pqs 2 esp stroke

Question 1

A 65 year old male patient presents to the emergency department with sudden onset left arm and leg weakness. He has a past medical history of hypertension, osteoarthritis, and depression.
Physical examination reveals left-sided hemiparesis. CT head reveals a right-sided hypo-dense region in the middle cerebral artery territory. Electrocardiogram (ECG) is normal.
Given the most likely diagnosis, which of the following is the most suitable long-term pharmacological therapy?

Answer 1

Clopidogrel 75 mg once daily, atorvastatin 80 mg once nightly
This is the correct answer. The patient presents with features suggestive of an ischaemic stroke, most likely secondary to small cerebral vessel atherosclerosis or carotid artery stenosis (the normal ECG make a cardio-embolic source less likely). Long-term management is with antiplatelet therapy (Clopidogrel is first line) and lipid-lowering therapy. The patient’s blood pressure therapy may also need to be adjusted

Question 2

The first-line treatment for Parkinson’s disease is usually a dopaminergic agent such as levodopa, which can cause

Answer 2

postural hypotension which patients should be warned about.

Question 3

55 year old, constipated

Answer 3

low MCV = microcytic anaemia - needs FIT test

Question 4

classic presentation of subdural haematoma

Answer 4

between dura and arachnoid

fluctuating GCS on a background of a head injury in the context of alcohol excess, with a CT head that demonstrates a crescent-shaped haemorrhage.

Question 5

G6PD deficiency

Answer 5

heinz bodies, fava beans

Question 6

A 72-year-old patient is blue-lighted to the hospital as a stroke call. He has a background of hypertension and diabetes mellitus. His physical examination reveals lateral and downward deviation and ptosis of the right eye. There is also left-sided weakness of the arm and the legs.
What is the most likely location of his lesion?

Answer 6

Branch of the right posterior cerebral artery
This patient is presenting with Weber syndrome, a midbrain stroke syndrome which manifests with ipsilateral third nerve palsy and contralateral hemiparesis. This syndrome is most often caused by a lesion in a branch of the posterior cerebral artery.

Question 7

A 76-year-old man with confirmed idiopathic Parkinson’s disease attends a neurology follow-up clinic. He has been on regular ropinirole for the last 3 years but despite the therapy, he has noted a worsening resting tremor and difficulty walking. On examination, there is evidence of a right-sided resting tremor, severe dyskinesia and rigidity.
Which one of the following is the most appropriate additional treatment option?

Answer 7

Levodopa

MAO B inhibitors (e.g. selegiline) are either used in patients who do not have any significant motor symptoms or as an adjunct for those who are already on levodopa therapy. COMT inhibitors are not used as a monotherapy but may be used as an adjunct to levodopa therapy.

Question 8

short term use of levodopa may cause

Answer 8

abnormal dreams (end of dose deterioration, early morning hypokinesia, dyskinesias, and on and off states is with long term use)

Question 9

The Bolitho Ruling means that

Answer 9

having the support of a responsible body of medical opinion is not enough, the actions undertaken must still stand up to logical scrutiny and meet the satisfaction of the judge, in order for a breach of duty of care to be disproven

Question 10

A right-handed patient with sudden onset weakness of right arm, slurred speech and facial asymmetry, is likely to have had a stroke caused by

Answer 10

occlusion of the left middle cerebral artery, resulting in infarction in the dominant hemisphere responsible for speech and language.

Question 11

medical term for IV vitamin k

Answer 11

Intravenous Phytomenadione

Question 12

Cerebellar strokes can result in difficulty with balance and coordination, slurred speech and tremors affecting fine motor tasks.

Answer 12

difficulty with balance and coordination, slurred speech and tremors affecting fine motor tasks.

Question 13

A 74-year-old man is on the stroke ward following a recent haemorrhagic stroke. He has been noted to have involuntary and quite violent wide-amplitude flinging movements of the proximal right arm.
What is the most likely diagnosis?

Answer 13

Hemiballismus secondary to a lesion in the left subthalamic nucleus
Hemiballismus describes unilateral wide-amplitude flinging movements, usually of the proximal limb. In the case of stroke, this is most commonly caused by a lesion in the contralateral subthalamic nucleus, which would impair the dampening effect on movement which is normally provided by the globus pallidus in the thalamus.

