A 70-year-old man presents with nausea that he believes is secondary to his regular medication. He has a past medical history of known Parkinson’s disease, hypertension and asthma, His drug history includes ramipril, levodopa and salbutamol. The GP decides to prescribe an anti-emetic to help manage his nausea whilst he explores treatment options.
Which of the following is the most appropriate anti-emetic to prescribe?
domperidone
doesnt cross BBB
What side effect of Levodopa is seen with short term treatment?
abnormal dreams
levodopa long term SE
Early morning hypokinesia or akinesia
End of dose deterioration
On and off states
Dyskinesias
postural hypotension common cause
furosemide
Ropinirole leads to
impulsivity
An 82 year old man is admitted from a care home with increasing confusion and lethargy over several days. His past medical history includes dementia, type 2 diabetes, and chronic kidney disease stage 4. On arrival, he is hypotensive, febrile, and hypoxic. Blood tests show raised inflammatory markers and acute kidney injury. Chest X-ray is suggestive of a right lower lobe infiltrate.
Despite treatment with intravenous fluids and antibiotics, his condition continues to deteriorate. He dies two days later. A death certification needs to be completed.
What is the most appropriate entry for Part Ia?
lobar pneumonia
parkinsons weird symptom
olfactory loss
what can u not put on death certificate
Cardiac, respiratory, liver, or kidney failure should not be included as causes of death on a death certificate.
An 87-year-old woman with a past medical history of dementia, congestive cardiac failure and ischaemic heart disease dies at home. Two days prior, her GP had visited her and noted that her blood glucose levels were deteriorating. On the day of her death, the patient’s daughter witnessed her last moments as she complained of chest pain and breathlessness and then suddenly collapsed and died. The daughter called for an ambulance, but the patient passed away before it arrived. She was not resuscitated as she wished not to attempt cardiopulmonary resuscitation.
Which of the following is the most likely cause of death to be included on the death certificate?
IHD
Cholinesterase inhibitors, such as
donepezil, rivastigmine, or galantamine,
An NMDA receptor antagonist, such as,
memantine
med that reduces seizure threshold
ciprofloxacin
An 85-year-old man is admitted to hospital with a urinary tract infection and delirium. He has no background of cognitive impairment but currently does not have capacity to make decisions about his treatment. He is becoming increasingly agitated, and often wanders around the ward trying to leave. The patient constantly asks staff if he can go home.
What is the most appropriate action?a
apply for DOLS
A 73 year old man presents with a two month history of increasing forgetfulness. He is brought by his daughter who expresses concern that he has been forgetting his grandchildren’s names and forgetting to lock the front door. He has also been forgetting stories from his childhood. The patient informs you that he has found himself forgetting to eat, feeling more irritable than usual and experiencing poor sleep. He reports that he sometimes sees and speaks with his recently deceased wife.
A mini-mental state exam (MMSE) is done, in which he scores 25/30.
What is the most likely diagnosis in this case?
Pseudodementia
Correct. This patient is likely experiencing depression, which is mimicking dementia. The MMSE is normal. This combined with sleep disturbance, irritation and global memory loss suggests a diagnosis of pseudodementia rather than dementia.
vascular dementia MRI finding
White matter hyperintensities on MRI
first line constipation mx
When lifestyle measures have not been successful, bulk-forming laxatives such as ispaghula husk should be offered as first-line
require adequate hydration
pressure ulcer staging
Open sores or wounds with varying degrees of tissue involvement (stages I to IV - see below)
Stage 1 - non-blanching
Stage 2 - partial thickness
Stage 3 - full thickness skin loss
Stage 4 - full thickness tissue loss
Unstageable: full thickness skin or tissue loss
slough pressure sore on heel - Wounds like pressure sores should be
cleaned with sterile saline before swabs are taken to ensure a more accurate microbiological assessment.
In this case, osteomyelitis is unlikely to be a concern without clinical indicators, such as deep ulcers or systemic symptoms. The wound must first be cleaned and assessed for depth of tissue involvement and accurate microbiological sampling.
A 78 year old woman with advanced dementia and peripheral arterial disease is admitted to acute medical ward with pneumonia. She has been bed-bound for the last two weeks and has not been able to change her position in bed. The doctor on the ward round notices that she has some skin breakdown at her sacrum which is completely covered with a thick, dark layer of tissue.
What grade ulcer is this pressure sore?
Ungradable
This is an ungradable ulcer. As this patient has an eschar (thick, dry, and black tissue) that completely covers the ulcer, it is impossible to assess its depth. However, if parts of the ulcer are visible around the eschar, then it can still be graded.
A 76 year old woman is brought to the clinic by her daughter due to increasing unsteadiness and two recent falls at home. She has a history of hypertension, generalised anxiety disorder, and osteoarthritis. Her current medications include lisinopril, lorazepam, and paracetamol as needed for pain. Her blood pressure is 128/75 mmHg, pulse 72/min, and BMI 22 kg/m². On examination, she walks slowly but has no focal neurological deficits. Her DEXA scan shows a T-score of -2.8 at the femoral neck, indicating osteoporosis.
Which of the following is the initial step in management for this patient?
remove lorazepam
Benzodiazepines (e.g., lorazepam) are specifically listed in NICE as potentially inappropriate for older adults because they increase sedation, cognitive impairment, and fall risk. In a patient with confirmed osteoporosis (T-score −2.8) and recent falls, discontinuing the benzodiazepine is the most effective measure to reduce short-term fracture risk. Therefore, they should be stopped from the treatment plan and replaced with a safer alternative. Additional bone protection strategies would be helpful after stopping the sedative medication.
