ACH

Question 1

What are the aetiologies of a fall?

Answer 1

DAME:

Drugs

Ageing

Medical records

Enviroment

Question 2

Medical causes for a fall?

Answer 2

Cateracts

Cardiac arrythmia

Neurological disease - neuropathy parkinsonism, stroke

Question 3

What differentialsa re there for vertigo?

Answer 3

Peripheral - BBPV, Meniere’s disease, vestribular neuritis, acoustic neuroma

Central - Migraine, brainstem stroke, cerebellar stroke, MS

Question 4

How is a lying and standing blood pressure done?

Answer 4

• Take baseline BP after 5 mins of lying down
• Take repeat BP at 1 and 3 min since standind up

Question 5

What is a positive/ abnormal result for a lying-standing BP?

Answer 5

Drop of 20 systolic or 10 diastolic. Also a diastolic of <90 mmHg

Question 6

What is a a FRAX score?

Answer 6

Predicts 10 year of absolute fracture risk

Question 7

What is the first line treatment for osteoperosis?

Answer 7

1st line is biphosphonates with Ca/Vit D suplimentation

Question 8

What are the contraindications to biphsophonates?

Answer 8

• swallowing difficulties
• Barretts oesophagus
• Severe CKD
• hypocalcaemia

Question 9

What SE are there for biphosphonates?

Answer 9

Indigestion

Heart burn

Stiffness

Question 10

What would you tell a patient about how to take their biphosphonate?

Answer 10

• Take on empty stomach
• Take with plenty of water
• Remain upright for 30 mins

Question 11

Patient has a coarse tremor which is worse on movement. Mentions that perants also have the tremor. MLD and treatment?

Answer 11

Essential tremor

Treatment with propanolol or other beta-blockers

Question 12

An elderly patient has a tremor which is worse at rest and only on one side of body. MLD?

Answer 12

Parkinsonian tremor

Question 13

What tremors are worse on movement?

Answer 13

Dystonic

Exagerated physiological tremor

Drug induced

Hyperthyroidism

Question 14

What is an intention tremor and what pathology does it indicate?

Answer 14

Amplitude of tremor becomes worse when reaching end point of deliberate and visual guided movement.

Indicates cerebellar pathology

Question 15

What signs are there fore cerebellar disease?

Answer 15

DANISH

Dysdiadochokinsia

Ataxia

Nystagmus

Intention tremor

Stuccarto/slurred dysarthria

Hypertonia/ Heel-shin test

Question 16

What is rigidity?

Answer 16

Velocity independent hypertonia common in parkinons

Question 17

What is spasticity?

Answer 17

Velocity dependent hypertonia mainly in anti-gravity muscles.

Common in chronic UMNL like MS

Question 18

What is the triad for lewy body dementia?

Answer 18

Dementia

Parkinsons

Visual hallucinations

Question 19

What drug can induce parkinsons?

Answer 19

Anti-psychotics

metoclopramide

Question 20

What is muilti-system atrophy?

Answer 20

Parkinsons with autonomic feature - hypotension, bladder instability

Question 21

What is athe diagnostic triad for normal pressure hydrocephalus?

Answer 21

Dementia

Gait disorder

Bladder instability

Question 22

How is normal pressure hydrocephalus diagnosed and treated?

Answer 22

Diagnosis by LP. Treated with VP shunt

Question 23

What scoring system is used for malnutrition?

Answer 23

MUST score

Question 24

What is the criteria for thrombolysis in a stroke?

Answer 24

• Symptoms of acute stroke
• Onset within 4.5 hours
• NIHSS scoring
• Absence of heamorraheg on CT
• There is an extensive exclusion criteria

Question 25

What feature ar ethere of a total anterior circulation stroke?

Answer 25

3 of: * Unilateral weakness of limb or face * Homonymous hemianopia * Higher cerebral dysfunction

Question 26

What feature are there of a partial anterior circulation stroke?

Answer 26

2 of: * Unilateral weakness of limb or face * Homonymous hemianopia * Higher cerebral dysfunction

Question 27

What features are there of a posteiror ciculation stroke=?

Answer 27

1 of the following: * Cerebellar or brainstem syndrome * Loss of conscioussness * isolated homonymous hemianopia

Question 28

What symptoms are thre of a lucunar stroke?

Answer 28

Any 1 of the following: * Unilateral waekness +/- sensory deficit * Pure sensory ataxia * Ataxic hemiparesis

Question 29

How are patients with delirium treated?

Answer 29

Attempt to orientate patient De-escelation techniques Haloperidol or antipsychotic (olanzapine)

Question 30

What is dysarthira?

Answer 30

Disorder of speech

Question 31

What is dysthasia?

Answer 31

disorder of language

Question 32

What types of dysphasia are there?

Answer 32

Receptive or expressive

Question 33

What are of the brain is related to receptive dysphasia?

Answer 33

Wernickes area

Question 34

What area is related to expressive dyspasia?

Answer 34

Brocas area

Question 35

Patient is aware that they are getting grammar right but the semantics of what they are saying is correct. What type of dysphasia?

Answer 35

Expressive

Question 36

Patient can speech perfectly fine however has trouble finding the right word so substitutes a word, they are unaware of a speech problem. What type of dysphasia is this?

Answer 36

Receptive

Question 37

What is the definition of malnutrition?

Answer 37

A state of nutrition in which a deficiency or excess of energy, protein and other nutrients causes measurable adverse effects on tissue/body form, body function and clinical outcome

Question 38

What types of dysphagia are there?

Answer 38

Oropharyngeal Oesophageal

Question 39

What indicatitions are there for artificial feeding?

Answer 39

Mechanical dysphasia Neurological Dysphasia Global neurological damage Increased nutrition requriements Essential medication

Question 40

How long can a NG be used for

Answer 40

6 weeks

Question 41

What is an features of Nasojunal tubes compared with NG?

Answer 41

Good for patient with higher risk of pulmonary regurgitation - from gastroparesis or altered anatomy However has to be done endoscopically

Question 42

What long term solution can be used for arteficial feeding?

Answer 42

percutaneous endoscopic gastroscopy (PEG)

Question 43

What complication are there from enteral feeding?

Answer 43

Tube related - trauma, blockage of lumen, mesplacement (lung or cranium). Feeding related - GI dyscomfort, refeeding syndrome, reflux leeding to aspiration

Question 44

How is at risk of re-feeding syndrome?

Answer 44

Little of no intake for \> 5 days

Question 45

What are the statutory principles of the mental capacity act 2005? (5)

Answer 45

1. Presumed capacity 2. Patient supported to make decision 3. Patient can make unwise decision 4. Best interest 5. Least restrictive

Question 46

What steps should be taken to asses mental capacity clinically? (2)

Answer 46

1. Diagnostic test - disturbance in patients brain or mind? 2. Function test - impairment sufficient for loss of capacity

Question 47

What question need to be asked to forefill a deprivation of liberty safeguard (DoLS)? (2)

Answer 47

1. Is the patient continually supervised or controlled? 2. Is the paitent free to leave If answer to 1 is Yes and 2 is No then consider DoLS

Question 48

Dose enteral feeding have provent benefit or survival in dementia patients?

Answer 48

No