Question 14

hypothermia ECG

Answer 14

J wave/osborne wave

Question 15

impulse control disorders means what medication cannot be used in Parkinson’s

Answer 15

Dopamine agonists e.g. pramipexole pramipexole/bromocriptine/rotigotine
Dopamine agonists are contraindicated in patients with impulse control disorders for example gambling addiction.

Question 16

quadrantinopias in stroke on right side

Answer 16

temporal - superior homonymous quadrantinopia

parietal - inferior

Question 17

early vs late alzheimer’s genetic predisposition

Answer 17

Early: presenilin 1

Apolipoprotein E (APOE) gene is a well-established genetic risk factor for Alzheimer’s disease (AD), which is associated with the formation of amyloid plaques and tau tangles. The APOE ε4 allele increases the risk of developing late-onset Alzheimer’s disease,

Question 18

is selegiline a time critical medication and why

Answer 18

yes as Parkinsons medications are time critical

Question 19

delirium screening on ward

Answer 19

4AT

Question 20

lacunar stroke vessels

Answer 20

Perforating arteries around the internal capsule, thalamus, and basal ganglia

Question 21

stroke due to AF long term anticoagulation

Answer 21

Rivaroxaban DOAC

Question 22

Large vessel atherosclerosis causes what type of stroke

Answer 22

ischaemic

Question 23

A 75 year old male patient is brought to the emergency department after his wife noticed he had sudden difficulty speaking and an inability to raise his right arm. He has a past medical history of hypertension. He is a non-smoker but admits to drinking 5 units of alcohol per day.
CT head is performed on arrival to the emergency department and reveals hyper-attenuation in the left parietal lobe.
Which of the following pathophysiological processes is a risk factor for the most likely diagnosis?

Answer 23

Cerebral amyloid angiopathy
This is the correct answer. The clinical findings and CT results are consistent with haemorrhagic stroke. Cerebral amyloid angiopathy is a form of vessel disease in which amyloid builds up in the wall of blood vessels. It is a risk factor for haemorrhagic stroke and dementia, and is thought to be associated with hypertension

Question 24

Cerebral amyloid angiopathy is

Answer 24

a risk factor for haemorrhagic stroke and dementia, and is thought to be associated with hypertension

Question 25

parkinsons tremor

Answer 25

pill rolling asymmetric low-frequency tremor of 3-5 Hz

Question 26

common symptom that can precede motor symptoms in Parkinson's

Answer 26

olfactory loss

Question 27

A 50-year-old man saw his GP, complaining of heart palpitations. The GP carried out an ECG which showed no abnormalities. The GP followed NICE (National Institute for Health and Care Excellence) Guidelines and arranged some follow up tests and a referral for the patient. Later that day, the 50-year-old man died of a heart attack. His widow is told the palpitations felt earlier in the day could have been the first sign, and she feels he should have been admitted to hospital as an emergency. His widow pursues a clinical negligence claim, which is unsuccessful. Which of the following best describes why the clinical negligence claim is unsuccessful?

Answer 27

duty of care was not breached

Question 28

most significant alzheimer's RF

Answer 28

age After the age of 65, the risk of developing Alzheimer's disease doubles every 5 years.

Question 29

The criteria for diagnosing Lewy body dementia is the

Answer 29

presence of dementia alongside two of the three core features: fluctuating attention and concentration, recurrent well-formed visual hallucinations, spontaneous Parkinsonism

Question 30

AICA stroke

Answer 30

Anterior inferior cerebellar artery The AICA primarily supplies the lateral pons and the anterior inferior portion of the cerebellum. In an AICA infarct, patients may experience symptoms such as: Vertigo, nausea, and vomiting (due to cerebellar involvement) Ipsilateral (same side) facial weakness or numbness Ipsilateral hearing loss or tinnitus (due to cochlear nucleus involvement).

Question 31

wallenbergs syndrome symptoms

Answer 31

Posterior inferior cerebellar artery The clinical presentation is consistent with Wallenberg's syndrome, which often results from an infarct or ischaemia of the posterior inferior cerebellar artery (PICA). The features of Wallenberg's syndrome include contralateral loss of pain and temperature sensation and ipsilateral Horner's syndrome, ataxia, nystagmus or IX, X, XI and XII palsies (which would explain the loss of gag reflex). The PICA supplies the lateral medulla, where these characteristic symptoms originate.

