A 68-year-old man presents with ankle swelling and signs of heart failure. He has a past medical history of hypertensive heart disease and is currently taking amlodipine and bendroflumethiazide. He was recently treated for an infection at the hospital but cannot recall the name of the medication or the infection. What are some possible causes of heart failure in this patient?
A 70-year-old man has a very poor memory. He makes up stories to account for gaps in his memory. He doesn’t realise what he is doing.
On examination he seems apathetic and has an unsteady gait. What is the most likely diagnosis?
A pediatrics consultant has entered into a shared care agreement with you regarding a patient’s antibiotic prescribing and monitoring. She has initiated treatment with antibiotics and after a period of stable monitoring, has entered into a shared care agreement with you for ongoing prescribing and monitoring, with any future dose changes initiated by the consultant.
With regard to shared care prescribing, the legal responsibility for prescribing lies with:
At what age will a death certified as due to old age or senility alone not be referred to the coroner?
A 75-year-old man presents with a short history of increasing confusion.
Preceding this, he fell three weeks ago in the bathroom. In the afternoon he was examined by his GP and he was alert with a normal physical examination. The patient has a history of hypertension for which he takes bendroflumethiazide.
Three weeks later the patient was visited at home because the dazed state had returned. He is afebrile, has a pulse of 80 per minute regular and blood pressure of 152/86 mmHg. His response to questions is slightly slowed, he is disoriented in time and there is some deficit in recent memory.
The patient moves slowly, but muscle strength is preserved. Neurologic examination shows slight hyperactivity of the tendon reflexes on the right. Plantar responses are unclear because of bilateral withdrawal. That gives him a GCS score of 14.
Which of the following would be the most appropriate next investigation for this man?
A 75-year-old gentleman recently began taking donepezil for his moderate dementia. His family became worried when they noticed he was more confused than usual. During examination, he displayed muscle rigidity, sweating, tremors, and was pyrexial. Repeated BP readings were: 160/90, 100/70, 150/80. A urine dipstick test came back negative, and his lung fields were clear upon auscultation. What is the most probable diagnosis?
A 70-year-old man is referred with a three month history of progressive disorientation and falls.
Four weeks beforehand, he locked his wife out of their house, claiming that she was trying to steal his clothes. He had also telephoned the police in the middle of night, claiming that he could see men hiding under his bed.
On examination, his face is expressionless, his speech is quiet and monotonic. There are no cranial nerve palsies, otherwise. Increased tone is present in all four limbs, with a slow festinant gait. Reflexes, power and sensation are all normal.
Halfway through your examination he tells you that he is leaving the room, because of the lobsters coming through the window. Unfortunately, therefore, formal cognitive testing and basic investigations cannot be performed.
Based on this evidence, what is the most likely diagnosis?
An 83-year-old man presents to your clinic complaining of breathlessness. He reports that a year ago he was able to do his gardening and play a round of golf, but in recent months he has been limited by breathlessness. He notes that the breathlessness settles with rest and denies any cough or chest pain. He doesn’t take any prescribed medication but reports taking ibuprofen from the supermarket for his knees. He has a history of osteoarthritis of the knees and occasional gout.
Upon examination, the patient appears well but mildly out of breath upon entering the room. His pulse is 86 bpm in sinus rhythm, and his blood pressure is 130/70 mmHg. Peak flow is 470 L/min, and heart sounds are normal. Chest auscultation reveals bilateral basal end-inspiratory crackles, and there is mild bilateral pitting edema to mid-shin.
What is the most appropriate next step in managing this patient?
You think that an 80-year-old man has dementia.
Which one of the following is more suggestive of vascular dementia than Alzheimer’s?
A 55-year-old man comes to his General Practitioner reporting a weight loss of 10 kg in the past four months. He has been experiencing increased fatigue but has not made any changes to his diet or exercise routine.
What is the most probable diagnosis?