The risk of aspiration pneumonia questions

The risk of aspiration pneumonia questions
An 83-year-old woman was referred
to the acute medical unit for assessment of her palpitations. One hour after
arriving, she complained of a return of
her palpitations with a central crushing
chest pain. She became distressed and
agitated. She was given aspirin and sublingual glyceryl trinitrate. On examination, her pulse was very weak and hard
to count. Her BP was 88/55 mmHg, her
respiratory rate was 20 breaths/min and
her oxygen saturation was 98% breathing air. A cardiac monitor was attached
and showed a narrow-complex irregular tachycardia with a ventricular rate
between 150 and 160 beats per minute.
What is the most appropriate next step in
management?
A. intravenous adenosine
B. intravenous amiodarone
C. intravenous digoxin
D. intravenous flecainide
E. synchronised cardioversion
Question 43
A 73-year-old man was admitted
with a three-day history of progressive
leg weakness and poorly localised low
back pain. He first noticed tingling and
weakness starting in his feet and legs,
and then spreading to his upper body
and arms. On examination, he had
reduced tone in both lower limbs, with
grade 4 power of flexion and extension
of hips and knees bilaterally, and grade
3 power of foot dorsiflexion and plantar flexion bilaterally. The deep tendon
reflexes in his lower limbs were absent,
and the plantar responses were flexor.
There was loss of all modalities of sensation in both feet in a stocking distribution. Examination of his upper limbs
was normal. What respiratory function
variable is it most important to measure
regularly?
A. FEV1
B. forced vital capacity
C. oxygen saturation
D. peak expiratory flow
E. respiratory rate
Question 44
An 89-year-old female presents with
distorted vision for two weeks to her
right eye only, with straight lines appearing bent. Her left eye has evidence of
drusen in the macular area. The fundal
picture shows haemorrhage and drusen,
visible as yellow lesions adjacent to the
haemorrhage.
What would be your likely treatment
for this woman?
A. dietary advice
B. intravitreal anti-VEGF therapy
C. laser treatment
D. PDT laser
E. steroid implants
Answers for Chapter 1
1 Correct Answer: A
Explanation: Improved oral hygiene
does appear to reduce the risk of aspiration pneumonia, although this has not
been proven in nursing home populations. Neither PEG tubes nor thickened
fluids have been shown to reduce the
risk. All antipsychotic drugs appear to
increase the risk of aspiration pneumonia by a similar degree. People living with frailty have a greater risk of
aspiration. It is an interesting idea that
physical group exercises might reduce
the risk, but this has not yet been
demonstrated.