Question 32

A stroke affecting the posterior inferior cerebellar artery can result in

Answer 32

contralateral loss of pain and temperature sensation, ipsilateral cranial nerve deficits including gag reflex loss, and horizontal nystagmus or ataxia (Wallenberg's syndrome).

Question 33

Multiple System Atrophy can be differentiated from idiopathic Parkinson's by

Answer 33

Multiple System Atrophy can be differentiated from idiopathic Parkinson's by its symmetric and atremoulus parkinsonism, constipation (suggesting autonomic dysfunction) and significant postural hypotension, a key feature of MSA.

Question 34

expressive aphasia and mild right drift of arm stroke location

Answer 34

Expressive aphasia, characterised by difficulty producing meaningful speech, is strongly associated with damage to the dominant left frontal lobe.

Question 35

75 year old man with difficulty speaking and writing with his left hand

Answer 35

Dysarthria-clumsy hand syndrome results from an ischaemic lesion in the genu of the internal capsule, causing speech and hand coordination difficulties (contralateral)

Question 36

first-line treatment for managing hallucinations in patients with Parkinson's disease and psychotic features.

Answer 36

Quetiapine is the first-line treatment for managing hallucinations in patients with Parkinson's disease and psychotic features.

Question 37

stroke symptoms after rugby tackle investigation of choice

Answer 37

Carotid artery dissection can cause stroke through clot formation. CT head and neck angiography helps diagnose dissection, arterial narrowing, or thrombus, guiding treatment with anticoagulation or surgery to prevent further stroke.

Question 38

midbrain stroke features

Answer 38

Weber's syndrome is characterised by contralateral hemiparesis and ipsilateral oculomotor nerve palsy due to midbrain lesions.

Question 39

C9orf72 gene mutations are associated with

Answer 39

C9orf72 gene mutations are associated with both amyotrophic lateral sclerosis and frontotemporal dementia, presenting overlapping clinical features.

Question 40

Donepezil contraindication

Answer 40

Acetylcholinesterase inhibitors, such as donepezil, are the first-line treatment for Alzheimer's disease, but bradycardia is a contraindication as these medications can increase vagal tone, potentially causing or worsening bradycardia, heart block, or syncope.

Question 41

galantamine

Answer 41

reversible inhibitor of acetylcholinesterase

Question 42

A 70-year-old man is brought back to memory clinic by his wife, after being diagnosed with a progressive neurodegenerative disorder a year ago. In addition to this condition, he also has a past medical history of asthma. His drug history includes salbutamol, beclomethasone and galantamine. A mini-mental state examination (MMSE) is conducted by the clinic consultant and the patient scores 12. His score last year was 18. What is the most appropriate pharmacological management option?

Answer 42

Add an N-methyl-D-aspartic acid receptor antagonist Correct. This patient has a history of a progressive neurodegenerative disorder, likely Alzheimer’s disease, given the use of galantamine (a cholinesterase inhibitor). His decline in MMSE score from 18 to 12 indicates progression to a more severe stage of dementia. An NMDA receptor antagonist, such as memantine, is typically recommended when Alzheimer’s disease progresses despite treatment.

Question 43

Opioids such as tramadol, while useful for pain management, can

Answer 43

lower seizure threshold in older adults with epilepsy.

Question 44

A 75-year-old man with a background of epilepsy, well-controlled on sodium valproate, is admitted with urosepsis. He has normal renal function. Which of the following antibiotics is important to avoid?

Answer 44

Ciprofloxacin Ciprofloxacin may reduce the seizure threshold, so is important to avoid in patients with a known history of epilepsy, if possible.

