final push

Question 1

when not to give calcium and vid D

Answer 1

breast cancer with high calcium, high PTH

Question 2

first choice bone protection

Answer 2

zoledronic acid

Question 3

digoxin recommended conc

Answer 3

1-2 micrograms/l

Question 4

What is the recommended INR range in a patient with AF, receiving warfarin for the prevention of stroke?

Answer 4

2-3

Question 5

erythromycin

Answer 5

increases INR, inhibits digoxin

Question 6

low Na+ can be caused by

Answer 6

thiazides of hypothyroidism

Question 7

UTI in elderly cause

Answer 7

e coli, staph, proteus sp

Question 8

do you manage bp in stroke acutely

Answer 8

no

Guideline from NICE found here: https://www.nice.org.uk/guidance/ng128/chapter/Recommendations#maintenance-or-restoration-of-homeostasis

advise that in the acute management of ischaemic stroke to avoid treatment of hypertension unless there are certain hypertensive complications such as:

hypertensive encephalopathy
hypertensive nephropathy
hypertensive cardiac failure/myocardial infarction
aortic dissection
pre-eclampsia/eclampsia

Question 9

5 bloods for confusion

Answer 9

FBC, glucose, Us and Es, calcium, TFTs

Question 10

how to obtain more info in elderly

Answer 10

collateral from family, from GP, hospital records, summary care records

Question 11

C diff complications

Answer 11

psuedomembranous colitis, toxic megacolon, peritonitis

Clostridium difficile is a very serious infection and mortality is approximately 25% for in hospital infection of frail elderly patients. This is due to a combination of the infection itself and the vulnerability of the patients which tend to be infected – the elderly, neonates, the immunocompromised etc. Severe infection is associated with the presence of pseudomembranes on sigmoidoscopy. More severe infection may lead to fulminant colitis and toxic dilatation (toxic megacolon), the diarrhoea may reduce and the abdomen swells and becomes tender. This may result in perforation, peritonitis and death. A dilated colon can often be seen on plain abdominal x-ray, with ‘thumb printing’ indentation in the wall of the colon

Question 12

Abx causing C diff

Answer 12

Question 13

random complication of lung tumours

Answer 13

rib erosion

Question 14

lung mets consequences

Answer 14

Primary lung tumours can metastasise to the bone as in this case presenting with pain, anaemia, hypercalcaemia. Brain – presenting with seizures or focal neurology. Liver –presenting with jaundice, painful hepatomegly. Adrenals – presenting with Addison’s disease.

Question 15

PCV risk for

Answer 15

stroke then ALL

Question 16

what else can raise BNP

Answer 16

chronic kidney disease

Question 17

falls examinations

Answer 17

BP, neuro, gait and balance

Question 18

labs after fall

Answer 18

FBC, Us and Es, LFTs, CRP,

Bone profile, TFT

G and S and clotting profile

Glucose

Question 19

reversible dementia found on neuroimaging

Answer 19

normal pressure hydrocephalus, subdural haematoma (banana)

Question 20

lewy body special Ix

Answer 20

Datscan for parkinsonism

Question 21

delirium contributions

Answer 21

Post-surgery state
○
Morphine use
○
Urinary retention
○
Previous cognitive impairment

Question 22

supportive features for delirium diagnosis

Answer 22

Acute onset
○
Fluctuating course
○
Inattention
○
Disorganised thinking

Question 23

. Further components of delirium assessment

Answer 23

Collateral history
○
4AT test / MMSE etc / cognitive screening
○
Review of medications
○
Infection screening
○
Pain assessment
○
Environmental assessment

Question 24

legal procedure when pt tries to leave

Answer 24

Legal procedure (1 mark)
○
Deprivation of Liberty Safeguards (DoLS).
6. Role of procedure (1 mark)
○
To protect and manage care while ensuring least restrictive measures.

Question 25

PR in faecal impaction

Answer 25

Small amount of type 1 stool (½) - Or copious type 6/7 stool (½) - With no sensation of defaecation (1)

Question 26

complications and assessment of fecal impaction

Answer 26

Question 27

DONT FORGET IN STROKE

Answer 27

BLOOD GLUCOSE

Question 28

stroke Ix

Answer 28

coags, lipids, troponin

Question 29

Answer 29

hyper dense area, MCA ischaemic stroke

Question 30

absolute thrombolysis CI

Answer 30

Question 31

delirium strategies

Answer 31

Orientation aids (clock/calendar), Reassurance, Sleep hygiene, Mobility encouragement, Hearing/vision aids, Minimise bed moves, Promote day–night rhythm.

Question 32

delirium

Answer 32

Acute onset, Fluctuating course, Inattention, Disorganised thinking

Question 33

delirium ix

Answer 33

ECG, FBC, U&Es, Glucose, CXR

Question 34

best interest decision components

Answer 34

Past/future wishes, Input from family or LPA, Clinical benefit vs harm, Least restrictive option

Question 35

MDT member best to assess cognition and advise on capacity

Answer 35

Geriatrician, Liaison nurse or dementia specialist nurse, Psychiatrist