Geriatrics

Question 1

Venous vs arterial vs neuropathic ulcers

Answer 1

Venous
-Shallow, painless
-Associated skin changes Eg haemosidderin desposits / eczema

Arterial
-‘Punched out’, usually deep and painful occurring at pressure points
- May have signs of chronic limb ischemia

Neuropathic
- Painless with surrounding paraesthesia
- Normal pulses present
-Usually have an underlying cause Eg diabetes

Question 2

Poor prognostic factors in ulcers are

Answer 2

lasting >1yr
previous requirement for surgical Rx of ulcers
ABPI <0.8
Poor compliance with treatment / lifestyle advice

Question 3

Generalised erythema, systemic symptoms and atypical t-cell invasion on skin biopsy

Answer 3

Cutaneous T-cell lymphoma

Question 4

TTP Rx

Answer 4

Plasma exchange [+ ffp]

Question 5

Rx of actinic keratosis - if they want gone

Answer 5

Topical 5-fluorouriacil cream

Question 6

Which Abx is strongest P450 inhibitor

Answer 6

Erythromycin
Then Calri / azithro

Question 7

Parkinson’s’ Sx is well controlled but having issues with dyskinesia from medication side effects. What can you prescribe?

Answer 7

Amantadine (NMDA receptor inhibitor)

Question 8

What class of drug is entacapone? What is it good for?

Answer 8

COMT inhibitor.
Good for patients getting ‘off’ symptoms as inhibits the breakdown of dopamine and so prolongs its action

Question 9

Allopurinol class? What does this do

Answer 9

Xanthine oxidase inhibitor
->Recudes urate production

Question 10

Anaemia. confusion. Hepatosplenomegaly. Increased viscosity. Raised IgM =?Rx?

Answer 10

Walldenstrom macroglobulinaemia
[low grade lymphoma]

Plasmapheresis - to reduce plasma viscosity
[Will then likely need chemo]

Question 11

Most important thing to work out if someone with AS needs replacement

Answer 11

Symptoms

Question 12

Pontine bleed comes from which artery

Answer 12

Basilar

Question 13

Parkinsonism, variable levels of arousal, forgetful, hallucinations, with some autonomic Sx? Rx?

Answer 13

Lew body disease

Cholinesterase inhibitors Eg Rivastigmine

Question 14

Bipolar started on lithium but no response what next?

Answer 14

Add in valproate

Question 15

MRSA but vanc allergic options

Answer 15

Teicoplanin or linezolid

Question 16

Amiodarone mechanism

Answer 16

K channel blocker

Question 17

lidocaine mechanism

Answer 17

Na channel blocker

Question 18

Sensory supply to anterior groin

Answer 18

L1/2

Question 19

An ulcerated nodular lesion with surrounding keratosis and paraesthesia on face

Answer 19

SCC

Question 20

Bullous impetigo + pyrexia Rx

Answer 20

IV co-amox

[rather than fluclox]

Question 21

Speckled appearance of LV on echo likely =

Answer 21

Amyloid

Question 22

Left hemiparesis, right horners, left nystagmus, tongue deviates right. Where is lesion

Answer 22

R brainstem

Question 23

Why does trimethoprim lead to raised Cr

Answer 23

COMPETITIVE inhibition of creatinine secretion

Question 24

1st line Rx HTN in > 80

Answer 24

MR Nifedipine

Question 25

Flat pigmented 2cm lesion on the face with an irregular border

Answer 25

Lentigo Melanoma

Question 26

Older male presenting with symptoms of bony mets probably has

Answer 26

Prostate Ca

Question 27

When would you prescribe Cef met AND amox for suspected meningitis

Answer 27

>60 or immunocompromised to cover for listeria

Question 28

Why ongoing UTI in someone whos catheter isn't changed but is given Abx

Answer 28

Biofilm formation

Question 29

Torsades in COPD on lots of diuretics what 2 classes Abx might he have been prescribed

Answer 29

Macrolide Eg clari Quinolone Eg Cirpo

Question 30

Rx of hallucinations / agitation in parkinsons.