Question 45

drugs that lower seizure threshold

Answer 45

Question 46

5 lacunar stroke syndromes

Answer 46

pure motor hemiparesis, pure sensory stroke, sensorimotor stroke, ataxic hemiparesis, and clumsy-hand dysarthria

Question 47

A 57-year-old man presents to the Emergency Department complaining of a clumsy right hand and difficulty speaking. His symptoms came on that morning, and were still present 8 hours later. His past medical history includes hypertension and migraines as a young man. He smokes ten cigarettes per day. On examination he was found to have some weakness of the intrinsic hand muscles on his right side only. Speech was mildly slurred. Visual fields and sensation were normal. Blood pressure was 180/110 mmHg. Which one of the following is the most likely diagnosis?

Answer 47

Left hemisphere lacunar stroke This man’s presentation with weakness of the intrinsic hand muscles and slurred speech is compatible with clumsy-hand dysarthria, one of the five classic lacunar syndromes, caused by lacunar infarcts especially due to left hemisphere as dominant if right handed!

Question 48

A 48-year-old man with a background of Huntington's disease presents to his GP. He appears distressed and says he has been experiencing increasing sudden, involuntary movements in his hands and neck. He is hoping to see if anything can be done to help control these symptoms. What is the most suitable treatment option?

Answer 48

Choreoathetosis, characterised by sudden, involuntary movements, can be managed with tetrabenazine due to its ability to decrease monoamine uptake.

Question 49

PSP key sign

Answer 49

vertical gaze palsy, hummingbird sign on MRI

Question 50

A 65 year old woman is referred to a neurologist via her GP, due to a tremor of her left hand. Examination reveals cogwheel rigidity of the tremulous hand, and a slow, shuffling gait. Her arm is also noted to be flailing around during the consultation. The patient says she has no control over these movements. The neurologist suspects a Parkinsonian syndrome. What is the most likely diagnosis?

Answer 50

Cortico-basal degeneration (CBD) This is the correct answer. CBD is a Parkinson-plus syndrome, including the Parkinsonian triad of tremor, hypertonia, and bradykinesia. Characteristically, it involves spontaneous activity by an affected limb, or akinetic rigidity of that limb

Question 51

how to verify a death

Answer 51

Question 52

where is broca's area

Answer 52

Broca's area, responsible for fluent speech production, is located in the inferior frontal gyrus

Question 53

An 85-year-old woman is brought into the emergency department following sudden onset left-sided weakness and slurred speech. This came on 30 minutes ago. She has a past medical history of atrial fibrillation for which she takes Bisoprolol, and multiple falls. After a discussion with her cardiologist, she had declined anticoagulation. On examination, she has left-sided weakness affecting her face, with forehead sparing, and weakness of her left arm and leg. Cardiovascular examination reveals an irregularly irregular pulse. A CT scan has been performed. Nil abnormalities are detected. Given the most likely diagnosis, which is the single best investigation to confirm the diagnosis?

Answer 53

Diffusion-weighted MRI brain This is the correct answer. This woman has had a thromboembolic stroke affecting her right middle cerebral artery, secondary to a thrombus in her left atrial appendage. This is a known complication of atrial fibrillation. CT scans are useful for detecting haemorrhagic strokes, but can be normal in the first few hours of an ischaemic stroke. Diffusion-weighted MRI can confirm early ischaemic stroke, which appears bright

Question 54

Risk factors for haemorrhagic stroke include

Answer 54

hypertension, anticoagulation, and sympathomimetic drug use such as cocaine and amphetamines.

Question 55

Posterior circulation strokes can present with

Answer 55

vertigo, ataxia, and dysarthria; alteplase is indicated within 4.5 hours for ischaemic strokes.

Question 56

A 31 year old female patient is referred to the neurology clinical with uncontrollable, purposeless, jerking movements. She has also found it difficult to concentrate over the past few months and has been suffering from a low mood. She reports that her brother, mother, and grandfather had similar symptoms in their 40s, followed by dementia and death within 10 years. Which of the following is true of this condition?

Answer 56

MRI shows atrophy of the caudate nucleus and putamen This is the correct answer. The presentation is consistent with the choreiform movements seen in Huntington's disease (described by the triad of dominant inheritance, choreoathetosis, and dementia). These are the typical findings on MRI

Question 57

riluzole is for

Answer 57

MND

Question 58

A 72 year old male patient presents to the emergency department with sudden onset difficulty speaking and an inability to raise his right arm. He has a past medical history of hypertension. He was last known to be fully functional 3 hours ago when his daughter spoke to him on the phone. Physical examination reveals a receptive aphasia and right arm paralysis. The blood pressure is 135/95 mmHg, but vital signs are otherwise within normal range. CT head reveals a hyper-intense lesion in the left middle cerebral artery vascular territory. Which of the following is the most appropriate acute management for the most likely diagnosis?

