A 57-year-old man presents to the clinic with a 1-week history of yellowing of his skin and itching. He drinks approximately 160 units of alcohol per week and has palpable hepatosplenomegaly. Blood results show low platelets, low WBC, elevated LDH and triglycerides, and elevated liver enzymes. What is the recommended treatment for this patient?
A 75-year-old man is brought to your clinic by his son. He has been diagnosed with Alzheimer’s dementia and has significant short-term memory impairment. His son is concerned about his father’s safety as he continues to drive 10 miles twice a week. What is the best course of action regarding his driving license?
A 75-year-old woman with mild Alzheimer’s disease presents for evaluation. She is currently on donepezil and has experienced some improvement in her short-term memory. However, she has recently been experiencing frequent early morning awakenings, has a poor appetite, and frequently expresses to her husband that she wants to end it all. She takes Ramipril for hypertension and atorvastatin 10 mg, but no other regular medications. What is the most suitable next step in her management?
A 78-year-old man was admitted to hospital with fever and confusion. He had been found collapsed at home by his daughter, who reported that he was usually fit and well and coped well on his own at home.
He had a past history of hypertension, which was well-controlled on medication, and he also suffered from osteoarthritis.
On examination, he looked pale and unwell and smelled strongly of stale urine. His temperature was 38.5°C. He was disoriented in time, place and person. His blood pressure was 90/50 mmHg with pulse 120 beats per minute and regular.
There were widespread petechiae on the limbs. His respiratory rate was measured at 30 breaths per minute. His heart sounds were normal and the chest clear. His abdomen was soft, but he was very tender in the suprapubic region and a mass was felt rising from the pelvic brim.
After taking blood, it was noted that there was continued bleeding from the venipuncture site. A urinary catheter was inserted and yielded 2000 ml of cloudy yellow offensive-smelling urine.
Which of the following statements is true?
An 83-year-old male is brought into your falls clinic by his son after his third fall this year. No fractures were sustained and he appears to have no significant head injuries. The fall appears mechanical in nature. He currently lives with his son, who reports the patient’s mobility to be progressively deteriorating, from full independence and no exercise limitations 1 year ago to restrictions at 50-70 yards now, limited by knee pain secondary to osteoarthritis. His other past medical history includes hypertension, type 2 diabetes mellitus, chronic kidney disease and previous gallstones.
You note he is withdrawn and makes little eye contact. His voice is quiet. When you ask him whether he is low in mood, he does not respond. He reports no suicidal ideations but has little hope for the future. He asks you to ‘not worry about it’, as he ‘has been the same way for several months now’. However, the patient does seem amenable to some kind of treatment.
On the Beck depression scale, he scores 11/63 (0-13 = no or minimal depression), on the geriatric depression scale, he scores 11/15 (greater than 10 = indicative of depression) and mini-mental state examination, he scores 19/30 (20-26 = mild cognitive impairment, 10-19 = moderate cognitive impairment). Routine investigations including B12, folate, thyroid function, liver function tests and bone profile are unremarkable.
What is the most appropriate treatment pathway?
In hyperthermia, as the body temperature rises, what is the earliest biochemical abnormality observed?
A 79-year-old woman attends the memory clinic with her daughter due to a 7-month history of memory loss. She reports feeling well today, but her daughter explains that last week she was confused and disoriented. Her daughter also expresses concern that her mother may be hallucinating as she has mentioned seeing her deceased husband sitting at the dinner table with her. The patient has a history of osteoarthritis and borderline diabetes but has been otherwise healthy with no recent illnesses.
During the examination, her heart rate is 86 bpm and regular. Her sitting and standing blood pressures are 152/95 mmHg and 138/86 mmHg respectively. On auscultation, her chest is clear with normal heart sounds. Her abdomen is soft with no palpable masses. There is a slight tremor in her left hand with increased rigidity. She walks well with a walking stick but has a shuffling gait. Her MMSE score is 20/30.
Based on the likely diagnosis, what is the most appropriate treatment to initiate?
An 81-year-old man presents to a memory clinic with concerns about his memory. His wife has noticed changes in his memory and has requested an evaluation for dementia. She reports that he forgets where he is, forgets things in the middle of conversations, responds to things that are not there, and has reported seeing things. However, at other times, he is able to have normal conversations. The patient has a history of prostate cancer managed with hormone therapy, COPD, hypertension, and osteoarthritis. He has no recent changes in medication and quit smoking 20 years ago. He used to drink heavily but has been sober for five years. On examination, the patient is alert and oriented with a slight tremor in his left hand and increased muscle tone.
What is the most likely diagnosis?
You are working in General Practice when a 70-year-old woman is brought in by her concerned daughter. She reports that her mother has been displaying unusual behavior lately, such as calling her in the middle of the night and believing that strangers are in the house. The patient also seems disoriented with time and often prepares for bed during the day. The daughter notes that some days her mother appears completely lucid.
Upon further questioning, the patient is aware of her surroundings but tends to ramble and go off-topic. She admits to experiencing visual hallucinations, including a cat that has been following her for several months. She also mentions feeling generally slower over the past year.
The patient’s current medications include rivaroxaban for atrial fibrillation and amitriptyline for fibromyalgia. Upon reviewing her medical records, you notice that she has been brought in multiple times over the past six months with similar complaints and has been prescribed antibiotics for a suspected UTI each time.
What is the most likely underlying cause of the patient’s presentation?
A 70-year-old woman is being evaluated at the memory clinic for worsening dementia and coexisting Parkinson’s disease, which is being treated with levodopa. On objective testing, she is found to have mild cognitive impairment. What medication should be recommended to alleviate her cognitive symptoms?