Questions Flashcards
What are the three 3Ws of normal pressure hydrocephalus? [3]
Wet: Urinary incontinence
Wobbly: ataxia
Whacky: memory loss
How does sub cut dose relate to oral dose of morphine? [1]
The subcutaneous dose of morphine is half of the total daily oral dose.
The side effect this woman is describing is likely peripheral neuropathy. This commonly occurs with treatment using [cancer tx]
The side effect this woman is describing is likely peripheral neuropathy. This commonly occurs with treatment using platinum agents e.g. Cisplatin, Carboplatin.
An 82-year-old woman is brought to her GP by her daughter due to increasing memory problems over the past year. She has difficulty remembering recent conversations and often forgets the names of family members. Her daughter has also noticed that she repeats questions frequently and has become more irritable. A physical examination is normal.
Her bloods show:
Haemoglobin (Hb) 120 g/L (115 - 160)
Calcium 2.2 mmol/L (2.1 - 2.6)
Thyroid stimulating hormone (TSH) 4.2 mu/L (0.5 - 5.5)
Free thyroxine (T4) 16 pmol/L (9 - 18)
Vitamin B12 460 pg/mL (180 - 1000)
Folate 5.6 ng/mL (> 4.0)
Which is the most appropriate next step? [1]
Neuroimaging is required to diagnose dementia
A 45-year old female has end stage renal cancer. Due to her cancer she has stage 4 chronic kidney disease.
Which is the best drug to prescribe in her syringe driver for pain?
Diamorphine
Morphine sulphate
Alfentanil
Tramadol
Hydromorphone
Alfentanil
- This drug is first line in those with stage 4 or 5 chronic kidney disease. This is due to limited renal excretion of parent drug or metabolites.
- Alternatives to morphine may be necessary for patients with poor renal function. These include oxycodone, alfentanyl or buprenorphine.
An 85 year old man is brought in by his son to the GP with a six month history of increasing forgetfulness and getting lost outdoors. He has had reduced mobility and multiple falls, which is very unusual for him. He has also been talking about a man in his garden, despite the fact he lives alone and does not have a gardener. His son reports that his father seemed to be improving a month ago, but things have started to get worse again.
He has a background of hypertension. He has never smoked and does not drink alcohol.
Which of the following is the most likely diagnosis?
This patient has symptoms consistent with Lewy body dementia, as suggested by fluctuating worsening cognition, visual hallucinations and mild features of parkinsonism. They may have postural instability and increased risk of falls, as in this scenario.
A 45 year old man is being treated for non-Hodgkin’s lymphoma. He attends his outpatient clinic and a questionnaire is completed regarding the side effects of chemotherapy. He complains that he has reduced sensation in hands bilaterally.
Which of the following is the most likely cause?
Rituximab
Doxorubicin
Cisplatin
Cyclophosphamide
Vincristine
Vincristine is associated with peripheral neuropathy and is a common therapeutic agent in non-Hodgkin’s lymphoma
What is the most appropriate anti-emetic to prescribe for Parkinson’s disease? [1]
Why? [1]
Domperidone is an effective anti-emetic for patients with Parkinson’s disease as it does not cross the blood-brain barrier and has anti-dopaminergic activity, helping to reduce nausea without affecting central dopamine levels.
Which drug is used specifically for reducing secretions from tumour sites? [1]
Which drug is used to manage bowel colic and abdominal cramping? [1]
Glycopyrronium is an antimuscarinic agent that helps reduce secretions throughout the body.
- It works by blocking acetylcholine at muscarinic receptors, thereby decreasing the production of serous fluid
- This makes it suitable for managing secretions from tumour sites, which can improve the patient’s quality of life and ability to continue working.
Hyoscine butylbromide,
- also known as Buscopan, is primarily used to manage bowel colic and abdominal cramping due to its antispasmodic properties. While it does have some antisecretory effects
A 75-year-old female with metastatic breast cancer is admitted to the hospice for ongoing care. She complains that, at night, strange men enter her room and move her belongings and that staff talk about her during the day. In addition, she sometimes sees a vision of her deceased sister in her room, and this has caused her anxiety and distress.
Which of the following medications would be most appropriate to treat her symptoms?
Lorazepam
Diazepam
Midazolam
Haloperidol
Hyoscine bromide
Haloperidol (an anti-psychotic) is the treatment of choice for hallucinations and agitation associated with delirium. Delirium is common in elderly and unwell patients and should be actively diagnosed and managed.
A 63-year-old female is on the Respiratory Ward. She has end-stage chronic obstructive pulmonary disease (known T2RF) and metastatic lung cancer. She is very breathless and complaining of some pain. Her obs are as follows: sats 89%, RR 34, BP 127/94, HR 96, temp 36.2°C. On the ward round with the consultant in the morning, it is decided that she should be made end-of-life (EOL).
Which of the following anticipatory medications will help with her symptoms?
Glycopyrronium 200 mcg SC
Haloperidol 0.5 mg PO
Levomepromazine 12.5 mg SC
Midazolam 2.5 mg SC
Morphine 2.5 mg PO
Morphine PO (Oromorph) can be used to help with pain and breathless due to it being an opioid. In this case, the patient has a very high respiratory rate, with normal saturations for her as she is a T2RF patient. The oromorph should help to reduce her respiratory rate and therefore the feelings of breathlessness alongside helping with her pain. Small doses should always be used to start with and titrate them up.
For what type of pain is ketamine used as a second-line treatment in palliative care?
Acute
Chronic
Neuropathic
Nociceptive
Radicular
Neuropathic
Which of the following painkillers can be used in palliative care when opioids are no longer as effective?
Buprenorphine
Ketamine
Methadone
Oxycodone
Pethidine
#49501
Ketamine
A 33-year-old male presents with a 10-year history of arm tremor. However, it has become worse recently, such that he now finds it embarrassing at work and is worried about losing his job. His father had a similar problem, although this was mild and always put down to benign tremulous Parkinson’s disease. On examination, he has a fine postural tremor but normal tone. Fine finger movements are normal, as is his gait.
What is the most likely diagnosis?
Essential tremor
Familial cerebellar degeneration
Familial Parkinson’s disease
Severe anxiety
Wilson’s disease
The fine postural tremor is typical of an essential tremor. It is often familial. The absence of other neurological signs helps to support this diagnosis.
What is an analgesic options would be most specific for metastatic bone pain? [1]
Intravenous administration of bisphosphonate (such as ibandronate) is a recognised treatment for patients who suffer from uncontrolled pain from bony metastases.
An 85-year-old female who recently moved to a nursing home complains of feeling lonely, not sleeping well and having lost her appetite over the past month. She is suspected to be suffering from depression. She has declined psychological interventions.
What would be the preferred treatment of choice?
Lithium
Monoamine oxidase inhibitor
No treatment
Selective serotonin-reuptake inhibitor antidepressant
Tricyclic antidepressant
#49387
Selective serotonin-reuptake inhibitor antidepressant:
- Newer SSRIs such as sertraline have fewer cardiotoxic effects, while tricyclics such as amitriptyline and imipramine should be avoided because of their cardiotoxic effects.
What factors do you think influnece decisions on resus status? [+]
There are 3 major mimics of dementia. What are they? [3]
Name 4 reversible causes of dementia
Hypothydroidism
B12 or Folate deficiency
Alcoholism
Normal pressure hydrocephalus
Eosinophilic intracytoplasmic neuronal inclusion bodies the brainstem and cortex would indicate which type of dementia? [1]
Lewy Body Dementia
