An 88-year-old female patient of yours has multiple medical problems.
She takes aspirin, paracetamol, bisoprolol, ramipril, codeine, omeprazole and nifedipine. She says she tries to remember to take her tablets but she doesn’t attend for repeat prescriptions as often as she should. When compliant, she is stable and well.
Which one of the following regarding this lady’s treatment is correct?
At what age will a death certified as due to old age or senility alone not be referred to the coroner?
You are called to see a 77-year-old woman at home.
She is known to suffer with COPD and over the last one to two weeks has started coughing up purulent phlegm and feels more breathless than usual. She uses inhaled treatment only and is not on home oxygen. She lives alone, with no social support.
On examination, she is alert and oriented, oxygen saturations are 93% in air and she is mildly breathless. You diagnose an infective exacerbation of her COPD.
Which of the following factors in this patient’s history and examination should most strongly prompt consideration of admission to hospital?
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?
You are working a morning session in a GP practice in the north of England.
Out of the six prescriptions you sign that morning, which one would be exempt from NHS prescription charges for a patient who is 65 years old?
A 93-year-old patient of yours wants to make an advanced decision but his family are not sure that he fully understands what he is doing. You have to assess his competence.
Which of the following statements about competence is correct?
A 73-year-old man comes in with painful lumps in his feet and is diagnosed with gout. After initial treatment with non-steroidal anti-inflammatory agents, he is prescribed allopurinol. What is the mechanism of action of allopurinol?
At what age can the term ‘Old age’ be included on a death certificate?
An 80-year-old man who lives alone is evaluated. He has a history of dementia. His neighbors are becoming worried about his behavior as they frequently observe him wandering outside in a seemingly disoriented state. You believe he may require a care package or residential care, but he adamantly refuses to consider such an option. Which legal framework is the most suitable for addressing this matter?
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?