Answer 30

Low dose atypical antipsychotics Eg Quetiapine

Question 31

Aspergillus down a microscope

Answer 31

Septate hyphae [If sinus infection and Septate hyphae it is aspergillus. They will likely be immunocompromised to some degree]

Question 32

Nasal stuffiness, facial pain and oedema with necrotic black nasal turbinates. Hypae [not septate] on microscopy

Answer 32

Mucor ssp.

Question 33

Hallucinations in Dementia with lewy bodies

Answer 33

Detailed and well-formed

Question 34

Why do old people get a lower dose of digoxin

Answer 34

Reduced renal clearnace

Question 35

What is the mechanism for developing a tolerance to nitrates

Answer 35

Generation of reactive oxygen species [Chronic nitrate therapy -> vascular oxidative stress -> enhanced degradation of NO]

Question 36

Choreform movements = lesion where?

Answer 36

Caudate nucleus

Question 37

Issues with arm swing and upper limb motor control = lesion where

Answer 37

Red nucleus

Question 38

saccade eye movement, sleep wake issues = lesion where

Answer 38

Thalamus

Question 39

Symtomatic CLL in old person. Option for single agent Rx? What is the choice for actually trying to treat it?

Answer 39

Chlorambucil [Can add in rituximab if needed] FCR combination chemo [fludarabine, cyclophosphamide, rituximab]

Question 40

Digoxin why does it take a while to have an effect if you don't load ?

Answer 40

High degree of protein binding ->Widely distributed around body tissues

Question 41

Bone pain, mildly low Ca, Raised ALP / PTH =

Answer 41

Osteomalacia

Question 42

Rx of stroke if >4.5hrs

Answer 42

Aspirin 300mg only

Question 43

Do you get neutropenia in CML

Answer 43

NO - you get a leukocytosis. But they are dysfunctional

Question 44

Which haem onc has the high assoc with autoimmune haemolytic anaemia

Answer 44

CLL

Question 45

NH resident found to be asymptomatic but MRSA positive on skin swab. Rx?

Answer 45

Needs topical decolonisation -Usually mupirocin + chlorhexidine

Question 46

Pins and needles in hands and feet -> Weak legs, Reduced sensation and proprioception, reduced reflexes =

Answer 46

B12 deficiency -> subacute degeneration of the spinal cord

Question 47

Left CN3 palsy + right hemiparesis where is lesion

Answer 47

Left paramedian arteries (supplying midbrain)

Question 48

Which CN pass through the jugular foramen? Symptoms of compression here?

Answer 48

IX, X, XI Weak neck, hoarse voice, absent gaga reflex

Question 49

DVT -> treated with heparin then develops an ischemic foot. What has happened?

Answer 49

Arterial thrombus secondary to HIT

Question 50

Multiple strokes with carotid stenosis when would you perform endarterectomy? What would be the Rx otherwise?

Answer 50

>50% stenosis with thought strokes were coming from there Clopidogrel for long term

Question 51

AF with pauses what type of pacemaker

Answer 51

DDDR

Question 52

Artery if amaurosis fugax

Answer 52

Internal carotid

Question 53

Digoxin mechanism

Answer 53

Inhibiton of sodium-potassium ATPase

Question 54

On aspirin with slighly prolonged PT and platelets of 140. Cause of extensive bruising?

Answer 54

Aspirin related [Platelets slightly low and slightly high PT - not enough for big bruising]

Question 55

What is most raised in a pathological fracture in prostate mets? Key drug for Rx ?

Answer 55

ALP [Ca often normal] Denosumab [Old denos with his dodgy prostate]

Question 56

Old person on antihypertensives. Which one causing hypoNa and HypoK

Answer 56

Indapamide

Question 57

Which arteries supply occiptal lobe? What is affected if bilateral cortical blindness ?

Answer 57

Posterior cerebral arteries Basilar - if bilat

Question 58

What would make you think fronto temporal dementia on exam

Answer 58

Failure to draw interlocking shapes

Question 59

Barthol index post-stroke when are you 60% more likely to die

Answer 59

<50 = low ability to perform ADLs

Question 60

Which -stigmine in alzheimers

Answer 60

Rivastigmine

Question 61

When no ach inhibitor in dementia?

Answer 61

MMSE <10

Question 62

Early falls with parkinsonism 2 key DDs?

Answer 62

PSP NPH