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Question 1
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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: 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.
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This question is part of the following fields:
- Geriatrics
- Medicine
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Question 2
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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 3
Correct
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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: 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 4
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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 5
Correct
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An 82 year old male woke up experiencing incoherent speech - he is also finding it difficult to find the right words to explain his thoughts. Doctors have examined him, and everything else appears to be normal. They have also found that his comprehension is good. From the list of options, choose the anatomical site which in this instance, is most likely affected.
Your Answer: Broca’s Area
Explanation:The combination of good comprehension but poor speech quality in this patient is consistent with damage to the Broca’s area. The Wernicke’s area is responsible for the understanding of speech, and so is not consistent with this patient.
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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 70-year-old woman is having trouble in speaking following a stroke. Her limbs are paralyzed, both left upper and lower limbs. Which anatomical site is most likely affected?
Your Answer: Internal capsule
Explanation:– The given scenario is typical of lesion in internal capsule. – Memory impairment is caused by a hippocampal lesion, – Impairment of arousal, facial paresis, visual field defect, facial paresis, hemiataxia, and hemispacial neglect are just some of the conditions caused by thalamic lesion. – Brainstem stroke on the other hand causes breathing abnormality, altered consciousness, and blood pressure disorder.
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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 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: 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 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 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: 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 10
Correct
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A 71-year-old woman residing in a nursing home for a couple of years complains of drooling of saliva and sudden difficulty in swallowing while eating. She is a known hypertensive on treatment. What would be your next step?
Your Answer: Endoscopy
Explanation:Dysphagia or difficulty in swallowing. Endoscopy allows for visual examination of the oesophagus and is indicated in patients with dysphagia to determine the underlying aetiology, exclude malignant and premalignant conditions, assess the need for therapy, and perform therapy including dilation.
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This question is part of the following fields:
- Geriatrics
- Medicine
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