Order cauda equina syndrome assessment A 70-year-old man who is independently mobile and lives with his son presents with a sudden fall accompanied by a burning back pain. Past history includes diet-controlled diabetes, hypertension and atrial fibrillation. In the previous days, he had been suffering from a lower respiratory tract infection for which his GP had commenced a five-day course of amoxicillin. The patient was […]

Discussion on muscle and sarcopenia questions Question 148 An 86-year-old widow presented as an outpatient, with her son. She had experienced three falls in the previous year, none with any associated palpations or chest pain. She had a past history of osteoarthritis which limited her mobility, hypertension, ischaemic heart disease, urinary incontinence and anxiety. She lived alone and was afraid to go out very much. […]

Order hypertension and osteoporosis discussion nocturia on average three times per night. Her past medical history includes depression, hypertension and osteoporosis. She is taking numerous medications. On examination, she has a soft systolic heart murmur, there is mild bilateral ankle oedema and her chest and abdominal examinations are unremarkable. Her body mass index is calculated as 27 kg/ m2. Which of the following medications could […]

Assess idiopathic Parkinson’s disease Question 116 An 85-year-old man presents with a 15-month history of fluctuating cognitive impairment most marked in the visuospatial domains, Parkinsonism, intermittent confusion and generalised myoclonus. His short-term memory seems very good. He was started on 62.5 mg three times daily of co-careldopa. Eye movements were normal. He has recently been reported to have unsteadiness and falls. What is the most […]

Order Montreal Cognitive Assessment The Montreal Cognitive Assessment (MoCA) is a widely used test of cognitive function. In the MoCA, a patient is asked to name as many words as possible beginning with the letter F. In which section of the MoCA would this instruction be given? A. attention B. language C. memory D. naming E. visuospatial/executive function Which of the following statements is the […]

Order Parkinson’s disease assignment You are reviewing a man with Parkinson’s disease in the outpatient clinic. You are discussing starting him on a dopamine agonist to improve his symptom control. He has heard reports in the media of people developing problems, including compulsive gambling, on this type of treatment. He asks you to tell him more about this potential adverse effect. Which of the following […]

Discussion on the ageing of skin questions Which of the following statements is true regarding classical HutchinsonGilford progeria syndrome (HGPS)? A. cancer risk is high, including thyroid neoplasms, melanoma, meningioma, soft tissue sarcomas, hematologic/ lymphoid cancers and osteosarcomas B. causative gene is WRN C. inheritance is autosomal dominant D. main symptoms include a lack of the pubertal growth spurt during early teen years, greying or […]

The risk of aspiration pneumonia questions An 83-year-old woman was referred to the acute medical unit for assessment of her palpitations. One hour after arriving, she complained of a return of her palpitations with a central crushing chest pain. She became distressed and agitated. She was given aspirin and sublingual glyceryl trinitrate. On examination, her pulse was very weak and hard to count. Her BP […]

Discuss the cause of acute gastroenteritis A 74-year-old man presents with a oneweek history of nausea, polyuria and drowsiness. He has no past medical history of note. He lives with his wife, is usually independent, occasionally drinks alcohol and is an ex-smoker. Physical examination did not reveal any focal abnormalities, but he scored poorly on a brief cognitive assessment. An ECG and chest X-ray are […]

Order hyponatraemia discussion questions A 78-year-old woman is assessed for hypertension in the outpatient clinic. She complains of light-headedness when she stands quickly but has had no recent falls or any history of blackouts. Her blood pressure recorded while lying down was 189/104 mmHg, and one minute after standing was 157/93 mmHg. Her ambulatory blood pressure monitoring shows a daytime average 146/89 mmHg. Which of […]