Answer 58

Supportive management and neuro-surgical review This is the correct answer. The patient presents with features suggestive of haemorrhagic stroke. Haemorrhagic stroke should not be managed with aspirin or thrombolysis. Acute management involves neurosurgical and neuro-critical care evaluation, admission to the neurology ICU, and airway protection

Question 59

A 50-year-old man is brought into the Accident and Emergency Department following an accident in his car. Shortly after his arrival, the police arrive. They tell the doctor that they would like to find out some basic details about the patient as they say he has committed a traffic offence. Which of the following best describes how the doctor should respond to their request?

Answer 59

Under the Road Traffic Act 1988, there is a legal duty to provide identifying information to the police (legal duty to breach confidentiality) about a driver who has committed a traffic offence, upon request

Question 60

restriction of upgaze. His wife also reports disinhibition of her husbands formerly very shy personality over recent months. In clinic he comes across as confident and friendly, though does not appear to appreciate the extent of his motor difficulties.

Answer 60

Progressive Supranuclear Palsy (PSP) is a neurological disorder characterised by parkinsonian symptoms, early postural instability, supranuclear gaze palsy, and cognitive impairment.

Question 61

chronic pain med that can cause constipation not opioid

Answer 61

Anticholinergic medications, including Amitriptyline, commonly used for chronic pain management, can cause constipation as a side effect.

Question 62

what lab findings would make you give iron

Answer 62

The findings of microcytic anaemia with significantly low ferritin are in keeping with iron deficiency anaemia. Therefore she requires iron supplementation to treat this

Question 63

how to differentiate between ACA and MCA in TACS

Answer 63

Dysphasia and visual defects are not characteristic of these lesions in the ACA, Wernicke's dysphasia in particular is a classic feature of a dominant hemisphere infarct, which, in most patients, is the left hemisphere

Question 64

An 82-year-old woman presents to the emergency department with sudden onset slurred speech and facial weakness, noticed by her carer 2 hours ago. She has a history of a metallic aortic valve replacement (on warfarin) and hypercholesterolaemia. On examination, she has a right-sided facial droop but can raise both eyebrows. She has impaired comprehension, unintelligible speech, a GCS of 11, and loss of vision in the right visual field of both eyes. CT scan shows loss of grey-white matter differentiation and hypodensity in the left temporal region. Preliminary blood results: INR 3.7 (normal 1.0) and serum glucose 5.7 mmol/L (normal 3.5-5.5 mmol/L). Given the most likely diagnosis, what is the single best treatment?

Answer 64

Aspirin 300mg PR This is the correct answer. This woman has had an ischaemic stroke affecting part of the left middle cerebral artery, hence the facial weakness (with forehead sparing), receptive dysphasia and homonymous hemianopia. She has two contraindications to thrombolysis: she is taking anticoagulation with an INR >1.7, and she has an unknown time of onset of her symptoms. Given that she has speech disturbance and reduced GCS and is therefore at risk of swallowing problems and aspiration, it is safer to give her the aspirin PR CT would show if haemorrhagic

Question 65

A 63 year old male presents to the Emergency Department with complete left sided paralysis and double vision. This came on suddenly. On examination, he was unable to abduct his right eye and had an absent corneal reflex. Where is the lesion?

Answer 65

Right pons Cranial nerve lesions are ipsilateral, except trochlear. Abducting the right eye is the lateral rectus muscle, supplied by the Abducens nucleus (VI). This comes out of the pons. Additionally, the absent corneal reflex (utilises CN V: afferent and VII: efferent in the reflex) is absent, further implicating the pons. Corticospinal fibres travel through the pons and decussate later in the medulla, hence hemiparesis would be contralateral to the site of the lesion

Question 65

A lesion in the pons will result in

Answer 65

contralateral hemiparesis, loss of lateral rectus function (causing double vision), and an absent corneal reflex.

