely sensory purely motor sensorimotor ataxic hemiparesis
70
Dr what is the cut-off time for thrombolysis in an ischemic stroke
4 and a half hours
71
Which subtype of stroke has the highest 12 months recurring statistics
Posterior circulation infarct
72
Which type of stroke has the highest early 12 months of occurrence
PACI partial anterior circulation infarct
73
What is the cut-off blood pressure reading for which thrombolysis is contraindicated
185/110
74
If a patient had the stroke more than four and a half hours ago what medical management should you start
Aspirin 300 mg once a day
75
What is the cut-off time for thrombectomy
6 hours following the onset of a stroke
76
After finishing a full examination of a patient you suspect had a stroke which member of the MDT must you refer the patient to you
Speech and language therapist for assessment of swallowing
77
If a stroke patient has difficulty swallowing how can you administer the nutrition in the first instance
Nasogastric tube
78
How long would a patient have to receive the nutrition by nasogastric tube before you should consider switching to a
PEG percutaneous endoscopic gastrostomy
Two weeks
79
What type of mattress should a stroke patient be placed on the when admitted into hospital to prevent pressure sores
Air mattress
80
If a patient has ongoing atrial fibrillation when they have a stroke how long would you need to delay anticoagulant treatment for
10 days
81
Consultant asks new witch scoring system correlates to TIA risk
Abcd2 score
82
If a patient scores four or more on the abcd2 score what should be the next step
I admission and investigation within 24 hours of their symptoms
83
If you suspect a patient has had a transient ischemic attack how long are they banned from driving
One month
84
What are the key investigations to run on a patient who you suspect might have had a TIA
Carotid Doppler and carotid endarterectomy
85
Name the key secondary prevention medications following a TIA
Clopidogrel warfarin blood pressure medication cholesterol medication
86
What is the gold standard investigation for swallowing problems
Video fluoroscopy
