Assess idiopathic Parkinson’s disease
An 85-year-old man presents with a
15-month history of fluctuating cognitive
impairment most marked in the visuospatial domains, Parkinsonism, intermittent
confusion and generalised myoclonus.
His short-term memory seems very
good. He was started on 62.5 mg three
times daily of co-careldopa. Eye movements were normal. He has recently been
reported to have unsteadiness and falls.
What is the most likely diagnosis?
A. dementia of Alzheimer type
B. diffuse Lewy body disease
C. idiopathic Parkinson’s disease
D. multiple system atrophy
E. progressive supranuclear palsy
A 74-year-old Italian-speaking woman
was admitted early in the morning to the
oncology unit for ongoing treatment of
advanced uterine cancer, for which she
had been receiving fentanyl. She had
been living alone in her home but still
maintaining daily activities and an active
social life. Her daughter lives nearby
and visits her intermittently throughout
the week. Forty-eight hours after admission, the nurses reported that the admitted patient was not sleeping, restless,
distressed, crying intermittently and
‘shaky’. For the past several hours, she
had been having frequent loose stools
too. In addition, the staff reported that
she was talking loudly in Italian when
no one was in the room. An interpreter
was belatedly called, and no symptoms
of urinary tract infection were reported.
She, however, kept pointing to her mouth.
The only intervention that seemed to help
her was allowing her to drive up and
down the corridors in her wheelchair. The
clinical nurse specialist began to suspect
pain as a possible cause of the delirium,
but, prior to its onset, her pain scale was
negative. The clinical nurse specialist
assessed her using an observational pain
scale which was positive, and pain was
then confirmed through a comprehensive
assessment. The admitting consultant
decided to examine her mouth, and she
indeed had an area of markedly inflamed
She is apyrexial.
Which one of the following is the least
likely cause of the delirium?
A. an error in medication prescribing
B. care transition
C. inadvertent cessation of fentanyl
D. language barrier
E. urinary tract infection
An 80-year-old man presents with an
abrupt change in personality and behaviour, reported by his primary carer. The
National Institute for Health and Care
Excellence suggests screening for possible delirium based on four risk factors.
Which one of the
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