TRIGGER WARNING: The following questions discuss progressive neurological conditions and death and dying. Please take care of yourself and decide if you are in the right place to do these questions.
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Impact of Chronic Disability
Stem 1, question 1 of 5
34 year old Caoimhe presents to the emergency department with a sudden painful loss of colour vision in her right eye and difficulties finding her balance in the last 48 hours. She has no fever and systemically well.
What is the most likely cause of her sudden vision loss?
Acute angle closure glaucoma
Central retinal vascular occlusion
Stem 1, question 2 of 5Caoimhe is later diagnosed with Multiple Sclerosis. Which of the following is not a possible sign or symptom of Multiple Sclerosis?
Transient motor dysfunction
Asymmetrical or single limb involvement
Stem 1, question 3 of 5A lumbar puncture can be used aid in the diagnosis of Multiple Sclerosis, which of the following is an expected result for Multiple Sclerosis?
Presence of oligoclonal bands
High white cell count
Presence of bacteria
Stem 1, question 4 of 5A year later Caoimhe's Grandfather is diagnosed with Parkinson's disease. What is Parkinson's disease?
A demyelinating central nervous conditions clinically defined by two episodes of neurological dysfunction that are separated in space and time
A neurodegenerative disorder characterised by progressive muscle weakness that can start in limb, axial, bulbar or respiratory muscles and then generalises causing progressive disability and death
An upper motor neuron lesion of cranial nerves IX, X and XII
A chronic progressive neurological disorder characterised by motor symptoms of resting tremor, rigidity, bradykinesia and postural instability with an insidious asymmetrical onset.
A lower motor neuron lesion of cranial nerves IX, X and XII
Stem 1, question 5 of 5What is the diagnostic criteria for Parkinson's disease?
Presence of bradykinesia with at least one of optic neuritis and balance problems
Presence of mask-like facies and shuffling gait
Presence of bradykinesia with at least one of resting tremor or rigidity
Presence of impaired saccadic and convergency on a background of rigidity
Presence of both upper and lower motor neurone symptoms that is progressive.
Stem 2, question 1 of 5
Rob, a 44 year old man, presents to GP with a 6 month history of a right foot drop and weakness which is now progressing up his leg. Rob also reports pain and twitching in both legs causing difficulties getting out of chairs and climbing stairs and is needed the assistance of his husband.
Which of the following is not an upper motor neurone symptom?
Positive Babinski's reflex
Stem 2, question 2 of 5During the consultation Rob mentions he is a former professional rugby player and his Grandfather died in his 50's from a "progressive paralysis condition". Given Rob's family and social history in addition to his presentation, what is the most likely diagnosis?
Amyotrophic lateral sclerosis
Spinal muscular atrophy
Becker's msucular dystrophy
Stem 2, question 3 of 59 months later Rob is finding is more difficult to speak and communicate his wishes, the GP discusses with Rob and his husband about advanced care planning. Which of the following is false about an advanced decision to refuse treatment?
The decision will only apply at a time when the individual lacks capacity to consent or refuse the specific treatment
It can only be a written decision and must be signed by the individual
The decision must state precisely what treatment is to be refused
The decision must set out the circumstances when the refusal should apply
The decision may not be applicable if there are reasonable grounds for believing that circumstances exist which the patient didn't anticipate and would have affected their decision.
Stem 2, question 4 of 5A few weeks later, Rob decides to give his husband Lasting Power of Attorney for health and welfare decisions. Rob is aware his disease is rapidly progressing and he is entering the end of his life. Which of the following is false about Lasting Power of Attorney?
A lasting power of attorney decision is made while the person still has capacity
Only the person making the decision must be over 18 years
The decision must be registered with the Office of the Public Guardian
The person with Lasting Power of Attorney has legal authority to make decisions and must be consulted on behalf of the patient
The decisions made must be in the patient's best interests.
Stem 2, question 5 of 5Rob decides he would like to die in a hospice and a short while later enters his local hospice. Rob struggles with clearing secretions, what medication can be given to help with this?