Question 66

bp CI for thrombolysis

Answer 66

A blood pressure greater than 180/110mmHg is a contraindication for thrombolysis.

Question 67

A 52 year old woman presents with vertigo and vomiting. On examination she has gaze direction changing horizontal nystagmus, no focal weakness but mild right past pointing and heel-shin ataxia. She vomits when you try to perform Dix-Hallpike but head thrust test is negative. What is the most likely diagnosis?

Answer 67

Posterior circulation infarct Given the above history a posterior circulation infarct is most likely. These can present with dizziness, vertigo, nausea, vomiting, ataxia, dysdiachokinesia, dysarthria. A useful acronym for remembering CEREBELLAR signs of stroke is DANISH. Dysdiachokinesia, Ataxia, Nystagmus, Intention tremor, Slurred speech, Hypotonia.

Question 68

In individuals with embolic infarcts confined to one hemisphere of the brain what is a common causative factor.

Answer 68

In individuals with embolic infarcts confined to one hemisphere of the brain, carotid artery stenosis is a common causative factor.

Question 69

A 50 year old woman who is known hypertensive but non-compliant with her medication presents with a severe headache, a right hemiparesis and some dysarthria. CT head shows a deep left basal ganglia intracerebral haemorrhage. She is not on any oral anticoagulants. Within one hour of admission, what should her target systolic blood pressure (SBP) be?

Answer 69

SBP <140mmHg The management of haemorrhagic stroke should include reversal of any anticoagulation (using beriplex/octaplex +/- vitamin K) and aggressive BP control. The systolic BP should be kept <140mmHg within an hour of admission and ideally kept above 120mmHg. This can be done with Glyceryl Trinitrate (GTN) or labetalol.

Question 70

Patients presenting with facial grimacing, uncoordinated movements, aggression, and a family history of neurodegenerative disease are most likely suffering from what disease due to what gene

Answer 70

Patients presenting with facial grimacing, uncoordinated movements, aggression, and a family history of neurodegenerative disease are most likely suffering from Huntington's disease due to an inherited autosomal dominant defect in the HTT gene.

Question 71

A 66-year-old woman attends the emergency department with sudden onset left-sided weakness and slurred speech. She states her symptoms started around 4 hours ago and have progressively worsened. Her only past medical history of note is atrial fibrillation for which she takes dabigatran. Her blood pressure is 135/77. A CT head confirms an intracerebral haemorrhage and the dabigatran is stopped. Which of the following is the next best step in her management?

Answer 71

Give idarucizumab This patient has a confirmed intracerebral haemorrhage and her anticoagulation must be stopped. The reversal agent for dabigatran is idarucizumab, making this the correct answer. if she was taking Warfarin - vitamin K and prothrombin complex concentrate

Question 72

Elderly patients with recurrent falls and postural hypotension may benefit from

Answer 72

Elderly patients with recurrent falls and postural hypotension may benefit from midodrine, an alpha-1-adrenergic receptor agonist that enhances vascular tone, improving blood pressure and reducing dizziness upon standing. evidence base for fludrocortisone is weak

Question 73

fludrocortisone MOA

Answer 73

Fludrocortisone binds to the aldosterone receptor, which increases activity of the distal tubule of the kidney, causing enhanced sodium ion and water transport into the plasma, and increasing urinary excretion of potassium and hydrogen ions

Question 74

features of an advanced statement

Answer 74

Advance statements, expressing an individual's preferences for future care when unable to make decisions and lacking capacity, can be made verbally but should ideally be recorded permanently. Not legally binding

Question 75

Benserazide,

Answer 75

Benserazide, a decarboxylase inhibitor, prevents peripheral breakdown of levodopa, thereby increasing its effectiveness as a treatment for Parkinson's disease.

Question 76

Acetylcholinesterase inhibitor

Answer 76

rivastigmine

Question 77

carbidopa and levodopa

Answer 77

decarboxylase inhibitor with a dopamine precursor

Question 78

entecapone

Answer 78

COMT inhibitors are a new class of medication which also prevent peripheral breakdown of levodopa, thus increasing its bioavailability. Examples of COMT inhibitors include entacapone.

Question 79

dopamine agonists

Answer 79

ropinirole and pramipexole.

