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Question 1
Incorrect
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A 65-year-old man, after suffering from a pathological rib fracture, complains of recurrent infection. Bone marrow aspiration revealed a calcium level of 3.9 mmol/l and alkaline phosphatase level of 160u/l. What type of cell would be found in abundance in the marrow spear?
Your Answer: Myeloid cells
Correct Answer: Plasma cells
Explanation:Multiple myeloma or plasma cell myeloma, is a cancer of plasma cells, responsible for producing antibodies. It often, presents early with no symptoms followed by bone pain and pathological fractures (metastases), raised calcium levels, bleeding, frequent infections, and anaemia. It usually occurs around the age of 61 and is more common in men than women.
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This question is part of the following fields:
- Geriatrics
- Medicine
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Question 2
Incorrect
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A 68 year old male presented with swelling in the lower pole of his parotid gland. It is revealed that this has been ongoing for the past 10 years. Upon examination, the swelling is firm in consistency. From the list of options, choose the most probable diagnosis for this patient.
Your Answer: Parotitis
Correct Answer: Pleomorphic adenoma
Explanation:A pleomorphic adenoma is also called a benign mixed tumour – this is the most common tumour of the parotid gland. It also causes over a third of all submandibular tumours. This type of a tumour is slow-growing and has no symptoms, which means it has great malignant potentiality.
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This question is part of the following fields:
- Geriatrics
- Medicine
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Question 3
Incorrect
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A 75 year old man was brought to the clinic by his wife because lately he has lost interest in activities he previously enjoyed. His wife is worried and claims he's generally withdrawn. What would exclude depression in favour of dementia?
Your Answer: Self-reported concern of poor memory
Correct Answer: Urinary incontinence
Explanation:Urinary incontinence is not a usual symptom of depression. A depressed patient is usually capable of maintaining control of his body sphincters. In dementia, however, urinary incontinence is an important and late symptom of the disease, non-related to any urinary tract pathology. It is rather related to the cognitive impairment caused by dementia.
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This question is part of the following fields:
- Geriatrics
- Medicine
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Question 4
Incorrect
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A 79-year-old woman has a waddling gait. History reveals enuresis and change in behaviour. What is the most likely diagnosis?
Your Answer: Psychotic depression
Correct Answer: Normal pressure hydrocephalus
Explanation:The waddling gait and behaviour change are attributes of normal pressure hydrocephalus along with loss of bladder control which commonly happens with elder age.
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This question is part of the following fields:
- Geriatrics
- Medicine
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Question 5
Correct
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A 75 year old man presented to hospital after suffering a stroke. The doctor admitted him and advised of the Barthel score index. During rehabilitation, which one of the following limitations are best described by Barthel score index?
Your Answer: Floor and ceiling effects
Explanation:Barthel scoring has floor and ceiling effects which is the most widely recognised limitation. Floor effect means that the patient who is bed bound can score initially low, whereas the ceiling effect shows that despite being bed bound, a patient can achieve a maximum score i.e. 100. The test is easy to perform and correlates well with other prognostic scales.
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This question is part of the following fields:
- Geriatrics
- Medicine
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Question 6
Correct
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A 85 year old male with a history of faecal impaction, who lived at a nursing-home presented with abdominal pain and distension, confusion and agitation. Which of the following is the first step of the management.
Your Answer: Phosphate enema
Explanation:The most probable cause for this presentation is faecal impaction following constipation, which is common among old people who live in nursing-homes. There can be number of reason for constipation in old age, including medications, endocrine and metabolic diseases, neurologic disorders, myopathic disorders, dietary habits etc. Enemas are a way of removing impacted faeces, which helps rectal evacuation.
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This question is part of the following fields:
- Geriatrics
- Medicine
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Question 7
Correct
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A 62 year old female complains of pain and stiffness in her shoulders. She also finds it difficult to get out of her chair. From the list of symptoms below, choose the one most likely to support the diagnosis of polymyalgia rheumatica.
