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  • Question 1 - A 68 year old male presented with swelling in the lower pole of...

    Incorrect

    • 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: Frey’s syndrome

      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.

    • This question is part of the following fields:

      • Geriatrics
      • Medicine
      22
      Seconds

  • Question 2 - An elderly man presents with fever of 38°C and a very severe headache....

    Incorrect

    • An elderly man presents with fever of 38°C and a very severe headache. His BP is 85/50 mm Hg. He has neck stiffness and photophobia. What is the most appropriate management?

      Your Answer: CT head and Lumbar puncture

      Correct Answer: CT head

      Explanation:

      In elderly patients, symptoms suggestive of meningitis could be due to an intracranial mass lesion (such as abscess, tumour or an intracerebral haematoma). Therefore elderly patients are increased risk of cerebral herniation from an LP. A CT head should be done before an LP to exclude a mass lesion.

    • This question is part of the following fields:

      • Geriatrics
      • Medicine
      25.8
      Seconds

  • Question 3 - A 79-year-old woman has a waddling gait. History reveals enuresis and change in...

    Incorrect

    • A 79-year-old woman has a waddling gait. History reveals enuresis and change in behaviour. What is the most likely diagnosis?

      Your Answer: Parkinsons

      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.

    • This question is part of the following fields:

      • Geriatrics
      • Medicine
      23
      Seconds

  • Question 4 - An 86 year old woman accidentally inhaled her hearing aid due to her...

    Incorrect

    • An 86 year old woman accidentally inhaled her hearing aid due to her advanced Alzheimer's dementia. Upon clinical examination, her respiratory rate is found to be 35, and thus a bronchoscopy is recommended. According to which of the following would you obtain consent for this patient?

      Your Answer: Relatives/next of kin will have to consent for the patient

      Correct Answer: The procedure does not require a written consent

      Explanation:

      This is an emergency case regarding a patient with impaired cognitive functioning. This is why the procedure does not require a written consent. In any other case where the patient has a normal mental capacity, the consent would be obtained as an informed written consent. In this case however, the suggested procedure is almost a matter of life and death, the doctor being required to act on behalf of the patient to her optimal advantage. Under English law no other person can consent to treatment on behalf of an adult, though it is desirable that next of kin are consulted before treating an adult without consent. Recent legislation gives legal authority to people appointed by the patient, or by the state, or a relative or carer, to consent (or refuse) on behalf of the patient. A mini-mental score may not adequately identify those unable to give consent.

    • This question is part of the following fields:

      • Geriatrics
      • Medicine
      30.4
      Seconds

  • Question 5 - An 87-year-old woman had to double up her dosage of morphine 60mg into...

    Incorrect

    • 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: 90mg MR morphine plus 30mg every 4 hours

      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.

    • This question is part of the following fields:

      • Geriatrics
      • Medicine
      28.2
      Seconds

  • Question 6 - A 85 year old male with a history of faecal impaction, who lived...

    Correct

    • 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.

    • This question is part of the following fields:

      • Geriatrics
      • Medicine
      15
      Seconds

  • Question 7 - An 81 year old male patient was admitted after an ischaemic stroke. Physical...

    Incorrect

    • 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: Right total anterior circulation infarct

      Correct 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.

    • This question is part of the following fields:

      • Geriatrics
      • Medicine
      41.1
      Seconds

  • Question 8 - A son has brought his 72-year-old mother to clinic. He is concerned about...

    Incorrect

    • A son has brought his 72-year-old mother to clinic. He is concerned about her short-term memory problems for the past 10 months. He has to remind her to take her medications and she has had two incidents of falling over in the last 10 months. Which of the following assists in the diagnosis of above condition?

      Your Answer: Disinhibition

      Correct Answer: Progressive loss of function

      Explanation:

      The clinical presentation is dementia. To differentiate Alzheimer disease and vascular dementia, the progressive loss of function is important. Progressive loss of function is usually associated with vascular dementia and rest of the responses are associated with Alzheimer disease.

    • This question is part of the following fields:

      • Geriatrics
      • Medicine
      30.5
      Seconds

  • Question 9 - A 62 year old female has complained she feels unsteady when she is...

    Correct

    • A 62 year old female has complained she feels unsteady when she is walking. She is examined and is found to have pyramidal weakness of her left lower leg. She also has reduced pain and temperature sensation on her right leg and right side of her torso up to the umbilicus. Her joint position sense is also impaired in her left big toe but is found to be normal elsewhere. She has definite left extensor plantar response, and the right plantar response is equivocal. Where is the lesion?

      Your Answer: Left mid-thoracic cord

      Explanation:

      In Brown-Sequard syndrome, there is paralysis and loss of proprioception, which occurs on the same (ipsilateral) side of the body, as the lesion. Loss of pain and temperature sensation, therefore, occurs on the opposite (contralateral) side of the body as the lesion.

    • This question is part of the following fields:

      • Geriatrics
      • Medicine
      42.5
      Seconds

  • Question 10 - A 65-year-old man, after suffering from a pathological rib fracture, complains of recurrent...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Geriatrics
      • Medicine
      27.3
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Geriatrics (2/10) 20%
Medicine (2/10) 20%
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