Question 80

selegiline and rasagiline.

Answer 80

Monoamine oxidase inhibitor (MAOI) MAOIs prevent the break down of neurotransmitters including dopamine in the brain, thus increasing their bioavailability. Examples of MAOIs include selegiline and rasagiline. These drugs are known for having many interactions.

Question 81

DOLS are part of the

Answer 81

Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act (2005) that provide additional protections when restrictions or restraints limit an individual's freedom.

Question 82

hypo or hyper dense subdural haem. on CT

Answer 82

In elderly patients with a history of falls and anticoagulant use, subdural haemorrhages may present weeks later with symptoms such as confusion and drowsiness, resulting in a crescent-shaped hypodense lesion on CT imaging.

Question 83

pt presents with intracerebral haemorrhage on enoxaparin Mx

Answer 83

Intracerebral haemorrhage is a complication that can arise from uncontrolled hypertension and the use of low molecular weight heparin, necessitating prompt cessation of anticoagulation therapy. stop enoxaparin

Question 84

You are called to see a 54 year old man on the acute medical unit who has developed new left sided weakness. He was admitted to hospital due to an acute kidney injury and a community acquired pneumonia. His background is significant for atrial fibrillation, polycystic kidney disease, chronic renal failure and hypertension. On examination, you note a dense left sided hemiplegia and suspect an acute stroke. His GCS is 15/15. His HR is 85 and his BP is 150/82. CT head demonstrates a haemorrhagic stroke. The nursing staff alert you to the fact that he is on warfarin. His most recent INR was 2.3. Which of the following is the next best step in his management?

Answer 84

Start labetalol, stop warfarin and give IV vitamin K and prothrombin complex concentrate This is the correct answer. Blood pressure control is vital in a haemorrhagic stroke. Vitamin K and prothrombin complex concentrate must be given in patients on warfarin presenting with a major haemorrhage. In haemorrhagic stroke patients on anticoagulation therapy, urgent control of blood pressure, discontinuation of warfarin, and administration of vitamin K and prothrombin complex concentrate are crucial steps to prevent further bleeding.

Question 85

In managing Parkinson's disease with motor fluctuations, adding what can improve symptom control.

Answer 85

In managing Parkinson's disease with motor fluctuations, adding a MAO-B inhibitor like rasagiline can improve symptom control.

Question 86

Montgomery ruling emphasises what

Answer 86

Healthcare professionals must provide patients with clear information about material risks and reasonable alternatives before obtaining consent for treatment.

Question 87

CPR success rate outside of hospital

Answer 87

10%

Question 88

A 70-year-old woman presents with memory impairment, apathy and difficulty with daily activities. Which of the following imaging findings is most likely to be associated with vascular dementia?

Answer 88

White matter hyperintensities on MRI White matter hyperintensities on MRI are commonly associated with vascular dementia as they represent chronic small vessel ischemic changes in the brain.

Question 89

Occupational therapists use what to assess functional independence in stroke patients during their rehabilitation process.

Answer 89

Occupational therapists use the Barthel Index to assess functional independence in stroke patients during their rehabilitation process.

Question 90

inheritance pattern of Huntingtons

Answer 90

Autosomal dominant neurodegenerative conditions, such as Huntington's disease, are characterised by the triad of movement disorder, psychiatric features, and a shortened life expectancy. (death within 20 years)

Question 91

ACA stroke cannot have

Answer 91

speech disturbance or hemianopia

Question 92

For constipation resistant to lifestyle modifications, initial pharmacological management typically involves prescription of

Answer 92

bulk-forming laxatives like ispaghula husk.

Question 93

n 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?

Answer 93

Ischaemic heart disease In death certificates, it is appropriate to list the pathological cause, like ischemic heart disease, rather than modes of dying, like liver, heart, or respiratory failure.

Question 94

assistance with washing and toileting = clinical frailty

Answer 94

7

Question 95

capacity assessment

Answer 95

tell me a bit about why you are in hospital why do you want to leave do you understand what the risks of that would be how are you feeling generally memory - age, where you are, why you are here can you remember what we discussed earlier about why you want to leave can you explain to me again just to make sure we are on the same page about what you want to happen disturbance in brain or mind?