Your Answer: Low grade fever
Explanation:Polymyalgia rheumatica is an inflammatory disease which usually causes stiffness and pain in the shoulder – this can also occur in the pelvic girdle muscles. Its onset can either be subacute or acute and is associated with a systemic inflammatory response. This, therefore, causes symptoms such as fever, weight loss, anorexia, and malaise. Polymyalgia rheumatica is unpredictable in its course and it is known that 30 per cent of patients also present with giant cell arteritis. The cause of this disease is unknown but studies have shown it have infectious origins. Diagnosis of polymyalgia rheumatica can be difficult and other inflammatory diseases have to be excluded first. Patients with this disease are usually over 60 years of age (it is very rarely seen in those under 50). Muscle weakness does not present, although this can be hard to assess when the patient is in pain. Low-grade fever and weight loss are typical of this disease due to chronic inflammation. As such, weight gain is very rare and peripheral joints are usually not affected (they can be affected but it is very rare). Also, muscle tenderness is not a specific symptom of the disease – it is therefore not a classical finding of polymyalgia rheumatica. Although patients usually complain of stiffness and pain, the muscles are usually not significantly tender – this is usually more associated with fibromyalgia or myositis. When investigated, a normochromic/normocytic anaemia; a raised erythrocyte sedimentation rate often over 50 mm/hr., and raised C reactive protein are usually revealed. Symptoms of giant cell arteritis should also be sought, such as headaches, visual disturbances, TIAs (transient ischemic attacks), jaw claudication, and thickened temporal arteries. The patient response to a moderate dose of steroids is useful when confirming a diagnosis of polymyalgia rheumatica. The maximum dose of prednisolone should not exceed 20mg once a day. After treatment, patients should show a 70 per cent improvement in symptoms within a month (between 3-4 weeks). Inflammatory markers should also fall back to their normal levels. Non-steroidal anti-inflammatories are of little use and are associated with morbidity. There is also little evidence for the use of steroidal-sparing agents.
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This question is part of the following fields:
- Geriatrics
- Medicine
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Question 8
Correct
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An 81 year old male patient was admitted after an ischaemic stroke. Physical examination reveals left hemiparesis. How would you classify this hemiparesis based on the WHO International Classification of Functioning, Disability and Health?
Your Answer: Impairment of body function
Explanation:Symptoms and signs are classified as ‘impairment of body function’. The types of impairment classified as ‘activity limitation’ include difficulties that a patient may have in executing certain activities. The type of impairment classified as ‘participation restriction’ are problems a patient may have in social roles. The type of impairment classified as ‘pathology’ would be the diagnosis/disease. Right total anterior circulation infarct relates to the Oxford Bamford classification for stroke.
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This question is part of the following fields:
- Geriatrics
- Medicine
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Question 9
Correct
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A 85 year old male with a history of Alzheimer's dementia was brought into Casualty by family members, who stated that he had episodes of aggression. Which of the following drugs is most suitable as the pharmacological management for this presentation?
Your Answer: Risperidone
Explanation:Regarding the pharmacological management, Risperidone is the most suitable drug from the given answers as it is recommended for the treatment of aggression associated with moderate to severe Alzheimer’s disease. Quetiapine and Benzodiazepine are not recommended.
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This question is part of the following fields:
- Geriatrics
- Medicine
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Question 10
Incorrect
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An 87-year-old woman had to double up her dosage of morphine 60mg into 120mg twice a day, in addition to another 10mg oral Morphine 6 times a day. What is the best method of management?
Your Answer: Fentanyl patches
Correct Answer: Subcutaneous morphine infusion
Explanation:Stable dose of Morphine is essential for chronic cases of pain that are non-malignant in origin. Using the SC route avoids having to intravenously cannulate a patient and allows for a continuous infusion of drugs over a calculated period of time providing constant dosing A significant advantage is that plasma levels of a drug are much more stable, and appropriate symptom control can be achieved without the toxic effects of the peaks and troughs resulting from episodic drug administration.
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This question is part of the following fields:
- Geriatrics
- Medicine
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SESSION STATS - PERFORMANCE PER SPECIALTY
