A 76-year-old man presents to the movement disorders outpatient clinic with a history of Parkinson’s disease. He is currently on co-beneldopa 650mg five times daily. The patient reports excessive drooling of saliva, which has not improved with speech and language therapy. What would be the best initial management plan for this patient?
A 26-year-old female who is obese visits her GP complaining of headaches and blurred vision. Upon examination, the GP notes bilateral blurring of the optic discs but no other neurological signs. The patient’s blood pressure is 130/74 and she has no fever. What is the probable underlying diagnosis?
A senior, delicate lady is admitted to the nearby nursing home following a stroke. How can her risk of developing a pressure ulcer be evaluated appropriately?
A 32-year-old man comes to the clinic complaining of severe pain around his right eye. He has been experiencing these episodes once or twice a day for the past week, with each episode lasting around 30 minutes. Although the pain is severe, it has not been getting worse. His girlfriend reports that during an attack, his eye becomes red and starts to water. Upon examination, his eye appears normal, and his visual acuity is intact. He is currently pain-free, with his last episode occurring about 3 hours ago. What would be the most appropriate next step?
You assess a 65-year-old male patient who reports frequent episodes of tripping. During your examination, you observe that he has a gait pattern characterized by high-stepping, where he excessively flexes his knees to ensure his feet clear the ground while walking. What is the probable reason for this clinical observation?
A 26-year-old female patient visits her doctor complaining of an increase in the frequency of her migraine attacks. She is currently experiencing approximately four migraines per month. What medication would be the most suitable to prescribe in order to decrease the frequency of her migraine attacks?
During a new patient consultation for an 82-year-old man who has recently joined the practice, you observe that he is significantly underweight and suspect that he may be malnourished. As per NICE guidelines, what is the BMI threshold for diagnosing malnutrition?
You are preparing to conduct a search for all your elderly patients who need the yearly flu shot. Which of the following groups should not be included in the registry?
John is a 91 year old man with severe dementia. He has been relatively stable over the past two years with a gradual decline in cognition. The nursing home contacts you to report that he has been exhibiting more aggressive behavior, including swearing and hitting staff, over the past month and requests a review. What would be the most suitable approach to managing this situation?
A 27-year-old woman with a history of type 2 diabetes mellitus, back pain, anxiety and depression presents to your clinic as an emergency appointment. She has been booking emergency appointments with the clinic almost every week with mild and vague generalised symptoms. A few weeks ago, you diagnosed her with self-limiting gastroenteritis.
Today, she complains of weakness in both her legs that has been worsening and moving up her legs from her feet over the last few days. She also reports some shooting pains and increased back pain. However, she denies any new incontinence or saddle anaesthesia.
Upon examination, her observations are normal, and she has good power in her upper limbs. However, there appears to be some numbness in both hands. She also has reduced sensation and power in both lower legs symmetrically up to just below her knees. Additionally, she has absent plantar reflexes and reduced ankle reflexes.
What is your plan for managing this patient?